CONSENSUS REPORT ON STI, HIV and AIDS EPIDEMIOLOGY: VIET NAM
Executive Summary Introduction Objectives and Methods Epidemiology of HIVISTI in Viet Nam HIV/AIOS estimation and projection in Viet Nam Conclusions and Recommendations Annexes
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2
3 4 14
20 22
2000
ABBREVIATIONS AND ACRONYMS
AIDS ANC
acquired immuno deficiency syndrome antenatal clinic attendees behavioural surveillance survey Centers for Disease Control and Prevention cytomegalovi rus female sex workers hepatitis
ass CDC CMV
FSW HBV HIV HPV HSS HSV HTLV-1 IDU lEe
a virus
human immunodeficiency virus human papillomavirus HIV sentinel surveillance herpes simplex virus human T-celllymphotropic virus injecting drug users information, education and communication Ministry of Labour, War Invalids and Social Affairs men who have sex with men nongovernmental organization sexually transmitted disease sexually transmitted infection sex workers Joint United Nations Programme on HIV I AIDS United Nations Development Programme
MOL/SA
MSM NGO STO STI SW UNAIOS UNOP
EXECUTIVE SUMMARY From the first reported HIV case in 1990 to 31 December 2000, a total of 32 359 HIV infections, 4728 AIDS patients and 2510 AIDS-related deaths were reported from all 61 provinces in Viet Nam. About 63% of reported HIV infections were among injecting drug users (IDUs). The majority of reported HIV cases were males (85%). HIV sentinel surveillance has been established in Viet Nam since 1994. Twenty provinces are included in the sentinel surveillance system. Findings show an overall increasing trend in HIV prevalence among most of sentinel groups: IDUs, female sex workers (FSWs), sexually transmitted infection (STI) patients, tuberculosis patients, pregnant women and military recruits. In 2000, HIV prevalence rates were found, on average, to be 24% among IDUs, 3.5% among FSWs, 1.4% among STI patients, almost 1% among military recruits, and 0.08% among pregnant women. HIV prevalence rates among FSWs, STI patients and pregnant women in southern regions were usually higher than in other regions. The southern and central regions had high prevalence rates among IDUs. However, since 1997, some northern provinces, bordering China, have recorded an increasing epidemic among this population. Limited data on STI prevalence have been available in recent years. On the basis of available data, the number of HIV infections was estimated to be 104 000 (rangingfrom 91 000 to 117000) in 1999. The Study Group projected that there would be 122 350 current HIV infections, ranging from 107000 to 137000, in 2000, and that about 4800 new AIDS cases would be found in 2000, and 11 500 in 2005. Although HIV infection rates are highest among IDUs, the majority of estimated HIV infections in 2000 are among heterosexuals (about 81%). The HIV epidemic among IOU populations is well established. There are some indications that HIV prevalence is increasing among some FSWs groups in the southern regions. It is recommended that more efforts should focus on strengthening the surveillance system of HIV / AIDS/STI in which sentinel groups need to be monitored more consistently over time at selected sites, simultaneously with HIV / AIDS prevention activities. .
Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
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INTRODUCTION
HIV I AIDS infection has become a serious health issue in Viet Nam. Since the first HIV positive case was detected in Ho Chi Minh City in December 1990, the HIV/AIDS epidemic has been developing rapidly. The HIV I AIDS estimation and projection programme was started relatively early in Viet Nam. In 1990, experts from the United Nations Development Programme (UNDP) carried out an estimation and projection activity and declared an estimated figure of 570 000 HIV infections by the year 2000. In 1993, the World Health Organization estimated that HIV infections would be around 350 000 in 2000. However, due to a shortage of serology surveillance data at that time, studies on HIVI AIDS prevalence patterns showed inaccurate projections. In 1998, the Ministry of Health (AIDS Division) conducted an HIV/AIDS estimation and projection exerdse. The HIV surveillance system was well-monitored and suffident data were collected to enable the Ministry of Health and the World Health Organization to estimate that there would be 135 000 HIV I AIDS cases by the year 2000. In order to estimate and project HIV I AIDS infections from 2001 to 2005 for the 5-year AIDS prevention plan, the Ministry of Health, with the relevant national sectors, technical institutes and international organizations, implemented an HIV I AIDS estimation and projection activity for 2001-2005.
