Draft law to force disclosure to spouses comes under fire
HO CHI MINH CITY - A draft law that will force people living with HIV/AIDS to inform their spouses of their health status is under fire from community health workers who claim the proposed legislation is unrealistic and ignores present realities in Vietnam. The draft ordinance, currently in the National Assembly's Standing Committee states, ''in case the HIV carrier refuses to inform his or her spouse about their heath condition, the local health center has the responsibility to inform the spouse within 30 days after receiving the HIV positive test.''
''It's unrealistic,'' said Hoang Thi Hanh, a community health worker here who revealed that convincing people to take an HIV test was hard enough. ''It's already difficult to tell the patient that he's got HIV; so I don't know how I could ask him to tell the bad news to his spouse,'' Hanh told IPS. Nguyen Oanh is a 26-year-old person living with HIV/AIDS and he recalled the difficulty of even getting health workers to reveal the true results of his HIV test.
''When the doctors started treating me strangely and kept me at a distance, I realised something was wrong. They could not even tell me I was HIV positive until I asked them,'' he said. The first HIV case was detected in Vietnam in 1990. According to official figures there are now 88,400 Vietnamese living with the disease, of which 14,000 have developed full-blown AIDS.
But many international agencies believe that these figures are under estimated, mainly because of under reporting and a lack of comprehensive data collection --obstacles that are complicated by a perception among some policymakers that HIV/AIDS is associated with ''social evils'' - namely prostitution and drugs. The World Health Organisation said the number HIV-infected people in Vietnam are increasing rapidly, with 200,000 infections reported in 2004. WHO attributed the increase to intravenous drug abuse, unprotected sex and transmission through blood transfusions.
It is only recently that people started to be aware that innocent women could also contract HIV - the virus that causes AIDS - and pass it on to their children if their spouses hide their illness and take no protective measures while having sex. The draft legislation, which is a revised version of the first Ordinance on HIV/AIDS promulgated in 1995, aims to limit these cases. In her appraisal report, Nguyen Hoai Thu, director of the National Assembly's social affairs committee, remarked that the revised provisions would be impracticable if people continued to regard HIV/AIDS a ''social evil''.
Because of its association with sex and death, community workers have also found out that the HIV/AIDS epidemic has been accompanied by an epidemic of fear, ignorance, and denial, leading to stigmatisation and discrimination against people with the disease and their family members. It was discovered that stigma and discrimination perpetuate the culture of silence and fear that surrounds the disease and can prevent individuals from being tested and treated for HIV/AIDS and associated infections.
Thu suggested that the ordinance instead should encourage young people to be tested for HIV before getting married. She also said the law could facilitate women to have the test before deciding to have a baby. Deputy Minister of Health Tran Chi Liem said the draft ordinance aims to fight stigmatisation and discrimination.
''It respects human rights and the basic principles of international law on HIV/AIDS prevention,'' he said. Community health worker Hanh, however, disagrees.
''If the draft ordinance says a HIV test is compulsory for people before they get married or for a woman before she has a baby, it's against the basic principles of international law on HIV/AIDS prevention,'' she said.
But Hanh agreed that if it was not compulsory, it would be ''very difficult'' to convince people to take it. While the draft ordinance intends to force people who have tested positive for HIV to inform their spouses of their status, voluntary counseling and testing centers (VCTCs) here have been doing it all along - albeit more gently. All over Vietnam, many VCTCs have been established providing patients with free HIV testing and counseling. The one started last year at Bach Mai Hospital in the capital Hanoi with the support of Family Health International, funded by the United States Agency for International Development, has so far provided free testing and consulting to some 3,100 people. About 23 percent have tested positive for HIV.
''All records of clients are kept confidential,'' said Dr Ngo Quang Huy, adding that doctors and counselors meet weekly to review cases for follow up counseling and support. Ta Kim Anh, 24, who has worked as a counselor at the Bach Mai Hospital's VCTC convinced Nguyen Van Thanh, a 22 year-old intravenous drug user, suspected to be HIV positive, to persuade his girlfriend to be tested at the center.
''The first meeting is the most important one as the counselor helps the client to clearly understand the nature of HIV and its implications. This helps conditions the person's mind for the test,'' said Kim Anh. The VCTC informs people of their HIV positive status only after they are ready to receive the unexpected. The center then refers them for treatment at special hospitals, and introduces them to support clubs for people living with HIV/AIDS, such as ''Bright Future'' and ''Sunflower''.
Nationwide, VCTCs increase awareness about the deadly disease through television, radio and newspapers. They also train and employ people living with HIV/AIDS to work at the centers as counselors and managers and engage them in support group activities. They have also started hotline services for queries related to HIV/AIDS. ''They (VCTCs) have worked effectively in preventing and controlling HIV/AIDS,'' said Nguyen Thanh Long, head of the Ministry of Health's HIV/AIDS Control and Prevention Department. Community health worker Hanh urged the government to follow the example of VCTCs. ''VCTCs have informed the spouses of HIV positive people without any constraints. And they have done it humanely, not causing too much grief.''
By Tran Dinh Thanh Lam - Inter Press Service - April 19, 2005
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