19 Oct 2015
The role of civil society in the response to HIV is growing

Vietnam inaugurated its first non-governmental principal recipient with the signing of its HIV grant in September 2015. A voluntary umbrella organization of non-governmental or semi-autonomous organizations operating in various science and technology fields, the Vietnam Union of Science and Technology Associations (VUSTA) was appointed PR after serving four years serving as sub-recipient under the Vietnam Authority on AIDS Control.    

Designation as the civil society PR provides a more advantageous platform – closer to the policy sphere of Vietnam – from which VUSTA can continue the pioneering work in the fight against HIV which it began while serving as an SR.

“Things are changing in Vietnam for the benefit of those are risk, including men who have sex with men, sex workers and persons who inject drugs”, said Olivier Cavey, Vietnam’s fund portfolio manager. “Civil society groups and the government are now cooperating to reduce new infections and, as confidence and trust are being built, we should see soon an increased impact.”

Civil society in Vietnam face great challenges in their participation in the HIV/AIDS response. The largest hurdle is legal registration, a pre-requisite for attracting steady financing and resources, as well as for increasing institutional capacities. It is often said that civil society organizations face a “Catch-22”: Without funds and an established presence, it is difficult to qualify for registration, yet groups need to register in order to raise funds and set up an office. Many community-based organizations and CSOs credit their successful launch to technical guidance from VUSTA on how to navigate a complex legal environment.

Other obstacles include limited organizational capacity and accountability, and the lack of a clear and consistent legal framework for CSOs. While many organizations have made significant contributions even without legal registration or external funding – legal status, proper remuneration and benefits would help to ensure civil society’s full integration into the health care system.

VUSTA’s appointments, first to SR and now to PR, are a political and practical boost for CSOs to address these obstacles. The platform provided them via VUSTA and the resources from the Global Fund strengthen them and expand their activities, thereby enabling them to play their rightful, critical role in the HIV response.

As PR under the NFM, VUSTA now has a more active role in the planning and implementation processes. It will provide CSOs with ongoing capacity building such as training courses, and infrastructure and hardware support, enabling them to mobilize the HIV response. The continuum of HIV services for key affected populations will be expanded from 10 to 15 provinces, implemented by VUSTA’s network of 90 CBOs – including networks of female SWs, MSM and PWIDs – working under three SRs.

With sex work, drug use and homosexuality considered social evils (the first two are illegal), HIV and the behaviors associated with it are highly stigmatized. VUSTA engages civil society in efforts to address stigma and promote an enabling environment for KAPs. Among such efforts are large-scale communication and community events, as well as small outreach sessions that have significant reach, to build legal literacy. Armed with information, financial support, and a platform, CSOs and CBOs can then collectively negotiate consistent prevention and control policies.

“Opening [drop-in centers], and providing capacity building and channels for dialogue allows us to do something about the injustices against us,” declared another drug user at the Coalition of Coming Home Clubs, a gathering place for injecting drug users, female sex workers and MSM. (VUSTA supported the opening of many drop-in centers.)

These centers also provide rehab and detoxification support, as well as antiretroviral treatment. They operate mobile voluntary counseling and testing clinics during community events and holidays, in order to reach high-risk populations who would otherwise not access STI, HIV or TB services. There are methadone treatment programs, part of a holistic approach to harm reduction that also includes legal support and community-building. Credit services are made available to members, who would otherwise have no access to them due to unstable finances or residence.    

Great strides are had in the policy response to Vietnam’s HIV epidemic, which is increasingly evidence- and rights-based. Examples of policy reforms include legalization of harm reduction programs like syringe and needle exchanges, and amendments to medical insurance policies to cover HIV-related services. This year, the prime minister issued a decree to transform the government-run “rehabilitation” centers – notorious for the brutalities against those detained and forced to undergo hard labor and “treatment” – into community-based treatment facilities over the next five years.    

Before the decree, repercussions from widespread advocacy against the rehabilitation centers included a corresponding increase in violence towards KAPs by local police. Working with its KAP networks, VUSTA leveraged the relationships it developed with policy- and decision-makers to set up seminars with police to promote health messages and to try to mitigate some of the violent crackdowns on SWs, drug users and other vulnerable populations.

Experiences like this increase recognition of civil society’s role and leadership in community-based monitoring of legal rights and social accountability, thereby strengthening the HIV response.     

VUSTA has an operating budget of $6.7 million for the period July 2015 to December 2017. According to one senior officer of the VUSTA project, being engaged in the Global Fund ecology allows CSOs to pool their collective weight to affect service delivery and the policy landscape. With VUSTA’s appointment to PR, it will now be more directly involved in policy advocacy, and civil society will be given a more enhanced role in dialogues with government agencies and international organizations.

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