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
OBJECTIVES AND METHODS General objectives: (1) to evaluate the STI/HIV I AIDS infection situation and trend; (2) to reach a consensus on STIIHIV/AIDS estimation in 1999, and AIDS projection for the period 2001- 2005; and (3) to recommend HIVI AIDS transmission prevention measures. Methodology: • • Collect data (reported STIIHIV I AIDS cases, HIV sentinel surveillance data, population data, etc.). Analyse available data and make an HIV estimation and HIV I AIDS projections prior to the consensus workshop (working group of national experts). Organize a consensus workshop to reach consensus on the current situation, recommend actions, and to disseminate information.
•
Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
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EPIDEMIOLOGY OF HIVISTI IN VIET NAM I. Reported HIV cases The first case of HIV infection was reported in Ho Chi Minh City in December 1990.
Figure 1: Cumulative reported HIVIAIDS infections Viet Ham, 1990-2000 Cases
IJ •
HIV AIDS
...
o
... ...
As of 31 December 2000, 32 359 cumulative cases of HIV infection, 4728 AIDS patients and 2510 AIDS-related deaths have been reported (see Figure 1). The number of provinces reporting HIV I AIDS cases is increasing every year: from 1 in 1990, to 7 in 1992, 30 in 1993 and 57 in 1997. In 1998, HIV was reported in all the 61 provinces of Viet Nam.
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
Figure 2: Cumulative reported HIV infections by risk group Viet Ham, up to Dec. 2000 Blood 1.21%
5.25%
The distribution of reported HIV I AIDS cases, by risk exposure category, is shown in Figure 2. Injecting drug users (IDUs) account for the majority (63.33%). However, the relative proportion of IDUs decreased from 87% in 1993 to 51.5% in 1996 (see Figure 3). In contrast, the proportion of heterosexuals (which include STI patients, female sex workers, women attending antenatal clinics) increased from 5% in 1993 to 10% in 1996.
Figure 3: Relative proportions of HIV-infected IDUs and female sex workers (FSWs) among reported cases by year Viet Ham, 1993-2000 90 80 70 60 50 40 30 20 10 0
_IOUS
. 1993 1994 1995 1996 1997 1998 1999 Dec-OO
_CSWs
Consensus Report on STl, HIV and AIDS Epidemiology: Viet Nam
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About 85.5 % of reported cases are male. The 20-29 year-old age group accounts for 50.4% of reported HIV cases (see Figure 4).
Figure 4: Cumulative reported HIV infections by age group Viet Nam, up to December 2000 % 60 50 40 50.43
30 20 10 0 «13 13-19 20-29 30-39 40-49 >50
Unknoy Age Group
II. Reported AIDS patients
As of 31 December 2000,4728 AIDS cases (WHO definition), including 2510 AIDS-related deaths have been reported (see Figure 5).
%
Figure 5: Reported AIDS cases by year Viet Nam, 1993-2000
1993
1994
1995
1996
1997
1998
1999
2000
Year
(JAIDS death
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
III. Sentinel surveillance of HIV infection: The sentinel surveillance system was established in 1994 in 8 provinces in Viet Nam. It was then expanded to 12 provinces in 1995 and 20 in 1996.
Objectives of the sentinel surveillance programme: (1) to identify the HIV prevalence rate and distribution among selected population groups; (2) to monitor the HIV infection trends among selected population groups; (3) to set up the priorities for intervention activities and resources distribution; (4) to evaluate the effectiveness of interventions; and (5) to project HIV/ AIDS. The 20 provinces retained for sentinel surveillance include Lang Son, Lao Cai, Bac Thai, Ha Noi, Hai Phong, Nam Dinh, Thanh Hoa, Ha Tinh, Hue, Oa Nang, Binh Dinh, Khanh Hoa, Oac Lac, Dong Nai, Vung Tau, Ho Chi Minh City, An Giang, Binh Duong, Can Tho and Kien Giang. The surveillance groups are STI patients, service women and FSWs, IOUs, tuberculosis patients, pregnant women and candidates for military conscription. Each province selects one or two sentinel sites for each target group: STI hospitals and clinics, re-education and rehabilitation centres (for IOUs and FSWs), entertainment venues, tuberculosis hospitals/clinics/centres, obstetric hospitals or family planning centres, and military recruitment offices. Blood collection is voluntary and confidential. The sample size is 400 for high-risk groups and 800 for low-risk groups. This cross-sectional sentinel survey is carried out once a year using the WHO Strategy II for HIV testing.
