Vietnam: Patients risk being left behind as foreign donors pull the plug on HIV/AIDS in Vietnam

People living with HIV in Ho Chi Minh City have been given all the more reason to be concerned. Their anti-retroviral drug treatment could be interrupted starting from 2018 when the drugs are scheduled to be provided under Vietnam’s health insurance system.

Most HIV clinics in the city have yet to sign a contract with Vietnam Social Security, the agency charged with administering the health insurance fund.

“If patients with HIV/AIDS stop using anti-retroviral (ARV) medicine for one week, they will become resistant to the medicine, leading to the problem of preventing an epidemic in the city,” Vietnam News quoted Dr. Trieu Thi Thu Van as saying at a meeting in early September.

The problem is not just limited to Vietnam’s largest metropolis. Half of the country's HIV outpatient clinics are located in health facilities that come under the “preventive” element of Vietnam's healthcare system. But to provide care and treatment under health insurance, these facilities need to meet “higher” standards to be classified as “curative”.

As an interim solution, experts suggest these clinics should merge with general hospitals. 

The above is just one example of the administrative nightmare Vietnam is facing as a result of transitioning its HIV/AIDS treatment program to health insurance as foreign funds will come to a full stop in 2020 as Vietnam has reached middle income status.

Thus far, the vast majority of funding for HIV/AIDS treatment and prevention has been coming from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund.

Since 2004, PEPFAR has been the main funder of HIV treatment, care and prevention in Vietnam, channeling a massive $288.7 million between 2004-2008 alone. The state budget paled in comparison, and thus, for over a decade, it wasn’t Vietnam’s state sector that shaped HIV/AIDS intervention, it was PEPFAR.

“PEPFAR had not opted to work through the existing health system but chose to build a ‘parallel’ system, connected to but organized apart from it,” Professor Alfred Montoya, an anthropologist at Trinity University in the U.S., wrote in 2013. “The Ministry of Health operates as a PEPFAR partner/client rather than a significant organizing force.”

Faced with changes ahead, Vietnam is actually one of the fastest in the region to integrate HIV treatment into health insurance and has actually drawn up plans for alternate funding sources until 2020. This reflects Vietnam’s “tremendous political will” to ensure a smooth transition, according to UNAIDS.

Currenly, only about 40-50 percent of HIV positive people have health insurance, according to local media reports quoting the Vietnam Administration of HIV/AIDS Control (VAAC). With nearly 116,000 people, or half of the HIV community, on ART, that’s roughly 60,000 patients without health insurance.

“The government is aware that not all have health insurance; indeed we want to make sure it works for everybody,” Marie-Odile Emond, UNAIDS Viet Nam country director, told VnExpress International.

Indeed, as this story was about to be published, the Ministry of Health started to call for comments on a draft circular aiming to resolve existing red tape that prevents people vulnerable to HIV from obtaining health insurance.

VN Express