Uû Ban Quèc Gia PhÃÂng Chèng Aids Võ
MINISTRY OF HEALTH
NATIONAL ACTION PLAN ON HARM REDUCTION
intervention in HIV PREVENTION
IN 2007 – 2010 PERIOD
(Promulgated in accordance with Decision No.34 /2007/Q§-BYT
Dated 26 September 2007 of the Health Minister)
Ha Noi - 2007
0
TABLE OF CONTENTS
part I.
rationale for development of action plan.............................4
I. legal Basis for development of the action plan ..........4
II. characteristics of situation of hiv/aids, drug
use and prostitution in viet nam ...........................................4
III. SITUATION OF HAMR REDUCTION INTERVENTION (HRI)
IMPLEMENTATION IN SOME COUNTRIES WORLDWIDE
AND IN VIETNAM .....................................................................................6
NATIONAL ACTION PLAN ON HARM REDUCTION
INTERVENTION FOR HIV PREVENTIONError! Bookmark not de
i. OBJECTIVES.................................................Error! Bookmark not defined.
2. Specific objectives ..........................................Error! Bookmark not defined.
IV. CONTENTS OF THE NATIONAL ACTION PLANError! Bookmark not defi
Part III .............................................................................................................20
Program monitoring, supervision and evaluation ............20
i. monitoring and reporting ...........................................................20
II. ENAHANCING OVERSIGHT, SUPERVISION OF
OPERATIONAL ACTIVITIES IN HARM REDUCTION
INTERVENTION PROGRAM. ...............................................................20
III. EVALUATION OF PROGRAM IMPLEMENTATION........................21
Budget needs ..................................................................................................22
I. basis for budgeting............................................................................22
II. budget needs .........................................................................................22
implementation roadmap .....................................................................24
I. for the period of 2007-2008...............................................................24
II. for the period of 2009-2010 .............................................................24
ORGANISATION OF IMPLEMENTATION....................................................25
1
ACRONYMS
ADB
Asia Development Bank
CO
Community
Outreach
CSWs
Commercial
Sex
Workers
DOH
Department of Health
DOLISA
Department of Labor, Invalids and Social
Affairs
DPS
Department of Public Security
HRI
Harm
reduction Intervention
IDUs
Injecting Drug Users
MOH
Ministry of Health
MOLISA
Ministry of Labor, Invalid and Social
Affair
MPS
Ministry of Public Security
MOCI
Ministry of Culture and Information
MOJ
Ministry of Justice
N&Ss
Needles and Syringes
OI
Opportunistic Infection
PC
Provincial
People
Committee
PE
Peer
Education
PLWHA
People living with HIV/AIDS
STDs
Sexually
Transmitted
Diseases
STIs
Sexually
Transmitted
Infections
SWs
Sex
Workers
VCT
Voluntary Counseling and Testing
WHO
World Health Organization
HIV/AIDS
Human
Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome
2
UNAIDS
Joint United Nations Program on
HIV/AIDS
3
Part I
rationale for development of action plan
I. legal Basis for development of the action plan
1. Law on HIV/AIDS prevention and control dated June 29, 2006.
2. Decree No. 108/2007/N§-CP dated June 26, 2007 of the Government
stipulating in detail implementation of some articles in the Law on HIV/AIDS
prevention and control
3. Decision No. 36/2004/Q§-TTg dated March 17, 2004 of the Prime
Minister on approving the National Strategy on HIV/AIDS prevention and
control till 2010 with a vision to 2010.
II. Characteristics of situation of hiv/aids, drug use and
prostitution in viet nam
As of December 31, 2006 the cumulative number of HIV infected cases
reported from across the country was 116,565, of which 20,195 cases
developing AIDS and 11,802 cases of death due to AIDS. It is estimated that
by 2010, there will be 350.970 HIV infected cases, 112.227 AIDS patients and
104.701 cases of AIDS death[1]. HIV/AIDS epidemic has spread to all
provinces/cities (to be called as province afterwards), with HIV case reports
received from 93% of rural and urban districts (to be called as district
afterwards) and 49% of communes/wards/and townships (to be called as
commune for short). The majority of HIV infected cases are found among the
young age people, with the age group of between 20-39 accounting for 80.28%
of the total reported HIV infected cases. HIV/AIDS epidemic is still in the
concentrated phase with the HIV infected cases mainly found among the high
risk groups such as the injecting drug users (IDUs), commercial sex workers
(CSWs). According to data gained from reporting cases, IDU group accounts
for 51.68% and CSWs 2.57% of the total HIV infected people, respectively[1].
[1] Review report on 2006 HIV/AIDS prevention and control activities, 2007 work plan,
Ministry of Health, 2006
4
As shown by data from Ministry of Public Security, by the end of 2006
the number of managed drug users was 160.226, and the most prevalent type
of drug currently used is heroin (over 80%) [1], focusing on the groups of low
education level, those who have previous criminal records, CSWs,
unemployed and instable income people, or those who have regular movement
of residence and work-place due to their employment features. In big cities,
there have been youngsters under 20 years of age using ATS drugs and are at
risk of HIV infection transmitted through unsafe sex behaviors. HIV
prevalence rate among IDU group was 22.5% in 2006 [2]. Needle and syringes
sharing rate is very high among IDUs (for example 37% in Ho Chi Minh City,
33% in An Giang province).
