Prostitution, AIDS, Social Evils,
Ho Chi Minh City
The government is also setting up small programs for high-risk groups using the "harm-reduction" model of AIDS education, a hands-on method that uses outreach workers. Harm-reduction education teaches sex workers to use condoms and to avoid high-risk sexual activity. Intravenous drug users are also taught to use clean hypodermic needles and not to share injection paraphernalia with other users. Government AIDS policy also focuses on educating government employees like police officers and medical workers about HIV transmission. There is some education in the schools, but it is only on HIV and AIDS transmission; no sex education courses exist. Moreover, there are no special hospitals for AIDS patients. In the destitute Vietnamese medical system, where a patient's family must go to the black market to buy medicine, the AIDS drug AZT is given only to pregnant women.
The Vietnamese government has set up pilot syringe-exchange programs in
Dr. Thue Vinh is a member of the District One AIDS Committee in
But the government campaign has some big holes. "We have classes in the schools on how HIV is transmitted," said Vinh, "but no sex education programs." Efforts to reach prostitutes who work in hotels are hampered by the hotels' refusal to accept free government condoms. Accepting the free condoms, the hotel managers reason, is the equivalent of pleading guilty to charges of promoting prostitution. They fear the police will shut them down.
Last February the AIDS committee also restarted their needle exchange, shut down two years ago because of conflicts with the police. The exchange has 87 clients out of the 500 users in the district. Estimates for IV drug users are bleak--the HIV infection rate may be as high as 80 percent. According to Aaron Peak, an American AIDS policy consultant in Vietnam, the addicts of Ho Chi Minh City frequent "shooting galleries," where they buy the opium they shoot and where one person injects all the clients, often with the same needle.
The District One Women's
At Save the Children, the atmosphere was much more relaxed. The offices were in a large house and the sex workers' meeting was held on the floor, with the half-dozen women volunteers, all present and former sex workers, sitting and discussing their work while exchanging lively banter.
Truong is a former sex worker and staff member. Although more than 100,000
"I'd say about 70 percent of the commercial sex workers start because of poverty," Truong said. "Most come from the provinces and are very poor; they have a low education level and no stable job. The Women's
Harm-reduction education has to be done without moral judgment, to actively address the needs of high-risk groups while appealing to their ability to take care of themselves. This flies in the face of abstinence models of HIV-prevention: don't have sex until you are married, don't have sex outside of marriage, don't do drugs ever.
Harm reduction is still controversial in the
Most AIDS education outreach efforts in
The Save the Children program is small, with a staff of just 24 in addition to its 50 outreach workers, but it is vital. By approaching the sex workers with respect, they gain their confidence and give them tools with which to protect themselves. Though some sex workers still have unprotected sex despite knowing about AIDS, the outreach workers have changed attitudes, raised self-esteem, and helped sex workers convince their clients to use condoms.
As a first step, the Vietnamese government should expand the education and outreach toward high-risk populations. For example, the needle-exchange program in
The European nongovernmental organization Medicins Du Monde has set up a "Condom Coffee Shop" in the city's youth center to educate young people about HIV and AIDS. "We are targeting the heterosexual population with education, trying to get to them before HIV spreads even further to the general population," said Martine David, the 23-year-old Canadian who runs the program. The coffee shop is staffed with young volunteers trained to discuss HIV and AIDS prevention with their teenage and young adult clientele. They stage puppet shows and dramas that address HIV and AIDS and distribute free condoms with names like Trust and OK. David said they hope to start inviting high school classes to the coffee shop. "There is no condom education in the schools," she said. "Mainly, the teachers are too shy."
"The government does a good job on AIDS education with TV and radio, but the attitudes don't change," said David. "People tell me 'I go out with good girls,' or 'I'm a university student.' They see AIDS as a problem for prostitutes and drug users."
Programs like the Condom Coffee Shop, though minuscule, are effective because they appeal to people's intelligence, as well as to their fear of AIDS. Programs like these need to be expanded and set up in different areas of Vietnamese society, such as bars catering to businessmen or farmers.
Government billboards and television announcements that warn of the risks of HIV and AIDS are necessary, but this passive form of education is not as effective as the more active, individual education that changes attitudes. In
While the first part of
It is essential that the control of these programs not be limited to "official mass organizations" such as the Women's Unions and the Youth Union. There must be mass participation on a local level to promote active education, not just the passive education from billboards and television. It is as necessary to reach the farmer in the countryside with AIDS education as it is to reach the doctor or government clerk in the city.
Although cultural practices that prevent the candid discussion of sex and AIDS remain strong in