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The national average of HIV prevalence among IDUs and FSWs has been increasing regularly for the last 6 years, reaching 23.9% among IDUs and 3.5% among FSWs in 2000 (see Figures 6 and 7).
Figure 6: HIV prevalence rate among IDUs national average, Viet Nam, 1994-2000 % 30 25 20 15 10
5
o 1994 1995 1996 1997 1998 1999 2000
Year
Figure 7: HIV prevalence rate among FSWs, national average, Viet Nam, 1994-2000
4
3.5
3 2.5
2 1.5 1
0.5
Ot--r--.---r---.--r---.------. 1994 1995 1996 1997 1998 1999 2000
Year
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Consensus Report on STJ, HIV and AIDS Epidemiology: Viet Nam
A regul.ar increase in prevalence rate has also been observed among STI patIents and tuberculosis patients (Figures 8 and 9).
Figure 8: HIV prevalence rate among STI patients national average, Viet Ham, 1994-2000 % 2
1.5 1 0.5
O+---,---.---r---.-_--.-_--.-_....... 1994 1995 1998 1997 1998 1999 2000
Year
Figure 9: HIV prevalence rate among tuberculosis patients, national average, Viet Ham, 1994-2000 % 2.0 1.5 1
1.71
0.5
o 1994 1995 1996 1997 1998 1999 2000
Year
HIV transmission among low-risk groups, such as pregnant women and candidates for military conscription, has also been tending to increase, reaching 0.08 % among pregnant women and 0.9% among military recruits (Figures 10 and 11) in 2000. Figure 10: HIV prevalence rate among pregnant women, national average, Viet Ham, 1994-2000 % 0.14 0.12 0.1 0.08 0.08 0.04 0.02 0 1994 1995 1998 1997 1998 1999 2000 0.08
Year
Consensus Report on STI, HlV and AIDS Epidemiology: Viet Nam
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Figure 11: HIV prevalence rate among candidates for military conscription, national average, Viet Nam, 1994-2000 % 1
0.95
0.8 0.6 0.4 0.2 0 Year
1994 1995 1996 1997 1998 1999 2000 Surveillance data show that the HIV epidemic varies by area and is evolving. In 1996, HIV infection rates among IDUs in southern and central regions of Viet Nam were relatively high (Figure 12), at 35% in drug treatment and vocational training centers in Ho Chi Minh City, 50% in Nha Trang, and 38% in Da Nang. However, at the end of 1996 and early in 1997, the HIV infection rate among IDUs increased rapidly in some northern provinces bordering China, such as Lang Son and Quang Ninh, where epidemics among IOUs were recorded. The HIV prevalence rate among FSWs in southern regions was higher than in other regions, particularly in the Mekong Delta, and in An Giang (prevalence rate 5%), a border province with Cambodia (Figure 13). Similarly, the HIV infection rates among STI patients and other low-risk population groups in the Mekong Delta provinces along the border were higher than in other provinces (Figures 14, 15).