Apart from increase in drug use practice, prostitution also has its
increasingly complex developments. According to data from the Ministry of
Labour, Invalids and Social Affairs (MOLISA), through surveys conducted in
some centers for treatment-education-social labour in some provinces, it is
clear that CSWs are younger in age: mostly found in the age group of 18-35
(accounting for over 80%, and those between 18-25 years accounting for
42.4%), especially those who are under 18 years of age account for 13.4% (5-
fold to compare with 2000); 20-25% of CSWs are addicted to drugs, and in
some centers this group account for up to 40%. The majority of CSWs are at
low education level, mainly focusing among those who are illiterate or at
completion of primary or secondary levels, which account for 90%. Condom
use rate with regular sex partners among CSW group, regardless being
improved to some extent, remains at 12 51%. Especially, it is more worrying
when the irregular condom use rate among CSWs infected with HIV is very
high, and according to MOLISA data, this rate is as high as 72.7%. HIV
infection risk behaviours among CSW group are reflected in 3.95% of CSWs
infected with HIV by 2006 [3].
[1] Review report on 2006 drug control activities and 2007 work plan implementation,
Ministry of Public Security, 2007
[2] Results from the HIV/STI Integrated Biological and Behavioral Surveillance (IBBS)
in Vietnam 2005-2006
[3] Review report on prevention and control of HIV/AIDS, drugs, prostitution in 2006;
orientation for implementation of work in 2007, MOLISA, 2007
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The above-mentioned situational characteristics show the HIV infection
risk among IDUs and CSWs is very high.
III. SITUATION OF HARM REDUCTION INTERVENTION (HRI)
IMPLEMENTATION IN SOME COUNTRIES WORLDWIDE AND IN
VIETNAM
1. Situation of harm reduction intervention implementation in some countries
in the world
The implementation of HRI varies in each country based on its
HIV/AIDS situation, viewpoints and real conditions. However, HRI activities
are focused on some programs: Community Outreach (CO), needle and
syringe program (NSP), condom use program, substitution treatment
program.
1.1. Condom use program
By the end of 2005, Thailand was estimated to have around 580,000 HIV
infected cases. The main transmission route for those HIV infected cases in
Thailand was through heterosexual intercourse (accounting for 80%).
Thailand has developed and boosted the 100% condom use program
(CUP) in facilities associated with prostitution. In 1989, the 100% CUP was
first piloted and then scaled up nationwide in 1991. As a result, the condom
use rate increased rapidly: from 14% in 1989 to over 90% in 1994, and the
number of sexually transmitted disease (STD) cases across the country
dropped substantially from 410.406 cases in 1987 to 27.362 cases in 1994.
Reduction of HIV infection rate is found in most groups such as pregnant
women (from 2.35% in 1995 to 1.18% in 2003).
1.2. Needle and syringe program
According to China s report on HIV/AIDS situation in 2005 and
responses, by the end of 2005, there was an estimate of 650.000 HIV infected
cases and 44,3% of those cases were infected with HIV through drug injecting.
Even though the NSP has not been widely implemented across China, in
Yunan and QuangXi where the pilot programs have been implemented,
significant results have been recorded from NSP. In YÕn S¬n, the clean N&S
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use rate increase from 20% to 78%, and in Jinming an increase from 28%
to 46%. In 2001, the N&S social marketing program was implemented in
Quangdong province, and it was reported that the N&S sharing rate reduced
by 50% [1].
1.3. Substitution treatment program
The Methadone substitution treatment programs have been implemented
in many countries in the world such as Australia, the USA, the Netherlands,
India, Myanmar, China, HongKong, etc. And in those countries, the
Methadone programs have made substantial contributions to the reduction of
crimes and HIV transmission among IDU group and from that group to the
community. Specifically:
Since early 2004, China has implemented pilot Methadone programs at 8
clinics located in 5 provinces. As at the point of time of 2005, Chinese
Government allowed the expansion of the program to 128 clinics in 21
provinces with the participation of 8,900 drug users.
Evaluation results show that in 8 first clinics, the proportion of drug
users practicing injecting drug reduced from 69,1% to 8,8% after one year of
treatment and the frequency of drug injection during the month decreased
from 90 times/month to 2 times/month. The proportion of those having
employment increased from 22.9% to 40.6% while crime-committed rate self-
reported by the clients reduced from 20,7% down to 3.6%. Among 92 HIV
negative people involved in the program and prolonged their treatment course
to at least 1 year, none was infected with HIV. It is estimated that in 2007 -
2008 period, China will have about 1,500 Methadone treatment clinics serving
approximately 300,000 heroin users[2].
2. Situation of implementation of HRI in Viet Nam
[1] Evaluation report on situation of drug use in Asian countries in HIV/AIDS context
[2] Workshop on Substitution Therapy for HIV/AIDS prevention: international
conference and issues posed in Viet Nam- Party s Central Committee on Science and
Education, 2005
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2.1. Implemented HRI activities in Viet Nam
In 1993, the first harm reduction intervention model was piloted in Dong
Da District Ha Noi and District 1 Ho Chi Minh City with the principal
activity of peer education (PE), encouragement of condom use and behavioral
change communication. So far, some HRI models for high-risk behavior
groups, focusing on IDUs and CSWs have been piloted in some provinces
across the country and gained certain results.
According to review reports of harm reduction intervention program
activities for 2000 2005 period made by 42 out of 64 provinces/cities, harm
reduction intervention programs or projects have been implemented in 37
provinces; harm reduction intervention activities have been conducted in 04
provinces but they ended in 2005 due to the completion of the projects; and
there are 05 provinces without implementing harm reduction program. The
specific results are as follows:
Among 37 provinces where harm reduction intervention activities were
conducted, as many as 144 districts out of a total of 246 districts and 1,428
communes out of a total of 4,005 communes have seen the implementation of
HRI activities with the involvement of 1,250 peer educators. HRI activities are
executed mainly in the form of pilot projects, undertaking mainly behavioral
change communication through community outreach and peer education,
needles and syringes distribution and collection, condoms distribution,
voluntary counseling and testing, STI consultation and treatment.
