Academic journal article Journal of Cultural Diversity

HIV Prevention, Stigma, and Care in Ho Chi Minh City and Da Lat Vietnam

Academic journal article Journal of Cultural Diversity

HIV Prevention, Stigma, and Care in Ho Chi Minh City and Da Lat Vietnam

Article excerpt

Vietnam gained independence in 1954 from the French. Among many significant "rebuilding" efforts to gain back autonomy and culturally relevant, sensitive healthcare systems, the healthcare infrastructure was reorganized to offer care to all through a universal access system (Nguyen et al., 2012). But with a population of 84.5 million, expanding equitable, accessible, and high quality healthcare to the entire population continues to be challenging. More specifically, addressing efficient and effective testing and treatment approaches for

HIV infection in an over-taxed system is extremely difficult. Current HIV prevalence rate in adults ages 15-49 is 0.50 in Vietnam as compared to the United States' prevalence rate of 0.60 in a population of 316.3 million people (UNAIDS, 2012).

Healthcare funding in Vietnam is multifaceted with 5% of its gross domestic product (GDP) to health costs (Lieberman & Wagstaff, 2009). Its Social Health Insurance (SHI) program accounts for 10% of total health spending, covering 40% of the population. Of this 40%, health service payments are made by supply-side subsidies, out-of-pocket spending, ana Vietnam Social Security (VSS), which reimburses only part of the provider's costs amounting to 13% of health care spending (Nguyen et al., 2012). In addition to the SHI program, a fee-for-service program also exists for the uninsured. The issue with the feefor-service program, however, is that it can charge individuals for services that might be unnecessary or leave others without access if they cannot pay. With the passivity of the VSS method of paying for healthcare provider costs, under-developed information tracking systems for patient records, and the lack of a system in place to check for unqualified providers that charge, large sums of money can be diverted to illegitimate sources and unregistered providers (Lieberman & Wagstaff, 2009). Healthcare providers gain more independence with less governmental supervision in tneir practice while patients struggle with the bulk of healthcare payments. And with the set system of prices for procedures, exams, and treatments in Vietnam, those who can afford such services are able to receive treatment while those who cannot afford to do so are turned away.

HIV Testing and Treatment in Vietnam

Testing and treatment for HIV/AIDS in Vietnam is difficult to access for the common citizen mainly due to cost, an accessibility issue posed as a result of insurance reform ((Nguyen et al., 2012). Most patients are not actively or adequately treated for HIV infec- tion or AIDS but are being treated through palliative care measures for the symptoms they face such as fever, diarrhea, night sweats, myalgias, weight loss, shortness of breath, anemia, and ascites (Smeltzer, Bare, Hinkle, & Cheever, 2010). Along with these symptoms, severe psychological stress is experienced by HIV-positive individuals who feel as though they are seen negatively by others (Hanh, Rasch, Chi, & Gammeltoft, 2009).

Guidelines were developed through the National Guidelines on Palliative Care for Cancer and AIDS Patients program which provided training sessions to teach health care providers to better approach and manage patients that suffer from HIV/AIDS (Krakauer, Ngoc, Green, Kham, & Khue, 2007). The Ministry of Health of Vietnam was funded by the President's Emergency Plan for AIDS Relief (PEPFAR) to create guidelines for palliative care, covering topics such as basics of ethics and medical principles. Programs created to educate trainers on HIV were conceived to help physicians, doctors, nurse investigators, and members of HIV /AIDS peer support groups to treat and teach their own patients through palliative medicine curricula designed in part by Harvard Medical School Center for Palliative Care (Krakauer, Cham, & Khue, 2010). It is in the context of both the progress of healthcare and current strategies to address the HIV epidemic in Vietnam that both students and faculty undertook a research study to explore challenges and solutions at a variety of levels and types of care. …

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