Figure 12. Trends in HIV prevalence rates among IDUs by region Viet Ham, 1994-2000 % 60 50 ~
.... I
•
, \
40
30 20 10 0 94
•
,
,
- . . - Centre II>
•
Horth South Total
H
95
96
97
98
99
2000
Year
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Consensus Report on STJ, HIV and AIDS Epidemiology: Viet Nam
Figure 13: Trends in HIV prevalence rates amons FSWs by reston, Viet Nam, 1994-2000
• •
North Centre
- -,cl!- - South
)(
Total
94
95
96
97
98
99
2000
Year
Fisure 14: Trends in HIV prevalence rates amons STI patients, by Region % 3. 2.5 2.0 1.5
+--------------,--....---1 +-----------7------1 +---------r=-------r--':'O":::::-------1 __ Nort ___ Centre _...._South __ Tota
Year
Consensus Report on ST/, HlV and AIDS Epidemiology: Viet Nam
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Figure 15: Trends in HIV prevalence rates among pregnant women by region, Viet Nam, 1994-2000 % 0.35 ........_................................_........_................. _._.._ .._.................... - ...\
0.3 0.25-1---------,;:----------j~_i .-_-~NO~R=TH:-:-1 0.2-1-----,------::-"---7-----+~_i
_
CENTR
0.15+----.......!..,.--~---~c_......--'.,._'___1~__i " ".'" " SOUTH _TOTAL
0.1
t-~~_:_-'""-:;r:.::....~=::..,J-1
0.05t-::;;:~::....:.-=~~_=.:::;o.<:~-""... o~~~~~~~
1 Year
__~~-~~L-~-~ 97
94
95
96
98
99
2000
IV. HIV molecular epidemiology Subtype E is predominant in Viet Ham, identified in both FSWs and IDUs. Subtype analysis indicates that 71 out of 72 HIV·1 subtypes in Viet Nam belong to subtype E. HIV·1 main subtypes are genetically similar to those found in Thailand and Cambodia. The comparison between subtypes also suggests that the HIV·1 subtypes in Viet Nam do not differ according to risk behaviour or residence: there is no difference between HIV subtypes in the North (Ha Hoi) and those in the South (Ho Chi Minh City, Hha Trang, Can Tho, An Giang). HIV subtype E, which had been observed previously among sex workers in some studies has recently been found, unexpectedly, among drug users in Asia. In fact, Viet Ham is the first country in which subtype E has been reported as the main subtype among this population group. The reasons for this remain unknown. A study carried out on IDUs about the origin of HIV subtypes suggested that the HIV subtypes found in IDUs in northern provinces, bordering China, are similar to those found in Guangzhou province, China, and that the HIV subtypes in IDUs in southern provinces are similar to those found in Thailand and Myanmar.
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
V. Sexually transmitted infectfons Etiology: Apart from ~IV, Herpes simplex virus (HSV), Hepatitis B virus (HBV), CytomegaloVIrus (CMV), Human papillomavirus (HPV), MCV, and HU':Tlan T-cell lymphotropic virus (HTLV-1) have been diagnosed, while CMV, HTLV-1 have not been detected yet. HSV diagnostic tests are not available and evidence for its presence is based essentially on clinical symptoms. Other causal agents commonly found are: Neisseria gonorrhoea, Chlamydia trachoma tis, Treponema pallidum, Trichomonas vaginalis, and Entamoeba histolytica. No data were available for Mycoplasma hominis, Calymmatobacterium granulomatis, Shigella and Campylobacter. Case reporting: More than 100 000 new cases have been reported annually by the local dermatology centers in recent years (Figure 16). However, as data reporting from health services in both the public and private sectors is incomplete, it is estimated that the real number of newly infected sn patients is many times higher. Moreover, it is known that many patients buy drugs for self-treatment, and that male STI patients usually go to private clinics for diagnosis and treatment, and are thus left out of reports. The 14-49 year-old age group accounts for 96.61%-98.73% of STI patients. The male to female ratios of reported cases are from 1:2 to 1:5. STI patient estimation: Based on available data, it is estimated that there are currently about 1 million cases of STI every year, including 150 000 syphilis cases, 150 000 gonorrhoea cases and 500 000 cases of chlamydial infection. Other STls include trichomoniasis and HPV infection, and total more than 200 000 cases. However, to obtain a more accurate estimation, there is a need to set up a better STI surveillance system~
Consensus Report on STL HIV and AIDS Epidemiology: Viet Nam
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Figure 16: STI cases reported by year Viet Ham, 1976-2000
I/) I/)
G>
as u
'0 ...
.Q
G>
E ~ c
140000 120000 100000 80000 60000 40000 20000 ..-/ 0 !:.~' <M'T"" " i
_ _ Total _ _ Syphilis
___ gonorrhea
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V .... ..,,~
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HIVI AIDS estimation and Projection in Viet Ham I. HIVIAIDS estimation for 1999 Method:
Estimation of HIV prevalence rates in 1999: The provinces were divided into different categories: • In sentinel surveillance provinces, the HIV prevalence rates among target groups (IDUs, FSWs, STI patients, tuberculosis patients, pregnant women and military recruits) of the sentinel surveillance programme were used to estimate the HIV prevalence rate. In non-sentinel surveillance provinces with good case detection and reporting systems, the serological prevalence rates from the case detection system were used if the number of persons tested in each subgroup was more than 50 for high-risk populations and more than 100 for low-risk populations. In the area of non-sentinel surveillance provinces with no data on HIV prevalence, or if the number of persons tested in each subgroup was below 50 for high-risk population and below 100 for low-risk populations, the average HIV prevalence rate for the whole area was applied.