Specifically:
a) The behavior change information-education-communication
activities are implemented in the forms of direct communication and through
the mass media, printing and distributing communication materials
containing HRI program contents. Communication consent on HRI program
accounted for 22 43% of the communication frequency on HIV/AIDS,
mainly via TV channels (43%) and local newspapers (32.4%).
b) Peer education and community outreach: This task is conducted
mainly through the peer educator network with the involvement of 1,250 peer
educators and as many as 202,216 persons have been contacted, including
46,691 IDUs, 44,234 CSWs and 111,291 persons from the mobile group. The
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number of outreach contacts was 818,660, with 1,864,716 distributed leaflets
and 552,367 distributed guiding booklets related to intervention activities.
c) Distribution of clean needles and syringes and condoms is the main
intervention activity in the harm reduction program.
- Regarding the N&S distribution program: The total number of
distributed N&S was 1,278,133 and 1,374,640 used N&S have been collected
by peer educators (accounting for 48.5% of the total number of distributed
N&S and 49.3% of the total number of used N&S collected), pharmacies
(accounting for 28% of the total number of freely distributed N&S and 19.7%
f the total number of used N&S collected), the network of collaborators,
health care facilities and the voluntary counseling and testing (VCT) centers.
- Regarding the condom distribution program: Statistically, over the
past 5 years, as many as 5,948,356 condoms have been distributed free-of-
charge. Peer educators and health care facilities were the main channels
distributing condom with the distributed condom quantity respectively
accounting for 45.5% and 27.3% of the total number of distributed condoms.
The network of counseling clinics, collaborators and pharmacies has also
played certain roles in distribution and sale of condoms.
d) Drug substitution treatment program
Currently, in Viet Nam, the Methadone substitution treatment has been
applied on piloting basis only at the Institute of Mental Health Bach Mai
Hospital on a scale of a research with a small number of people involved (68
persons). The research findings have proved that the substitution treatment
has significant impacts on reduction of illicit use of opioid substances as well
as injecting behaviors, with the rate of 35.48% before treatment, and after 6
months of treatment, this rate was reduced by 3.22% and 0% after 9 months.
e) Some other supportive activities:
- Voluntary counseling and testing, and STI consultation and treatment
have been conducted properly through some projects activities:
Project " HIV/AIDS prevention and care in Viet Nam Phase II"
(Life-Gap) supported by the US Centers for Disease Control and Prevention is
being implemented in 40 provinces, conducting and maintaining the operation
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of 48 VCT sites. Their main activities are voluntary counseling and testing,
treatment of opportunistic infections, and referral to other services.
Project "Community actions preventing AIDS" supported by the Asia
Development Bank (ADB) is being implemented in 05 provinces covering such
activities as STI consultation and treatment, encouragement of condom use,
which has contributed to reduction of STI morbidity rate among CSW group
(for example: the gonnorhea morbidity rate among CSWs in Quang Tri
province has reduced from 24.8% to 2%).
- Support for community re-integration: This activity has been
conducted by a very small number of projects but it proved that a
comprehensive intervention program would improve the project s
effectiveness, reduce relapse rate and risk behaviors, and HIV transmission.
For example, project Peer education-based comprehensive intervention on
injecting drug users in Lang Son supported by the Ford Foundation has
provided vocational training and capital/credit to 40 peer educators,
organized post-detox support and rehabilitation for 100 persons, and
maintained the regular group meetings. The comprehensive intervention
model has contributed to reducing HIV prevalence rate among IDUs from
46% down to 32% after two years of intervention.
2.2. Difficulties
a) Attitudes and awareness
- The concept of harm reduction intervention as well as the effectiveness
of harm reduction intervention program are still new to the public, thus there
has not been an unification in attitudes and awareness. Stigma and
discrimination towards IDUs and CSWs, PLWHA, and people who were
released from Centers for Treatment Education - Social Labor and
reintegrated into the community, including peer educators implementing
intervention activities in the community, have made the operational activities
encountering lots of difficulties.
- While intervention activities are being implemented, collaboration
among sectors, branches, organizations has not been closely linked, plus
asynchronous implementation, which leads to misunderstanding on the
objectives of the intervention program.
10
b) Regulations and policies:
- Stipulations on implementing measures on harm reduction
intervention in HIV prevention: the policy framework for those activities has
been promulgated but there is still a lack of guiding documents. Legal
documents on drug and prostitution prevention have not included the contents
of harm reduction program.
- The regimes and policies for treatment of those staff involved in AIDS
prevention, direct provision of management and care to IDUs, CSWs infected
with HIV in centers for treatment - education - social labor, prisons, detention
centers, correctional centers, etc. are not logical in terms of the beneficiaries
and the cost norms, thus attraction of working in those facilities has not been
promoted.
c) Resources and funding investment
- Lack of staff working for community based harm reduction
intervention as well as health workers working in centers of treatment -
education - social labor, prisons, detention centers, correctional centers, etc.
- Funding for implementation of harm reduction activities is still
limited. Currently, funding for community-based activities is mostly depended
on the international support.
2.3. Constraints
a) Scope and locations for intervention are still limited and fragmented.
b) The intervention models are still at the piloting phase and not
unified, which resulted in low prevention effectiveness.
c) The harm reduction intervention staff is working on a part-time
basis, with insufficient knowledge and experience in implementing
intervention programs due to their lack of training or inadequate training.
- Peer educators involved in the program are still practicing drug use or
prostitution. There is always a high rate of drop-out among peer educators
due to their health condition or returning to the centers of treatment -
education - social labor.
