Thi Pruitt and Dr. Hala Madanat, Health and Human Performance
East Asia is the fastest growing region of the world. Its average annual growth income has ranked top-of-the-world for the past three years. In addition to economic development, East Asia is now also the world’s home for some of its fastest growing AIDS epidemics. Approximately 31,000 children under age 15 are living with HIV and AIDS and there were 11,000 new infections in 2005—an average of 30 children infected per day. Not different from its region, between 1990 and 2005, Vietnam has reported 104,111 HIV infected cases. About 12,000 to 15,000 newly infected HIV patients were reported annually. However, due to logistical problems and deeply held cultural prejudices, these numbers are woefully underreported. Therefore the problem in East Asia is assuredly far worse than currently understood. This study targeted children infected and affected by HIV and AIDS through two methods: 1) Working directly with at risk children and their families, and 2) through policy makers developing policies to protect children and educate the public.
The project was set up under the direction of Save the Children United Kingdom (SCUK) which currently conducts research on, and gives aid to, families with children infected and affected by HIV and AIDS. The ground work was implemented by our two partners, the Ho Chi Minh City (HCMC) Committee for Population, Family and Children and the local government. As a member of the SCUK HIV and AIDS team, I attended meetings with our partners on a monthly basis. Most meetings focused on training, raising awareness and advocating about children and HIV and AIDS in the Vietnamese government.
At the beginning of 2006, the project doubled in size with the addition of three more districts within HCMC. Our team conducted a needs assessment training, in which we trained local government workers from the new districts how to conduct interviews and collect data. Later, SCUK reviewed and analyzed the gathered data to help create appropriate objectives and gain funding for the new sites. Using the information gathered at this training, we created program and budget plans for both the old and new areas according to each district’s future potential and past achievement. The plans for all sites were quite similar except for two districts, where unique activities were designed particularly to benefit their target audience.
Together with the HIV and AIDS Team, I supervised an all-day Project Activities Planning Workshop. At this meeting, each district had the opportunity to create an action plan as well as a tentative budget for the new year. We helped our partners set goals and create activities focused on HIV and AIDS infected and affected children and their families. Some districts came up with great ideas, although it was quite a challenge to remind them to keep their objectives realistic. We also attended the Annual Project Review Meeting of each district to record and evaluate their accomplishments as well as any unfinished tasks of the past year.
Besides working with policy makers, team members also traveled to project sites where we visited children in the project and their family members. Social and self-discrimination towards individuals with HIV/AIDS is a serious problem in conservative eastern societies like Vietnam. It prohibits them from attending school, establishing friendships with neighbors and extended family members, taking care of themselves in the home and developing self-esteem. Therefore meeting with the children and their parents is one way to help create trust, make individuals feel welcome, and guide them to overcome personal turmoil and social stigma. We invited HIV and AIDS infected and affected children and their care-takers to a monthly playgroup, where the children could play together, and the adults had the opportunity to share their thoughts and feelings and receive support from others in the same situation. These playgroups provided much needed social and emotional support.
The most common mode of HIV transmission in Vietnam is intravenous drug use. Nonetheless, in recent years, prevalence of HIV transmission through unprotected sex is on the rise. This prevalence is climbing rapidly in the big cities and southern provinces. Particularly, in the Mekong Delta Province of An Giang, unsafe sex made up 98% of the total HIV cases. SCUK conducted research to identify the risk of HIV and AIDS in children in this region. I attended the in-depth interviews with the director of the province, local leaders, and children to assess their needs and garnered some very valuable statistics.
In addition to traveling, planning, and attending meetings, I conducted interviews and wrote case studies. Most of the children I interviewed had lost one or both parents due to AIDS. Their personal stories almost always had the same pattern—one parent contracted HIV from drug injection or unsafe sex, and transmitted it to his or her spouse. Infected children were the victims of the mother-to-child transmission. HIV eventually progressed to AIDS. The parents died of opportunistic diseases, leaving their children behind as orphans. Grandparents or close relatives became the care-takers of the kids after the loss of both father and mother. Often neighbors also helped if no grandparent or relative was alive. These tragic stories, no longer rare in Vietnam, are the consequence of little education and no prevention.
Overall, the project was successful. The collected result was significant, and has marked a great impact on my personal experience. The only problem arose was I did not have enough time to write five case studies as planned. Instead, I was only able to finished three case studies. Further, this project with SCUK focused on children’s current situations. A longitudinal study following these children would complement this study and greatly improve our understanding of how HIV/AIDS truly affects those children whose families are so afflicted by it.
East Asia is currently experiencing a boom in HIV/AIDS cases as it grapples a boom economically and children bear the brunt of this epidemic’s long term effects. My work with SCUK in Vietnam was an invaluable eye-opening experience. I saw a side of public health unable to be taught in classrooms or garnered from internships in the United States. I grew to love those I served and understand clearly how one person’s choice can affect his or her family and love ones. Most of all, I saw that children are thrust into the downward spiral that leads to HIV/AIDS infection through social stigma, lack of education and health care, and poor parental choices. I was a part of much to help elucidate and alleviate this depressing situation, but there is so much more to be done.