Tuesday, May 10, 2011

Vietnam: Compulsory treatment centres “counterproductive on every single level”

Photo: Brendan Brady/IRIN

HANOI, (IRIN) - International health experts criticize Vietnam’s estimated 70 compulsory drug treatment centres.

The centres are part of a government strategy aimed at "correcting the illegal behaviours of drug use and sex work”, according to UNAIDS.

They are believed to hold 20,000-70,000 drug addicts and/or former sex workers, said a Hanoi-based health expert familiar with Vietnam’s drug treatment procedures.

Vietnam’s compulsory treatment centres “are counterproductive on every single level,” said Simon Baldwin, a former senior technical officer for HIV and drugs, at the US NGO Family Health International, which is working on drug treatment in Vietnam.

More than 90 percent of injecting drug users held at these centres relapse into drug addiction upon release, according to UNAIDS.

Beneficiaries at the centres, which began opening in the mid-2000s, are supposed to receive counselling, health checks, and vocational training to assist recovery and prevent relapse. But according to health experts, employees are not trained to treat drug addiction, and the fear of being sent to the centres encourages drug users to go underground.


When Vietnamese heroin addicts leave compulsory treatment centres, they face a “palpable and substantial” societal stigma against drug use, said Robert Ali of the World Health Organization’s (WHO) Collaborating Centre for Research into the Treatment of Drug and Alcohol Problems.

Vietnam has made significant drug policy reforms since the mid-1990s, but most Vietnamese citizens and officials still see drug addiction as a “moral weakness” or “social evil” rather than a medical disease with a social dimension, Ali said.

Health experts say compulsory treatment centres coupled with widespread social stigma around drugs make it difficult for outreach workers to access the most vulnerable drug-user populations.

“The people who use drugs are a very marginalized and vulnerable population,” said Ali. “One of the challenges for Vietnam is recasting and understanding what drug addiction is and being more accepting of people in the [drug-using] community.”

Nguyen Thi Huynh, former chief of the Harm Reduction Department, Vietnam Administration of HIV/AIDS Control, said tolerance for drug addiction in Vietnam had improved over the last 20 years as a result of government interventions: “We have done a lot of outreach on television programmers, and the understanding of Vietnamese citizens about HIV and drug-use issues has changed a lot. The stigma is not as bad as it was before.”

Methadone clinics opened

In the shadow of its controversial compulsory treatment centres, Vietnam has since 2008 opened 13 methadone clinics for heroin addicts.

The clinics will not replace the treatment centres but health experts hope Vietnam will move away from the compulsory treatment model towards a holistic drug treatment model which includes voluntary methadone treatment.

Methadone, a substitution therapy used to treat opioid dependence, helps assuage withdrawal symptoms for heroin addiction and prevent the spread of HIV among injecting drug users.

“Methadone treatment in Vietnam appears to be modelled on best practices,” said WHO’s Ali. “Individuals can determine whether they want to be in treatment, and they’re provided with good clinical support and guidance.”

Health experts commend Vietnam’s methadone clinics as a positive step forward in drug-treatment policy, but the government’s motives for introducing the clinics remain controversial.

“The government has rolled them out more out of concern over HIV/AIDS than for the lives of drug users themselves,” said a Hanoi-based methadone expert who preferred anonymity.

Roughly a quarter of a million people are HIV-positive in Vietnam, and the figure is rising, according to a 2010 presentation by Kevin P. Mulvey, a substance abuse treatment adviser at the US embassy in Hanoi. Health experts say Vietnam’s rate of HIV infection among injecting drug users, which UNAIDS reports is 57 percent, is among the highest in South Asia.

Vietnam’s methadone clinics receive support from the US President's Emergency Plan for AIDS Relief (PEPFAR).

More than 2,000 patients were receiving methadone treatment across Vietnam in September, according to a 2010 presentation by Nguyen Thi Minh Tam, deputy head of the Harm Reduction Department, Vietnam Administration of HIV/AIDS Control.

Roughly 80,000 patients will receive methadone treatment at a minimum of 245 sites by 2015, according to a November decree by the Vietnamese health minister, Nguyen Quoc Trieu.

Hong Kong and Thailand implemented methadone treatment programmes in the 1970s. China and Malaysia followed suit in the mid-2000s, and Cambodia opened a pilot methadone clinic in September.

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