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PART II
NATIONAL ACTION PLAN ON HARM REDUCTION INTERVENTION
FOR HIV PREVENTION
i. OBJECTIVES
1. General objective:
To control the HIV prevalence rate among drug injecting user group
under 20% and commercial sex worker group under 3%, reduce the HIV
prevalence rate among high-risk behavior groups and spread from high-risk
behavior groups to the community, contribute to the successful
implementation of the National Strategy on HIV/AIDS prevention and control
in Viet Nam till 2010 with a vision to 2020.
2. Specific objectives
2.1. To have 100% of provinces/cities to develop the network of staff
working for harm reduction intervention program.
2.2. To increase the condom use rate among the commercial sex
workers to 90% and the proportion of commercial sex workers to be given
sexually transmitted disease examination and treatment to 80% as in line with
the regulations.
2.3. To increase the clean needle and syringe use rate among drug
injecting user group to 90%, reduce the needle and syringe sharing rate
among drug injecting user group to below 10% and that among HIV infected
drug injecting user group at 5%, achieve the proportion of used needles and
syringes to be collected at 90% of the distributed number of needles and
syringes.
2.4. To implement treatment of opioid substance dependence by
substitution therapy in at least 10 provinces.
II. PRINCIPLES OF PROGRAM IMPLEMENTATION
1. Organisation for implementing harm reduction intervention
activities in HIV prevention should be relevant to specific situation and
conditions of each ministry, sector, and locality.
12
2. Integration should be made between harm reduction intervention
activities in HIV prevention with drug and prostitution prevention and
control programs and other action plans included in the National Strategy on
HIV/AIDS prevention and control in Viet Nam till 2010 with a vision to 2020.
3. Close collaboration among Ministries, sectors, branches,
organisations and the People s Committees at different levels should be made
in implementing harm reduction intervention program.
4. Such behaviour of taking advantages of intervention activities to
create favourable conditions for drug use and prostitution should be
minimised.
III. SOLUTIONS for IMPLEMENTation
1. Group of social solution
1.1. Solutions on legislation and policy
Continuing the development and elaboration of legal document system
related to harm reduction intervention activities in HIV prevention in order to
ensure the concordance of legislation between HIV/AIDS prevention and
control with drug and prostitution prevention and control, development of
national guidelines on harm reduction intervention in HIV prevention.
1.2. Solutions on improving inter-sectoral collaboration and community
mobilisation
a) Advocating local leaders and authorities, sector, branches,
organisations, civil societies, faith-based organisations, enterprises, factories,
recerational establishments, train and coach stations, hotels, rest houses,
restaurants, and other service providing facilities to support and get involved
in the program through conferences, thematic talks, seminars for propaganda,
dissemination of education on legislation for HIV/AIDS prevention and
control, holding meetings to share experience between units directly
conducting harm reduction intervention measures in HIV prevention and
relevant agencies, organisations and units;
b) Strengthening collaboration among staff working in the Public
Security, labour-Invalids-Social Affairs and Health care staff in executing
program activities;
c) Strengthening the role of the family and the residential community in
propaganda, education and advocacy of safe behaviours in HIV prevention;
d) Bringing into play the proactiveness and active participation of the
target population for intervention in planning and execution of the program;
13
®) Advocating and collaborating with governmental and non-
governmental organisations, international organisations in order to mobilise
the techincal and financial supports in implementing intervention programs.
1.3. Solutions for enhancing information education communication
and advocacy
a) Enhancing propaganda and education activities on intervention
program, harm reduction intervention activities and benefits, roles of harm
reduction intervention activities in order to raise the awareness of the
authority personnel at different levels, staff working in the anti-social evil
system of the ministries, sectors, barnches, organisations with an aim to
ensure the collaboration and unification in program implementation, reaching
the community consensus on harm reduction intervention activities;
b) Strengthening propaganda activities for the high-risk behaviour
group on HIV situation, harm reduction intervention programs and other
supporting services being implemented, creating favourable conditions for
improving access to intervention services as well as behaviour change and
practice of safe behaviours;
c) Diversifying communication formats with a focus on direct
communication.
2. Group of technical solutions
2.1. Ensuring a unified and effective implementation of the program
nationwide and in line with the law provisions.
2.2. Strengthening activities conducted by outreach groups and scaling-
up peer education models in HIV prevention.
2.3. Intensifying activities of N&S, condom distribution; strengthening
condom social marketing to ensure the availability of N&S and condoms for
an easy access.
2.4. Providing and encouraging utilization of lubricants to people
involved in men having sex with men.
2.5. Gradually scaling up the treatment program for opioid substances
by substitution therapy for those who are dependent on opioid substances.
2.6. Piloting the comprehensive prevention intervention in some
provinces/cities and then drawing the lessons learnt and scale-up.
2.7. Integrating the harm reduction intervention program into
prevention and treatment activities.
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2.8. Conducting regular monitoring and supervision for quality and
effectiveness assurance of the intervention program.
2.9. Conducting researches on harm reduction intervention.
3. Group of solutions for improving management capacity and strengthening
resources
3.1. Elaborating the mechanism for management, execution of the
program.
3.2. Capacity building for the network executing and implementing
harm reduction intervention activities;
3.3. Elaborating the system of data collection, reporting and
management of harm reduction intervention program;
3.4. Enhancing the supervision and monitoring of harm reduction
intervention activities conducted at different levels.
3.5. Mobilizing domestic resources from programs at central and local
levels, social organizations, international organizations and NGOs in order to
ensure the resources for harm reduction intervention program.
IV. CONTENTS OF THE NATIONAL ACTION PLAN
1. Objective 1: To establish a network of staff, collaborators, and peer
educators for implementing the harm reduction intervention program.