•
•
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
The table in Annex 1 gives an overview of HIV prevalence based on the results of sentinel surveillance. The HIV prevalence rates estimated from sentinel surveillance and case detection systems were used for HIV estimation for each province and for the country.
Estimation of subgroup population sizes for the whole country: • Injecting drug users: The drug users estimation was based on reports from the Ministry of Labour, War Invalids and Social Affairs (MOLlSA) and from the provinces. The IOU rate was based on provincial reports and a survey carried by the MOLISA in 1999. The lowest number of injecting drug users was estimated by multiplying the estimated drug users by the drug injection rate. The highest number of injecting drug users was the number of injecting drug users estimated by the MOll SA. Female sex workers: The lowest number of commercial sex workers was the reported number by the MOLISA. The highest number of commercial sex workers was the number estimated by the MOLISA. STI patients: The STI patient group was estimated from reports from the Central Dermato-Veneorology Institute. The lowest number was the reported number. The highest number equaled the reported number multiplied by 7. Data on the population aged 15-49 were taken from the population survey (4/1999) by the Bureau of Statistics.
•
•
•
Consensus Report on STL HIV and AIDS Epidemiology: Viet Nam
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Estimation of HIV cases: HIV-infected cases in each group = HIV prevalence rate of each group multiplied by the estimated population size of each group. The estimated number of HIV infections is the total of the four estimates among the four groups indicated above. Results: HIV infection estimation among IDUs:
According to the Ministry of Labour, War Invalids and Social Affairs (MOLlSA), in 1999 there were 98 000 reported drug users, and the Ministry estimated the total number of IDUs as 128 000. According to a study by the MOll SA, about 35% of the total number of drug users were IDUs in most of the regions. This rate, however, was considered low. The Study Group, therefore, used the estimated rate reported from the provinces to the AIDS Committee of the Ministry of Health. As the proportion of IOUs to total drug users varied among regions, the Study Group divided the provinces into different drug-use patterns: northwestern provinces with low rates of injecting drug use (about 35-40%); and the other provinces with a high rate (80%). Based on the HIV prevalence rate among IOU and the injection rate among all drug users reported from the provinces, the number of cases of HIV infection was estimated to be 16000 among IDUs. If all the drug users were assumed to inject drugs, the total number of HIV infection cases among drug users would be estimated to be 24000. HIV infection estimation among FSWs:
According to the MOLlSA, the total number of reported female sex workers was 13 600 nationwide in 1999. However, this was considered to be a low estimate. Acknowledging that sex work is increasing in Viet Nam, the MOLISA estimated that the real number of female sex workers nationwide was at least 40 000. On this basis, it was estimated that, in 1999, there were 900 to 3500 cases of HIV infection among FSWs.
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Consensus Report on STL HIV and AIDS Epidemiology: Viet Nam
HIV infection estimation among STI patients:
As reported by the Vietnamese Dermato-Veneorology Institute, there were 120 000 STI cases reported nationwide in,1999. Based on the HIV prevalence rates among STI patients and the estimated STI population, it was estimated that there were between 2600 and 18000 HIV-positive STI patients.
HfV infection estimation among the 15·49 year-old age group: The prevalence rate among this population remains at the very low level of 0.08%, but the population size is high. According to the population survey in 1999, the population aged 15-49 in Viet Nam was 40 602 960, with a male/female ratio of 1:67. On this basis, it was estimated that there were 34 500 HIV-infected males and 36 500 HIV-infected females in 1999.
Estimation of total HIV infections: According to the above-mentioned estimation for each subgroup, 104 000 cases of HIV infection, with a range of 91 000 to 117 000, were estimated in 1999 (Table 1).
