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Policy dialogues regarding the law enforcement on HIV/AIDS, drug and sex work

Sept. 19, 2018

In law enforcement in the fields of HIV/AIDS, drug and prostitution prevention, there are some inadequacies that need to be adjusted to ensure its efficiency among of the community and to improve the effectiveness of law. For that reason, on March 31st, 2017, a workshop on policy dialogues regarding the law enforcement on HIV/AIDS, drug and prostitution took place in Ho Chi Minh City. Attending the workshop there were representatives from the Department of Social Vices Prevention and Control, Ministry of Public Security and members of the National Assembly from the southern provinces, SCDI and representatives from communities of people who use drugs, sex workers.
In the opening remarks, Mr. Dang Thuan Phong, Vice Chairman of the National Assembly's Committee for Social Affairs, reviewed the initial changes in law enforcement related to these fields. According to him, the former notion that people who use drugs, sex workers are considered social evils and isolated from society, should be changed. In the world, people using drugs with enough economic conditions are less likely to be associated with social evils than Vietnam. However, the sex workers were previously forced into compulsory education, but now they are capable to be educated at home, although Vietnam has yet to allow the establishment of “red light district” and legitimizing prostitution, but prostitution is no longer criminalized. Still, shortcomings persist, such as difficulties in the treatment of HIV due to the reduction of international subventions, stigma and discrimination persist and the difficulty of using health insurance in the course of treatment. Hence, the role of the community is important in sharing, contributing and giving recommendations to improve the law enforcement.

Photo: Vice president Dang Thuan Phong, deliering the opening remarks

The workshop received positive feedbacks from the community in moving from compulsive to community-based rehabilitation. "Compulsory rehab is very inadequate: high re-infection and relapse rates, people are forced to use drugs; while community-based rehab is much better in terms of supportive attitudes, without discrimination and stigma, reduced cost ... the volunteers are empathetic and get along well with people using drugs "- from the opinion of 1 community representative in Ba Ria - Vung Tau.
However, the focus of the workshop is for community representatives to raise shortcomings, barriers to policy enforcement to improve operational performance, and better legislation in the future.

Photo: Community  representative shared their ideas at the Conference

The first problem is insufficiencies in health insurance: in purchasing health insurance due to insufficient residence documents or identification card, the health insurance has to be purchased according by household, which is risky of exposing personal information when treating, leading to treatment withdrawal; costs related to HIV and STIs are not covered by health insurance, the people living with HIV have no right to get treatment anywhere but their resident address, they are not capable of selecting their treatment site according to their wishes. Medical centers still bother the patients with papers (household registration, temporary residence), inconsistency in the sale of health insurance in different points of sale. The new health insurance circular was promulgated in the province but not nationwide yet.

Recommendations from the community were: health workers need to better understand the confidentiality of information; the necessity of establishing a legal framework, where the CSOs could be involved, to collect HIV testing and treatment fees. In addition, it is necessary to add livelihood models to CBOs and CSOs in order to be sustainable in the HIV/AIDS prevention and control. The use of health insurance is currently only applied to state-owned HIV treatment facilities, thus allowing private facilities to provide treatment may be an option to reduce the burden on public health services. As suggested by Dr. Pham Duc Manh: There is a need to set up an organization, which stands to buy health insurance for the underprivileged. Speaking of items that need to be covered by health insurance, the list takes time to be supplemented and revised accordingly.
The second problem is stigma still exists in the community of people living with HIV/AIDS, sexually transmitted diseases and transgender people: Transgender people are sometimes discriminated against and refused treatment by local authorities. They find it difficult to access work services, health care, law and transgender rights. Persons with HIV who require treatment and surgery still face barriers of information confidentiality, due to the lack of strict management. Stigma at provincial health centers remains: hospitals still refuse to perform surgery for HIV infected people, or for most female sex workers who are infected and need gynecological surgery. In Can Tho, stigma and discrimination have not slowed down, according to MSM Can Tho community, despite efforts of the group to re-integrate and contribute to the society. By the end of 2017, when applying HIV treatment with health insurance, due to the risk of disclosure information and discrimination, many people in the province do not wish to transfer treatment to provincial hospitals.
Colonel Ta Duc Ninh - General Staff Police Department - Police Department - Ministry of Public Security has received and appreciated comments from the community: If they feel the MMT program is really efficient but the law enforcement cannot meet  the expectation, the community can send a letter to the Social Affairs Committee or the office of the Public Security Bureau on drugs to make modifications if reasonable.

Photo: Other comments from Conference participants

Vice Chairman Dang Thuan Phong believes that the "the development of community groups will help the society to understand its current issues, thereby reducing and eliminating stigma." Delegates from the National Assembly's Committee for Social Affairs have welcomed all community ideas and pledged to provide effective communication solutions to reduce stigma, improve the support, improve the efficiency of disbursement from policy bank. In addition, the issue of children from 12 to under 18 years of age using drugs is a new recorded issue and brought up during the conference, which requires further research, where initial results from SCDI’s  project “Protect the Future” is exemplary.

The inadequacies in law enforcement and operation will be filtered systematically and considered when making policy amendment in the next time. The workshop created a dialogue forum with stakeholders to provide the delegation with the necessary information to evaluate the law enforcement on HIV/AIDS, drugs, prostitution Prevention and Control. 

Vân Anh


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