1.1. Setting up a pool of full-time staff (at central and provincial levels),
staff responsible for harm reduction activities (at district and commune levels)
within the system of HIV/AIDS prevention in the Health sector, the drug
prevention in the Public Security sector, and the social evil prevention in
the labor-Invalids-Social Affairs sector in order to implement harm reduction
intervention program. A focus should be laid in developing the network at
district and commune levels.
1.2. Establishing a network of collaborators from the central to local
levels belonging to ministries, sectors, branches involved in harm reduction
intervention program, especially the community outreach program,
encouraging the participation of the social workers.
1.3. Developing a network of peer educators involved in harm reduction
intervention activities:
a) Selecting and recruiting those who are voluntary and eligible to
participate in harm reduction intervention activities as peer educators;
15
b) Compiling ground rules for peer educator s operational activities
with clearly defined tasks, group working, monthly, quarterly and annual
action plan and specific targets to be achieve in each activity.
1.4. Training:
a) Developing training curriculum for full-time staff, responsible staff
in the area of harm reduction intervention, collaborators and peer educators.
Training curriculum should be appropriate to specific characteristics of each
target group;
b) Organizing training and retraining for target
groups to meet their needs and the specific features of the harm reduction
intervention program.
2. Objective 2: To increase the condom use rate among CSW group to
90% and increase the proportion of CSWs to be given STI examination and
treatment in line with the regulation to 80%.
2.1. Conducting behavior change communication in order to improve
knowledge and encourage to implement safe behaviors for HIV and STIs
prevention among high-risk groups.
a) Conducting direct communication for awareness of HIV prevention,
condom distribution program, encouragement of condom use, and guidance in
condom use, knowledge on N&S provision program, sexually transmitted
diseases (STDs), introduction of STD examination and treatment services, etc.
to high-risk behavior groups so as to help them change behaviors and be
aware of implementing safe behaviors:
- Holding thematic talks for CSWs, staff and receptionists working in
restaurants, hotels and owners of establishments doing business in hospitality
services, coach stations, ports, tourism or other cultural and social services;
- Organizing periodical group meeting among different target groups
for information updates, experience sharing and access to STD examination
and treatment services as well as other related services;
- Strengthening direct communication activities to high-risk behavior
groups through community outreach workers.
b) Conducting communication through the mass media: providing
communication equipment and facilities, arranging timeframe for TV and
radio broadcasting programs to advertise the effectiveness of the intervention
program, advantages of condom use in HIV prevention, propagandizing
contents of the harm reduction intervention program to gain the community
consensus in implementation of harm reduction intervention programs, thus
reducing stigma and discrimination.
c) Compiling, printing and distributing communication materials such
as pamphlets, booklets on condom program. Providing publications on
marketing and encouragement of condom use.
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2.2. Supplying and guiding condom use
a) Free distribution of condoms:
- Developing a network of condom distribution through public and
private health facilities, hotels, restaurants, project offices, mobile STIs
service.
- Maintaining and developing a network of condom distribution
through per educators and collaborators.
- Developing a new condom distribution model that will be conducted
appropriately to characteristics of different target groups.
- Condom distribution should be conducted appropriately to
characteristics of different target groups in order to ensure the availability
and convenience of use.
b) Condom social marketing:
- Conducting marketing of and directly distributing high quality
condoms to CSWs through the network of condom social marketing.
- Organizing propaganda, education activities for such subjects as
owners of hotels, rest houses, restaurants, recreational establishments.
Running training courses on the benefits of condom use in prevention of HIV
and STDs, negotiation skills with clients and guidance to be given to
establishment owners in order to gain their support and create availability of
condoms in their establishments.
- Developing a network of condom supply chain such as installing
condom vending machines at recreational points, train and coach stations, bus
stops and other public locations.
c) The condom subsidized sale program:
- Developing a condom subsidized sale network through private and
public pharmacies.
- Maintaining and developing a network of condom subsidized sale
through per educators and collaborators.
- Developing a new condom subsidized sale model that will be
conducted appropriately to characteristics of different target groups.
d) Providing and encouraging lubricant use:
- Developing a lubricant providing network to men having sex with men
(MSM) group.
- Providing water-based lubricant supply simultaneously with condom
supply.
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2.3. Increasing the availability of STD examination and treatment
services, creating favorable conditions for CSWs to access the services (in
collaboration with the National Program on STI management and treatment)
a) Establishing mobile STD examination and treatment clinic: the clinic
should be located in discreet places where CSWs are numerous, with opening
hours appropriate to the specific features of CSWs, creating the most
favorable conditions for CSWs to get access to services.
b) Mobilizing public and private health facilities to participate in STD
examination and treatment program for CSWs.
2.4. Providing training to health staff on technical issues as well as
counseling and condom use.
2.5. Developing professional guidelines on implementation of harm
reduction intervention measures in HIV prevention with condoms;
3. Objective 3: To increase the clean N&S use rate to 90%, reduce the
N&S sharing rate among IDU group to below 10% and among HIV infected
IDU group to 5%, to achieve the proportion of used N&S collected at 90% of
distributed N&S.
3.1. Behavior change communication for N&S program
a) Conducting direct communication for IDU group on knowledge of
prevention of HIV, clean N&S distribution program, encouragement of clean
N&S use, guidance on clean N&S use, safe injecting skills through organizing
talking sessions for IDUs, periodical group meetings for different groups to
update information, share experience and get access to other intervention
prevention services and treatment.
b) Mobilizing the community to participate in the program and support
the clean N&S provision, and guidance for clean N&S use.