Table 1: Estimates of HIV infections in Viet Ham, by the end of 1999 Population Heterosexual IOU Total Low Intermediate High
75,000 16,000 91,000
84,000 20,000 104,000
93,000 24,000 117,000
II. HIV/AIDS projection up to 2005 using EPIMODEL BaSing on the different HIV prevalence trends for the groups studied, the Study Group ran EPIMODEL separately for injecting drug users and heterosexual populations, with the assumption that the HIV transmission level through injecting drug use is at a high level, and that heterosexual transmission is still at a low level (see Annex 2 on the parameters used for these projections). It was projected that there would be 122 350 new HIV infections, ranging from 107000 to 137 000, in 2000, and that about 4800 new AIDS cases would be found in 2000, and 11 500 in 2005 (see Tables 2-3; Figures 17-18)
Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
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Table 2: Projection of HIVIAIDS in Viet Ham, by the end of 2000 ..
Population Heterosexual • low • high IDU
Cumulative HIV 97.000 120.600 21.000 31.700 118.000 152.300
Current HIV infections 87.000 107.500 20.000 30.200 107.000 137.700
Cumulative AIDS
Cumulative Deaths 8.700 10.800
10.600 13.100
low high Total • low • high
• •
1.000 1.500 11.600 14.600
750 1.100 9.500 11.900
Table 3: Projection of AIDS in Viet Ham, by the end of 2005 Population Heterosexual • low • high IDU low high • Total • low high Cumulative AIDS 43.300 53.600 8.400 12.600 51.600 66.200 Cumulative Deaths 39.300 48.700 7.400 11.100 46.700 59.800
• •
Figure 17: Annual new AIDS cases, 2001 to 2005
2000
2001
2002
2003
2004
2005
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Consensus Report on STL HlV and AIDS Epidemiology: Viet Nam
Figure 18: Annual new AIDS-related deaths, 2001 to 2005
2000
2001
2002
2003
2004
2005
III. Limitations of estimation and projection Although the input data for HIV infection estimation in Viet Nam in 1999 were more accurate than in the 1998 estimation, there were limitations: The reported numbers on sizes of the studied population groups, such as IDUs, FSWs (provided by the MOLlSA) and STI patients (from the Dermatology Institute), could not reflect the actual number. There was bias in sample selection and reporting of sentinel surveillance. In some areas, prevalence rates have been estimated from case , detection with small sample sizes. Data on the progression rate from asymptomatic HIV to AIDS in Vietnamese HIV-infected cases were not available. There were no data on the prevalence rate among rural pregnant women, although the majority of the Vietnamese people live in rural areas. Therefore, data estimated using this projection model must be re-
examined and adjusted regularly, when supplemental data become available.
Consensus Report on STl, HIV and AIDS Epidemiology: Viet Nam
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CONCLUSIONS AND RECOMMENDATIONS I. Conclusions 1. Based on the estimated 104 000 (range: 91,000-117,000) HIV infections in 1999, it was projected that there would be 122 350 (range: 107,000·137,700) current HIV infections, 4800 new AIDS cases and 4100 new AIDS-related deaths in 2000. By the year 2005, the MOH projected that there will be about 11 500 annual new AIDS cases and 11 000 deaths due to AIDS. Although the majority of estimated HIV infections are among heterosexuals (due to the large size of sexually active population), the dominant transmission pattern observed is among IDUs. It is estimated that Viet Nam will reach an epidemic peak in 10 years' time, and HIV/AIDS prevalence will continue to increase. The northern provinces face the risk of HIV booming among IDUs and a new wave of HIV infections will occur in southern provinces among new IDUs. HIV transmission through heterosexual contact is expected to be predominant in southern provinces. Although HIV transmission is documented, it is still at an early stage in Viet Nam. This is a suitable stage for planning and implementing HIV/AIDS transmission prevention and control activities.
2. 3.
4.
II. Recommendations For further effident prevention of the spread of the HIV I AIDS epidemic and more accurate estimation of the HIV I AIDS trend, the following recommendations are made: 1. More effort should be put into strengthening the surveillance system for HIV I AIDS/STI, simultaneously with AIDS prevention and control activities, such as monitoring the sentinel groups more consistently over time at selected Sites, implementing periodic behavioural surveys, and establishing an AIDS monitoring system to enhance AIDS treatment
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
2.
