Achievements and challenges in HIV/AIDS control in Vietnam.

Abstract

In the global AIDS update produced in 2017 1 by the Joint United Nations Programme on HIV/AIDS (UNAIDS), Vietnam was among the countries with the highest HIV prevalence for 2014–2016 in the groups with the highest risk of HIV transmission: men who have sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW). Vietnam ranked 4th, 8th and 11th in terms of HIV prevalence for PWID, MSM and FSW, respectively, worldwide 1. These numbers raise concerns about the control and prevention of HIV infection in these populations in Vietnam, but it is undeniable that the country has attained several major achievements in HIV/AIDS control since 2007 2. The HIV/AIDS epidemic in Vietnam began when the first case of HIV infection was detected in December 1990 2. The numbers of new cases of HIV/AIDS and deaths from AIDS in Vietnam gradually increased thereafter and reached a peak in 2006–2008, with 30 846 people newly infected with HIV in 2007 2. After 2008, the numbers of new HIV/AIDS cases and deaths from AIDS decreased rapidly 2. By the end of 2015, the number of new HIV cases had dropped to 10 195 across the country, and the numbers of new AIDS cases and deaths from AIDS were only 6130 and 2130, respectively (Fig. 1a). Individuals with HIV/AIDS are found in every subpopulation in Vietnam, but the groups with the highest risk of HIV/AIDS are MSM, PWID and FSW 3. According to our analysis using national statistics on cases of HIV/AIDS from 2011 to 2015 in Vietnam (free access available at http://www.gso.gov.vn), the numbers of new HIV cases, new AIDS case and deaths from AIDS have tended to decline steadily (Fig. 1a), with annual decreases of 13.98% in people newly infected with HIV, 2.31% in new AIDS patients, and 9.65% in deaths from AIDS (Fig. 1b). The consistent decrease in new HIV/AIDS cases indicates that HIV/AIDS control in this nation is effective. Furthermore, the numbers of patients living with HIV infection and AIDS in the whole country continuously increased in the period from 2011 to 2015 (Fig. 1a), with an annual increase of 11.90% in the number of patients living with HIV infection and 46.41% in the number of patients living with AIDS (Fig. 1b). These increases in the numbers of surviving HIV/AIDS patients and the decrease in deaths from AIDS reflect improvements in health care for patients with HIV/AIDS in Vietnam. However, the regional distribution of cases of HIV/AIDS reflects variations in the population, the economic situation, development and health care services among the regions of Vietnam. Optimal utilization of health care services is not achieved by most patients with HIV/AIDS in Vietnam as a consequence of many obstacles, such as the high proportion of these patients without health insurance (HI). In a report that surveyed 1133 HIV/AIDS patients in Nam Dinh Province in 2013, the coverage of HI among these patients was only 46.0% 4. An updated report indicated that 82% of HIV-infected patients on antiretroviral therapy (ART) nationwide had HI, as of September 2017 5. However, patients have not yet been reimbursed from their HI for the costs of HIV viral load (VL) testing and ART and, under the terms of their HI, will not be reimbursed until, at the earliest, the end of this year for VL testing and the beginning of 2019 for ART 5. Consequently, the actual numbers of patients living with HIV/AIDS in Vietnam from 2011 to 2015 show that great achievements have been made in HIV/AIDS control in this country, but many challenges remain, particularly in reducing the numbers of new HIV/AIDS cases among the PWID, MSM and FSW populations, and in enhancing medical services for HIV-infected individuals in poorer areas across the country. Conflicts of interest: The authors declare that they have no conflicts of interest. Financial disclosure: No funding was received for this work.