3.2. Provision and guidance of clean needles and syringes
a) Developing the network of clean N&S and sterile injecting equipment
through pharmacies, health workers, project offices, STI mobile clinics.
b) Maintaining and developing the network of Clean N&S free
distribution through peer educators and collaborators.
c) N&S subsidized sale: N&S are on subsidized sale for IDUs, CSWs
practicing drug use through pharmacies, N&S vending machines and some
other systems
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d) N&S collection: used N&S are collected through the network of peer
educators, collaborators, selected health facilities and pharmacies.
®) Distribution of sterile injecting equipments: Cotton, disinfectant
gauge and distilled water are distributed simultaneously with distribution of
N&S for IDUs.
e) Developing forms of N&S distribution, building different models of
N&S distribution.
3.3. Developing professional guidelines on implementing harm
reduction intervention measures in HIV prevention with clean needles and
syringes;
4.
Objective 4: Introduction of treatment of opioid substance with
substitution therapy
4.1. Advocating sectors, branches, mass organizations and the public in
the substitution therapy implementing sites to support and participate in the
program.
a) Conducting communication on the mass media, organizing
conferences, seminars, direct communications at the places where substitution
therapy is being conducted on harm reduction intervention and treatment of
opioid substance dependence by substitution therapy so as to gain the support
from local authorities and the people, creating favorable conditions for
implementation of the program.
b) Compiling, printing and distributing communication materials such
as pamphlets, booklets, etc. on treatment program for opioid substance
dependence by substitution therapy.
4.2. Implementation of treatment of opioid substance dependence by
substitution therapy
a) For 2007-2008 period: Piloting in 02 provinces with 06 treatment
sites. Substitution drugs are estimated to be given to 1,500 drug users.
b) For 2009 2010 period: Based on the results to be gained from 2007
2008 period, plans for scaling-up implementation of treatment for opioid
substances in 08 provinces.
(A summary of action plan is available in Annex I)
19
Part III
Program monitoring, supervision and evaluation
(In combination with the Action Plan for HIV/AIDS Program monitoring
and evaluation)
i. Monitoring and reporting
1. Reporting intervention activities being implemented in accordance
with the reporting regime as stipulated in the Regulation of reporting and
forms for reporting HIV/AIDS prevention and control activities promulgated
in attachment to Decision No. 26/2006/Q§-BYT dated September 6, 2006 of
the Health Minister.
2. Supplementing some indicators relating to harm reduction
intervention activities in the forms for reporting for the purpose of monitoring
and evaluation of harm reduction intervention activities effectiveness.
3. Developing a mechanism for information exchange in order to
provide, update and exchange information on harm reduction intervention
activities within the province as well as across the country.
4. Conducting training for staff who are responsible for program
monitoring, supervision on utilization of indicators, data collection, synthesis
and analysis.
II. ENHANCING OVERSIGHT, SUPERVISION OF OPERATIONAL
ACTIVITIES IN HARM REDUCTION INTERVENTION PROGRAM.
1. Organizing meetings, periodical meetings to evaluate harm reduction
intervention program effectiveness, promptly settling difficulties arising
during the course of implementing program.
2. Organizing periodical and extraordinary supervisory and review
visits.
2.1. Mid-term review (for 2007 2008 period).
2.2. Evaluation of program activities for 2007 2010 period.
3. Conducting specific and operational researches to evaluate program
effectiveness as well as making necessary adjustment/revision.
3.1. Conducting studies to evaluate community outreach activities.
20
3.2. Conducting studies to evaluate comprehensive intervention models
for high-risk groups (IDUs, CSWs, etc.), efficiency in application of treatment
for opioid substances by substitution therapy.
III. EVALUATION OF PROGRAM IMPLEMENTATION
1. Purpose:
1.1. To evaluate the effectiveness of intervention program in HIV
prevention in terms of the coverage, the percentage of target groups to be
contacted, etc.
1.2. To evaluate the harm reduction intervention service delivery and
service quality;
1.3. To evaluate the responsiveness of ministries, sectors, organizations
in harm reduction intervention, and inter-sectoral collaboration;
1.4. To evaluate the responsiveness of provinces in implementing harm
reduction intervention activities;
1.5. To evaluate the human resource commitment made from the
central level to local level.
2. Indicators for evaluation:
2.1. Evaluation is made according to the National evaluation indicators
set stipulated in Decision No. 04/2007/Q§-BYT dated January 15, 2007 of the
Health Minister on promulgation of the Indicator List for Monitoring &
Evaluation of the National HIV/AIDS Prevention and Control Program.
2.2. Supplementing some indicators relating to harm reduction
intervention activities which can be used for evaluating intervention program
effectiveness in HIV prevention on the coverage, the percentage of target
groups to be contacted, etc.
21
Part IV
Budget needs
I. Basis for budgeting
1. Human resource needs for implementation of harm reduction
intervention program
2. Expenditure norms stipulated by the Government of Viet Nam and
the practical application in some international cooperation projects:
2.1. The low estimate level: Based on the norms stipulated in the Inter-
ministerial Circular No. 51/2002/TT-LT/BTC-BYT dated June 3, 2002 of the
Ministry of Finance and the Ministry of Health guiding expenditure contents
and norms for National Target Programs for prevention and control of some
social diseases, dangerous epidemics and HIV/AIDS.
2.2. The high estimate level: The norms are based on the practical needs
and applications in some international cooperation projects.
II. Budget needs
1. Budget needs for 2007-2010 period
1.1. Low estimate level:
771,368 million VND
1.2. High estimate level: 1,352,286
million
VND
2. Budget breakdown for activities is available in Annex 2
22
BUDGET ESTIMATES FOR IMPLEMENTING PROGRAM “HARM REDUCTION INTERVENTION
PROGRAM IN HIV/AIDS PREVENTION”
2007 2010 PERIOD
Unit: million VND
BUDGET ESTIMATE
No.