Systematic evaluation studies on HIV / AI DS/STI epidemiology in Viet Ham should be developed, along with expansion of HIV/ AIDS surveillance to the countryside, to provide a more general picture on epidemiology of HIV / AIDS in Viet Ham. Interventions should focus on the three groups at highest risk: IDUs, FSWs and STI patients. Information-education-communication (IEC) measures should be continued, focusing on the grassroots level and pushing forward the engagement of the health care system and other relevant ministries and sectors in interventions.
3.
4.
Consensus Report on STL HIV and AIDS Epidemiology: Viet Nam
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ANNEX 1
Aggregated rate, median rate and range of HIV prevalence rates in 20 sentinel provinces in Viet Ham, 1994-1999.
1994 IDUs Number of provinces Aggregated rate N positivelN. tested 95%CI Median Range Number of provinces Aggregated rate N positiveIN. tested 95%CI Median Range Number of provinces Aggregated rate N positivelN. tested 95%CI Median Range Number of provinces Aggregated rate N positivelN. tested 95%CI Median Range 7 18.25
1995
1996 19 9.40
1997 20 13.35 100917558 12.58-13.12 5.34 0-68.559 20 2.60
II 14.81
1998 20 16.92
1999 20 20.46
774/4240 17.0-19.4 1.84 0-33.07 7 0.59
592/3996 13.7-15.9 1.20 0-43.59 11 4.03
757/8050 8.76-10.0 4.66 0-50.77 20 0.90
1415/8362 16.12-17.72 13.12 0-85.0 20 2.44
486019093 16.0 0-75.8 20 3.77
FSWs
24/4059 0.36-0.82 0.50
54/5241 0.76-1.30 0.00 0-4.80 II 0.34
74/8148 0.69-1.1 1 0.61 0-4.09 19 0.38
120/4609 2.14-3.06 0.4 0-12.14 19 0.60 47n850 0.43-0.77 0 0-3.57 20 1.16 129111100 1.09-1.23 0.25-7.84
18317498 2.09-2.79 0.75 0-14.66 20 0.94 6116494 0.70-1.16 0.00 0-6.03 20 0.98
259/6864 1.5 0-6.5 20 1.64 10816567 0.99 0-1.98 20 1.19 9117619 0.75 0-3.75 20 0.08 13/16172 0.00 0-0.38
0-2.75 8 0.46
STI patients
30/6518 0.30-0.62 0.28 0-1.00 7 0.56
2617559 0.21-0.47 0.00 0-1.32
40/10445 0.26-0.50 0.15 0-1.32 19 0.45 52111553 0.33-057 0.00 0-1.39
TB patients
25/4427 0.34-0.78 0.20 0-0.13
12 0.58 3115312 0.38-0.78 0.46 0-1.92 12 .07
7517424 0.76-1.20 0.63 0-11.82 20 00.08 12/14853 0.04-0.12 0.00 0-1.88
Pregnant Women
Number of provinces Aggregated rate N positiveiN. tested 95%CI Median Range
8 0.02 211147 0-0.07 0.00 0-1.03
9/13586 0.03-0.11 0.00 0-0.38
19 0.04 1121491 0.02-0.08 0.00 0-0.19
20 0.12 22118119 0.07-0.17 0.00 0-1.22
Military Recruits
Number of provinces Aggregated rate N positiveiN. tested 95%CI Median Range
0.00 -
3 0.00 0/2715
7 0.03 2/5942 0-0.07 0.00 0-0.15
16 0.04 7117098 0.01-0.07 0.00 0-0.22
20 0.13 22/17041 0.08-0.18 0.00 0-1.38
20 0.15 25116540 0.\1-0.21 0.12 0-1.88
20 0.41 59/14407 0.13 0-2.5
Aggregated rate - sum of HlV -positive subjects divided by sum of all subjects tested in all sentinel provinces. Median rate = the middle point of the range of prevalence rates in all provinces.
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Consensus Report on STJ, HIV and AIDS Epidemiology: Viet Nam
ANNEX 2
Parameters used for projections
Viet Nam is still at the stage where the epidemic focuses on high-risk groups. Based on experience and available data about HIV I AIDS transmission, the Study Group dedded to select the following parameters to apply in EPIMODEL: • • • • The year when extensive spread of HIV transmission started: 1993 Estimated number of HIV infections in 1999: highest - 117 000; lowest - 91 000 Continuing transmission of HIV prevalence after 2000. The'mean progression rate from HIV to AIDS: 10 years.
