Vietnam: Below the Surface of Ecomomic Transformation - Rapid Social Change and its Influence on the HIV/AIDS


Bettina Schwind

Since the opening-up of the economy in 1986, vast and unprecedented changes have taken place in Vietnam. Its achievements in liberalising its economy have been acknowledged with Vietnam's accession into the WTO in January 2007. But what is beneath this well-planned and organised surface of rapid economic liberalisation?

The economic transformation certainly has contributed to the overall wellbeing of the population as a whole, while simultaneously fuelling rapid changes in Vietnamese society. Along with an ever-increasing mobility of goods and people, Vietnam's economically attractive and booming urban centres have grown significantly. It is here that the social consequences of the transformation process are most apparent. A deepening of social disparities has, amongst other consequences, contributed to the intensification of prostitution and the use of illicit drugs, adding to the spread of HIV/Aids.

The first official diagnosis of HIV/Aids infection was in the early 1990s in Ho Chi Minh City. Since then the rate of infection has been on the rise and today HIV/Aids has been detected in all 64 provinces. While in the early phases of the epidemic injecting drug users and female sex workers were affected in higher proportions, the epidemic has now reached the general population. Today an estimated 260,000 Vietnamese are living with the virus. Most of these are men, with the majority being less than 29 years old. Nonetheless, a growing number of infections in females have been registered in recent years due to an increasing rate of infection resulting from sexual transmission. Those men in particular who visit commercial sex workers play a crucial role in either spreading or preventing HIV/Aids and, hence, may be identified as 'bridging elements'.

Their key role is depicted in a current media campaign launched by the Ministry of Health. This campaign seeks to promote a new social norm - 'Live like a real man' - portraying men that consciously decide against engaging in commercial sex, reflecting the nations' on-going liberalisation of attitudes towards sex education and HIV/Aids.

Earlier preventive programmes and HIV/Aids information campaigns predominantly targeted injecting drug users and commercial sex workers, both seen as purveyors of the 'social evils' of Vietnamese society - a term that reflects the long-standing attitude that recourse to drugs and prostitution is acting against moral and traditional customs. Decaying street signs can still be seen within the old quarter of Hanoi drawing upon these attitudes by displaying the outlines of a naked woman with the words HIV/Aids. Thus, female commercial sex workers are blamed for spreading HIV/Aids, while high-risk men are implicitly understood - rather misleadingly - as being seduced and therefore victimised and, thus, as playing a passive role in the spread of the disease.

However, the opposite is the case. It is a quite common feature of male behaviour in Vietnam to seek sex outside of marriage. This is perceived as a form of entertainment and even a 'business' activity, as well as part of 'being a man'. It is not seen as acting against family values, despite the common perception that 'family' is regarded as the core entity of Vietnamese society. Building and protecting the family is a female responsibility, with women being regarded as the virtuous protectors of familial harmony. Men who are actively involved with their families are admired, but they are not required to be so. Therefore, the behaviour of high-risk men in succumbing to worldly pleasures is regarded as normal, whereas women are expected to show forgiveness and understanding towards their husbands. By contrast, women face the prospect that wrongdoing will lead to punishment and rejection by their spouses.

For these reasons, a gender-based difference in the care of those infected with HIV/Aids may also be identified. While sero-positive men are often cared for by their families, women face abandonment and negligence by their families due to their 'misconduct'.

Overall, stigmatisation of those infected with HIV/Aids is still a widespread phenomenon that is closely intertwined with the 'social evils' standpoint. For example, families of sero-positive persons fear to acknowledge the infection openly, being anxious concerning possible mistreatment and isolation by society - at their work places and with their children facing rejection at school. Those working with HIV/Aids patients often choose not to state this publicly in the fear of being shunned.

However, a commitment to changing attitudes and behaviour in relation to sex education and AIDS prevention is gradually taking effect. This is reflected in the new law on HIV/Aids prevention and control that came into effect 1 January 2007. Its aim is to enhance the rights of those infected with HIV/Aids and to reduce stigmatisation. The law also sets out the inclusion of antiretroviral drug treatment within the existing health insurance structure and, hence, is a major step forward in fighting the epidemic.

WATCHPOINT: The realisation of the potential benefits of this new law still lies ahead. Will it help to change behavioural attitudes, social norms and taboos that are deeply rooted in Vietnamese society, thereby removing some of the obstacles in the fight to stem the spread of HIV/Aids?


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