Ho Chi Minh City is Viet Nam’s commercial hub and most populous city, with a population of about 9 million people1. The city is home to an estimated 25% of people living with HIV in Viet Nam, although many come from neighbouring provinces. The city’s HIV epidemic is concentrated among people who use drugs, female sex workers and gay men and other men who have sex with men: HIV prevalence among female sex workers and gay men and other men who have sex with men is estimated at 6% and 17%, respectively2.
Ho Chi Minh City joined the Fast-Track cities initiative in 2015. Since then, city authorities have shown a strong commitment to the HIV response, including efforts towards reaching the 90–90–90 targets. In 2017, Ho Chi Minh City reported that an estimated 86% of people living with HIV knew their status, and 76% of them were on HIV treatment. This is well above the national results.
1 Preliminary results of the 2019 Vietnam Population and Housing Census.
2 Vietnam 2017 Global AIDS Monitoring.
Assessing the problem
City authorities have long recognized that HIV-related stigma is a significant barrier to service use, particularly for people living with HIV and for members of key populations. In 2016, Ho Chi Minh City committed to tackling this problem by building the capacity of health-care workers and fostering closer dialogue with the community of people living with HIV.
The first step was to conduct a survey to better understand the scope and nature of HIV-related stigma and discrimination in three health facilities. The survey showed high levels of fear and/or worry among health-care workers when taking care of patients living with HIV, as well as perceived experiences of discrimination among the patients themselves.
“The results of the survey conducted in my hospital showed that stigma and discrimination remain prevalent among our health-care workers,” said Le Tien Dung, Vice Director of Pham Ngoc Thach Hospital. “Discriminatory acts and practices come from limited awareness and knowledge of HIV, HIV transmission or universal precautions”1.
Building capacity
The results of the first survey informed the development of a training programme that covered standard precautions and other aspects of caring for people living with HIV. The training used participatory tools and methods, including dialogue with exercises and story-telling sessions by members of the Viet Nam Network of People Living with HIV (VNP+). The training module was tested in one facility with co-trainers from community organizations before it was offered to selected staff from the three facilities. Health-care workers from the three facilities were then educated as trainers, and a training-of-trainers manual was developed.
A follow-up survey showed a significant improvement in stigmatizing and discriminatory attitudes; it also found greater knowledge and capacity among the trained health-care workers. “The training helped to improve health-care workers’ understanding of these issues,” said Dung1.
One hospital committed to learning the lessons of this study by developing a code of practice that provides guidance for health-care workers on nondiscriminatory behaviour. “The code of practice developed for my facility originated in actions proposed by health-care workers during the training,” said Sam Nhu Ha Vu, the lead nurse at Pham Ngoc Thach hospital. “I think the code of practice will be very easily implemented and translated into routine practices here”2.
Critical to the success of the study was the participation of people living with HIV at all stages, from the baseline survey to the development of training materials. It was very much a learning experience for all participants. “Thanks to this initiative, the partnership between health-care workers and myself has greatly improved—we have much better mutual understanding,” said Nguyen Anh Phong, the leader of VNP+. “With this project, doctors and other staff in the hospital have become more open, more responsive and receptive of community’s role in providing care and support.”
This pilot initiative was led by the Viet Nam Administration for HIV/AIDS Control (VAAC), Ho Chi Minh City Provincial AIDS Center, VNP+ and UNAIDS, with funding and technical support from UNAIDS, M·A·C AIDS Fund and the UN Delivering Results Together (DRT) Fund.
What happened next
The pilot initiative came to an end in 2017, but it informed the development of both a national plan to reduce HIV-related stigma and discrimination in health-care settings and a new Ministry of Health directive. The directive includes technical guidelines for planning and implementing interventions and for developing standard operating procedures to reduce stigma and discrimination at various levels of health facilities.
One hospital included in the study has further embraced the initiative, mobilizing additional resources to conduct training for all 300 nurses. The first training workshop was held in 2019, integrating content on reducing HIV-related stigma and discrimination into a standard Ministry of Health training curriculum on basic health education and communication for nurses.
The model is being replicated in other high-burden provinces with support from different development partners. It also has the potential to benefit other countries in the region: in 2019, Ho Chi Minh City was able to share its experience as part of the multicountry Southeast Asia Stigma Reduction Quality Improvement Learning Network.
1 Pilot model to reduce HIV-related stigma and discrimination in healthcare settings, Ho Chi Minh city, 2016–2017. UNAIDS factsheet. UNAIDS Viet Nam; c2017 (http://unaids.org.vn/en/fact-sheet-pilot-model-to-reduce-hiv-related-stigma-discrimination-in-healthcare-settings/, accessed 27 August 2019).
2 Summary progress report, M·A·C AIDS Fund grant: April 2017 to January 2018. UNAIDS Viet Nam; 2018.