Therefore: • • • Position of heterosexual transmission group on HIV epidemic curve in 1999: 242 The shape of the HIV prevalence curve: expo 5 The average time for the progression from HIV to AIDS: 10 years + Yearly increase rate of 1% + It is projected to reach a peak in 2010
And: • • • The position of the IOU transmission group on the epidemic curve in 1999: 280 The shape of the HIV prevalence curve: gamma 5 The average time for the progression from HIV to AIDS: 10 years + Yearly increase rate of 6% + The prevalence rate will be 40% in 2005 + It is projected to reach a peak in 2010
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ANNEX 3 List of experts on the HtV/AtDS estimation and projection t. Vietnamese experts (Study Group in Viet Nam): 1. Dr Tran Chi Liem, Vice-Minister of Health, Chairman, AIDS Division, Ministry of Health 2. Dr Trinh Quan Huan, Director, Department of Preventive Medicine, Vice-Chairman, AIDS DiviSion, Ministry of Health 3. Professor Hoang Thuy Long, Director of the National Institute of Hygiene and Epidemiology (NIHE), Chairman, HIVI AIDS Surveillance Subdivision 4. Associate Professor Chung A, Director of AIDS Standing Bureau, Vice-Chairman, AIDS Division, Ministry of Health 5. Associate Professor Pham Van Hien, Director, National Institute of Dermatology and Venerology (NIDV), Chairman, STD Subdivision 6. Professor Le Dang Ha, National Institute of Clinical Research and Tropical Diseases (NICRTD), Chairman, AIDS Treatment Subdivision 7. Professor Nguyen Cong Khanh, Director, NIC, Chairman, Children Subdivision 8. Professor Do Trung Phan, Director, National Institute of Haematology and Blood transfusion (NIHBT), Chairman, Blood Safety Subdivision 9. Professor Ha Ba Khiem, Director, Ho Chi Minh Pasteur Institute 10. Dr Nguyen Duc Vy, Director, National Institute of Mother and Child Health Care (NIMCHCP), Chairman, Mother-Newborn HIVI AIDS Prevention Subdivision II. Dr.Trinh Thi Le Tram, Vice-Director, Legislation Department, Chairwoman, HIV/AIDS Legislation and Policy Subdivision. 12. Professor Duong Dinh Thien, Hanoi Medical College 13. Professor Dao Dinh Duc, NICRTD 14. Professor Bui Dai, 108 Hospital 15. Dr Nguyen Tran Hien, Vice-Director of Public Health Department, Hanoi Medical College. 16. Dr Nguyen Thanh Long, AIDS Division, Ministry of Health 17. Dr Dinh Sy Hien, Vice-Director, Nha Trang Pasteur Institute 18. Dr Nguyen Van Kinh, AIDS DiviSion, Ministry of Health 19. Dr Pham Duc Manh, AIDS Division, Ministry of Health 20. Mr Tran Viet Trung, Ministry of Labour, War Invalids and Social Affairs 21. Mr Nguyen Van Khanh, Ministry of Labour, War Invalids and Social Affairs 22. Dr Nguyen Ngoc Bau, Ministry of Defence 23. Dr Nguyen Thanh Lam, MOl 24. Mr Bui Duc Thang, NIHE 25. Mr Nguyen Anh Tuan, MPH, NIHE 26. Ms Pham Kim Chi, NIHE 27. Dr Duong Cong Thanh, NIHE 28. Dr Phan Thu Huong, AIDS Division, Ministry of Health 29. Dr Nguyen Minh Tam, AIDS Division, Ministry of Health 30. Dr Nguyen Duy Hung, NIDV 31. Dr Pham Minh Phuong, NIDV
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Consensus Report on STI, HIV and AIDS Epidemiology: Viet Nam
II. International experts 1. 2. 3. 4. 5. 6. Professor James Chin - WHO Dr Dominique Ricard - WHO Dr Tim Brown, PhD - UNAIDS Dr Jessus Maria Garcia Calleja· UNAIDS Dr Cyrie Pervilhae - UNAIDS Geneva Dr Laurent Zessler- UNAIDS Viet Nam
Consensus Report on STL HW and AIDS Epidemiology: Viet Nam
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