ACTIVITY
2007 2008 2009 2010
TOTAL
Low level High level Low level High level Low level High level Low level High level Low level High level
1
MANAGEMENT, DIRECTION
200 320 100 160 150
160
100 160
550
800
TRAINING, WORSHOP, CONFERENCE,
2
10.062
18.240
15.400
27.400 11.000
13.600
11.000
13.600
47.462
72.840
SEMINAR
3
INTERVENTION ACTIVITIES
91.480
159.320
91.480
159.807 198.500
303.460
198.500
303.460
579.960
926.046
4 SALARY,
ALLOWANCE
5.064 21.960
5.064 21.960 12.134
47.040
12.134 47.040 34.396
138.000
5 EQUIPMENT
6.000 12.000 18.000 36.000 14.000
26.000
14.000 26.000 52.000
100.000
SOCIAL SUPPORT FUNDING (JOB
6
3.400 6.800 3.400 6.800 3.400
6.800
3.400 6.800 13.600
27.200
TRAINING AND CREDIT LOAN)
MONITORING, SUPERVISION &
7
7.000 14.000
7.000
14.000
13.000
27.000
14.000
30.000 41.000
85.000
EVALUATION
8
CONTINGENCIES
600 600 600 600 600
600
600 600 2.400
2.400
TOTAL
123.806
233.240
141.044
266.727 252.784
424.660
253.734
427.660
771.368
1.352.286
Total budget for 4 years (2007-2010)
Low estimate level:
771 billion and 368 million VND
High estimate level:
1,352 billion and 286 million VND
Note: the Methadone substitution therapy is included for 2007 and 2008 only.
23
part V
Implementation roadmap
I. For the period of 2007-2008
1. Elaborating the legal document system to form the legal basis for
organization and implementation of harm reduction intervention activities.
2. Developing technical guidelines and communication materials on
harm reduction intervention activities.
2.1. Developing and strengthening the contingent of full-time staff for
harm reduction intervention at all levels, organizing training on harm
reduction intervention.
2.2. Implementing harm reduction intervention program in 30
provinces with the highest numbers of HIV infected people through the
following activities: communication to create an enabling environment for
implementation of harm reduction intervention activities; community
outreach; provision and guidance of condoms and clean N&S.
2.3. Introducing Methadone substitution therapy in 02 provinces.
2.4. Conducting specific and operational researches to form the
foundation for planning of the nest period: Evaluating harm reduction
intervention activities in Viet Nam during 2001 2006 period to be conducted
in 2007, and the mid-term review (for the period of 2007-2008) to be
conducted in 2009.
II. For the period of 2009-2010
1. Continuing and enhancing activities being conducted during the
period of 2007-2008.
2. Implementing the harm reduction intervention program in the
remaining 38 provinces.
3. Implementing Methadone substitution therapy with the expansion to
08 other provinces.
4. Evaluating the effectiveness of harm reduction intervention program
during 2007-2010 periods and developing action plan for 2010-2020 periods.
24
PART VI
ORGANISATION OF IMPLEMENTATION
I. RESPONSIBILITIES OF THE MINISTRY OF HEALTH
1. Taking the lead in coordinating with relevant agencies and Provincial
People s Committees to develop and implementing long-term and annual
plans for harm reduction intervention program implementation.
2. Developing and promulgating within the given authorities or
submitting to competent levels guidelines for implementation of harm
reduction intervention program, with special focus on developing legal
documents on coordination approaches and related regimes, policies for
implementing harm reduction intervention measures in HIV prevention.
3. Collaborating with the Ministry of Justice to revise legal documents
related to harm reduction intervention program in order to amend,
supplement or recommend the competent authorities to amend, supplement
legal documents to be appropriate to the reality.
4. Setting up the Technical Assistance Group for harm reduction
intervention program consisting of experts in the field of HIV/AIDS
prevention and control from such ministries, sectors, organizations as
Ministry of Health, Ministry of Public Security, Ministry of Labor-Invalids-
Social Affairs, Ministry of Justice, Ministry of Finance and some relevant
ministries, sectors, organizations.
5. Taking the lead and collaborating with relevant agencies to conduct
inspection, supervision, and summarize the progress of program
implementation.
6. Conducting annual and end-of-period review and reporting to the
Government and relevant agencies; evaluating the program effectiveness in
2010, which could form a basis for development of 2011-2020 period plans.
7. Allocating and mobilizing resources to achieve program objectives.
II. RESPONSIBILITIES OF THE MINISTRY OF public security:
1. Taking the lead and collaborating with the Ministry of Health and
relevant agencies in building, organizing implementation of long-term and
25
annual plans for harm reduction intervention program implementation within
the assigned functions and tasks, and allocating appropriate resources to
achieve the program objectives.
2. Giving directions to public security units at different levels to
collaborate with health care units and relevant ministries, sectors, mass
organizations at the same level to implement harm reduction intervention
program.
3. Implementing harm reduction intervention measures in HIV
prevention within the assigned functions and tasks.
III. RESPONSIBILITIES OF THE MINISTRY OF labor invalids -
social affairs:
1. Taking the lead and collaborating with the Ministry of Health and
relevant agencies in building, organizing implementation of long-term and
annual plans for harm reduction intervention program implementation within
the assigned functions and tasks, and allocating appropriate resources to
achieve the program objectives.
2. Giving directions to Labor Invalids Social Affairs units at
different levels to collaborate with health care units and relevant ministries,
sectors, mass organizations at the same level to implement harm reduction
intervention program.
3. Implementing harm reduction intervention measures in HIV
prevention within the assigned functions and tasks.
