The Vietnamese government warns that multi-million dollar donor cutbacks could undermine progress in the country’s HIV/AIDS services.
“One of the biggest challenges is the government’s resource limitation,” Bui Hoang Duc, deputy head of the monitoring and evaluation department at the Vietnam Administration of HIV/AIDS Control (VAAC) within the Ministry of Health, told IRIN. “It is quite difficult for the government to maintain or to increase success of previous programmes.”
More than 70 percent of Vietnam’s HIV/AIDS response comes from international donors, which plan to reduce or phase out projects due to the country’s new middle-income status and the global financial crisis.
The cost of expanding and sustaining programmes could almost triple from US$113 million in 2012 to $301 million in 2020, but available resources are estimated to fall to $53 million by 2020, according to a report by the Joint UN Programme on HIV/AIDS (UNAIDS).
In 2012, Vietnamese lawmakers passed their first National Target Programme on HIV/AIDS Prevention and Control, increasing the budget for HIV services by 20 percent compared to 2011, UNAIDS officials said.
Still, Duc cautioned that the budget could only meet up to 3 percent of demand for the life-prolonging antiretroviral therapy (ART) and places limits on the screening of pregnant women for HIV and keeping peer educator networks and harm reduction programmes afloat.
“We think that the long-term impact of these concerns may increase HIV cases and deaths to AIDS,” he said.
According to VAAC, there were almost 209,000 people living with HIV (PLHIV) in 2012, expected to rise to more than 263,000 in three years. Only 59 percent of eligible HIV patients were on ART in 2012, below the Millennium Development Goal of 70 percent by 2015.
The HIV epidemic has been mainly concentrated among injecting drug users (IDUs) and commercial sex workers, who have high rates of HIV prevalence at 11.4 and 3 percent respectively, health officials say. Estimates suggest there are more than 150,000 IDUs in Vietnam.
“The funding cuts are happening before the country of Vietnam is ready for them,” said Josselyn Neukom, country director for Population Services International (PSI) in Vietnam, an international NGO helping these high-risk groups. “It is definitely a big concern for PSI and others dedicated to supporting the Ministry of Health to address Vietnam's priority unmet health needs, including HIV/AIDS."
Since 2004, the US president’s Emergency Plan for AIDS Relief (PEPFAR), the largest contributor to Vietnam’s HIV response, has doled out almost $600 million.
In recent years, PEPFAR has decreased funding to Vietnam from $98 million in 2010 to $69 million in 2012. US officials declined to speculate on future expenditures.
However, according to a 2011 report by the US Agency for International Development (USAID), PEPFAR funding could plunge to an estimated $43 million by 2015.
US officials are pushing Vietnamese leaders to take ownership of the epidemic. The Leadership, Management and Governance project under USAID is currently tasked to help transition 5,000 health workers engaged in donor-funded HIV/AIDS ventures into government-run programmes.
Worldwide PEPFAR funding has been reduced by $543 million since 2010 and President Barack Obama’s administration even proposed another $50 million cut for 2014.
Separately, the Global Fund, for which Washington is a major donor, originally signed a $125 million grant for HIV/AIDS from 2011 to 2015 with Vietnam, but only $66 million has been committed in the first three years. The remaining funds are not guaranteed since the Global Fund works on the concept of performance-based funding.
After 2015, Vietnam is still eligible to apply for grants, but the amounts will depend on donor contributions, the country's needs assessment and gap analysis, among other factors, said Marcela Rojo, a Global Fund spokesperson.
Furthermore, the UK Department for International Development (DFID) will end a six-year $36.5 million project at the end of 2013. The year before, an eight-year $38.5 million project from World Bank also shut down.
Deputy Prime Minister Nguyen Xuan Phuc said in a local news report that such cuts are premature, but in response to the ongoing drawdown, he added that the country will attempt to diversify its funding sources by promoting public-private partnerships and health insurance.
The government could also collect money from airline and airtime levies, or general taxation and efficiency savings to avoid cuts in HIV services, according to the UNAIDS report.
Moreover, job creation and loans for people infected with HIV could help them afford the costs of treatment, especially ART, when donors pull out, said Dong Duc Thanh, a community liaison officer of the Pathways Project, a US government-funded venture to enhance Vietnam’s civil society.
“In my view, PLHIV need to be equipped with information and preparation for technical support and training so as to be pro-active in accessing treatment for the long run,” he said in another USAID report.