It is clear that in Viet Nam HIV infection is rapidly being transmitted among Injecting Drug
Users (IDUs), through sharing needles and syringes. Nearly 60% of reported HIV cases
up to September 2002 were due to transmission through IDU. Currently, the proportion
of reported HIV cases due to sexual transmission is low. However, as in other Asian
countries, the number of these cases is increasing, and it is expected that sexual
transmission will become the dominant mode of HIV transmission in Viet Nam in the
coming years.
The general view that IDUs are unemployed has contributed to the perception in Viet
Nam that the impact of the epidemic will be relatively small because of the relatively low
contribution of IDUs to the economy. Furthermore, it is often asserted that the marginal
impact of HIV/AIDS-related healthcare costs at the household level, over and above the
devastating household impact of IDU, is minimal.
A few points have to be made in this regard. The first is that not all IDUs are
unemployed. Various studies in Viet Nam found that at least a third of IDUs have some
form of employment. Secondly, since the early 1990s, the investments into rehabilitation
of IDUs, which are not trivial, are increasingly linked with HIV/AIDS. The returns to these
investments are substantially reduced if the IDUs die of HIV/AIDS during early
adulthood. Thirdly, a forward-looking assessment of the potential impact of HIV/AIDS
will have to take into account the decreasing age of IDUs and patterns of intravenous
drug use. Lastly, bridging population behaviours – behaviours that bridge the high-risk
populations such as IDUs and the general population – determine the extent to which the
epidemic spreads to the general population. It is therefore important to shift the focus
from the stigmatized notion of high-risk populations such as IDUs, sex workers to an emphasis on high-risk behaviours, because it is these high-risk behaviours that will
determine the rate of transmission of the virus beyond the high-risk groups in Viet Nam.
It is also important to consider the numbers and role of the clients of sex workers as a
“bridging population”, who transmit the infection into the general population. The
economic cost of the epidemic spreading beyond the IDU population needs to be
considered in calculating the returns to investments made into HIV prevention among
IDUs.
Since 1988 Viet Nam’s borders have progressively opened resulting in increased traderelated
and tourism-related mobility. Within the country there is also more mobility due to
improved infrastructure, urbanization and increased disposable income. These
economic forces that currently contribute to Viet Nam’s vulnerability to the HIV/AIDS
epidemic were the ones previously identified as reasons for the slow growth of the
epidemic in Viet Nam (Tran 2002). Furthermore, it is important to note that these factors
will contribute to the spread of HIV among the non-IDU population, rather than expanded
spread among current IDUs.