IV. RESPONSIBILITIES OF oTHEr Ministries and sectors
being the members of the national committee for aids,
drugs and prostitution prevention and control
1. Taking the lead and collaborating with the Ministry of Health and
relevant agencies in building, organizing implementation of long-term and
annual plans for harm reduction intervention program implementation within
the assigned functions and tasks, and allocating appropriate resources to
achieve the program objectives.
2. Giving directions to units under their management to collaborate
with health care units and relevant ministries, sectors, mass organizations at
the same level to implement harm reduction intervention program.
26
V. RESPONSIBILITIES OF THE provincial and centrally-run
municipal people s committees
1. Giving directions in development and organization of implementing
long-term and annual plans on harm reduction intervention in their localities
and allocating appropriate resources to achieve the program objectives.
2. Mobilizing all the public to support, and get involved in harm
reduction intervention activities in HIV prevention.
3. Giving directions in introduction, supervision of implementation,
summarizing and reporting periodically to the Ministry of Health and
relevant agencies.
VI. RESPONSIBILITIES OF THE provincial and centrally-run
municipal department of health:
1. Playing the advisory role to the Provincial People s Committee in
developing long-term and annual action plans on harm reduction
intervention.
2. Collaborating with relevant provincial departments, sectors, and
branches to guide units in implementing harm reduction intervention
activities as well as supervising, monitoring and evaluation of harm reduction
intervention implementation in the localities.
3. Giving directions to technical agencies under their management to
implement harm reduction intervention program.
VII. RESPONSIBILITIES OF THE focal point agencies in
hiv/aids prevention and control in provinces and
centrally-run cities:
1. Developing long-term and short-term plans on harm reduction
intervention program in the localities.
2. Being the focal point for coordinating with relevant sectors,
branches, organizations within the province to direct and implementing harm
reduction intervention activities in HIV prevention, including the following
activities:
27
2.1. Implementing harm reduction intervention activities.
2.2. Organizing advocacy, conferences, workshops in order to gain the
support from authorities at different levels, sectors, branches, organizations,
community, individuals to get involved in harm reduction intervention
activities.
2.3. Getting involved in organizing technical training courses.
3. Collaborating with relevant agencies to monitor and evaluate
program implementation in the province.
The minister of health
Nguyen Quoc Trieu
28
Annex 1
Summary of work plan
Location/Time
Implementing or
No. Activity
collaborating
2007 -
2009 -
agency
2008
2010
I
Objective 1: To establish a network of staff, collaborators, peer educators
implementing harm reduction intervention program
1
Setting up a pool of full-time staff,
- MOH
64
64
staff responsible for harm reduction - MPS
provinces province
activities, prevention of drug
- MOLISA
/cities
s/cities
offenders and prevention of social
- Provincial PC.
evils.
- DOH, DPS,
DOLISA
2
Establishing a network of
- Relevant
64
64
collaborators from the central to
ministres,
province province
local levels belonging to ministries,
sectors,
s/cities
s/cities
sectors, branches involved in harm
organisations
reduction intervention program,
- Provincial PC
especially the community outreach
program, encouraging the
participation of the social workers.
3
Developing a network of peer
- MOH
64
64
educators involved in harm
- MPS
province province
reduction intervention activities.
- MOLISA
s/cities
s/cities
- Provincial PC.
- DOH, DPS,
DOLISA
4 Training
- MOH
64
64
- MPS
province province
- MOLISA
s/cities
s/cities
- Provincial PC.
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
29
- Developing training curriculum
- MOH
and contents
- MPS
- MOLISA
- Organizing training and
- MOH
64
64
retraining
- MPS
province province
- MOLISA
s/cities
s/cities
- Provincial PC.
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
Objective 2: To increase the condom use rate among CSW group to 90% and
II increase the proportion of CSWs to be given STI examination and treatment
in line with the regulation to 80%.
1
Conducting behavior change
- MOH
64
64
communication in order to improve
- MPS
province province
knowledge and encourage to
- MOLISA
s/cities
s/cities
implement safe behaviors for HIV
- MOCCT
and STI prevention among high
- Provincial PC
risk groups
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
2 Supplying
and
guiding condom use
- MOH
30
64
- MPS
province province
- MOLISA
s/cities
s/cities
- Provincial PC
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
30
3
Increasing the availability of STD
- MOH
30
64
examination and treatment services, - MPS
province province
creating favorable conditions for
- MOLISA
s/cities
s/cities
CSWs to access the services
- Provincial PC
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
III Objective 3. To increase the clean N&S use rate to 90%, reduce the N&S
sharing rate among IDU group to below 10% and among HIV infected
IDU group to 5%, to achieve the proportion of used N&S collected at
90% of distributed N&S
1
Behavior change communication
- MOH
64
64
for N&S program
- MPS
province province
- MOLISA
s/cities
s/cities
- MOCCT
- Provincial PC
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
2
Provision and guidance of clean
- MOH
30
64
needles and syringes
- MPS
province province
- MOLISA
s/cities
s/cities
- Provincial PC
- DOH, DPS,
DOLISA
- International
organizations,
NGOs
31
IV Objective 4: o introduce treatment of opioid substance with substitution
therapy
1
Advocating sectors, branches, mass
- MOH
02
At least
organizations and the public in the
- MPS
province 10
substitution therapy implementing
- MOLISA
s/cities
province
sites to support and participate in
- Provincial PC
s/cities
the program
- Pro. Depart. Of
Health
- Sectors,
branches,
organisations
2
Implementation of treatment of
- MOH
02
At least
opioid substance dependence by
- MPS
province 10
substitution therapy
- MOLISA
s/cities
province
- Provincial PC
s/cities
- Pro. Depart. Of
Health
- International
organizations,
NGOs
32
Annex 2
33
0
Document Outline
