Since the first person living with HIV/AIDS was identified in Ho Chi Minh City in December 1990 and the first AIDS case was diagnosed in 1993, the HIV epidemic has spread rapidly throughout Vietnam. At the end of 1998, 11,349 HIV and AIDS cases had been reported in Vietnam, including 4,258 cases in Ho Chi Minh City. Female sex workers, and especially intravenous opium users, were among the groups most affected. Since 1995, HIV/AIDS cases among young heroin users and highly mobile populations have been increasing.  The Friend-to-friend programme is successfully promoting self-help activities ion Ho Chi Minh City.

The number of HIV infections in people who are neither intravenous drug users nor sex workers, however, has also increased considerably, and this presents new challenges for HIV/STD prevention. Most HIV/AIDS cases are found in the south of the country and this put a burden on the Ho Chi Minh City AIDS Committee. Building on experiences from other countries in the region, the AIDS Committee successfully implemented such measures as needle-exchange programmes, condom distribution, peer education, outreach activities and established a meeting place, the Café Hy Vong, for female sex workers and intravenous drug users.  From the beginning, the Committee regarded meeting the special needs of people with HIV/AIDS as important prevention activities, and the AIDS Committee encouraged PHAs to discuss their concerns with the committee.

Hospital doctors and rehabilitation centres are required to report all HIV/AIDS cases to the Ho Chi Minh City Preventive Medicine Centre, which then informs the doctor in the respective district. In this way, the medical establishment can provide care at district level. Meanwhile, some PHAs wanted counselling, and they formed the "Friend-to friend" group in October 1995. Until then, the idea of self-help groups was completely unknown in Vietnam. The Ho Chi Minh AIDS Committee gave the Friend-to-friend programme its full support. The group contacts other PHAs and organizes meetings and social gatherings where they can share feelings and experiences, and get information and counselling. The meetings take place every three months, and create close relationships among PHAs.

In collaboration with the Tropical Diseases Centre, Friend-to-Friend members receive training in basic counselling skills, medical care and home-based care in a one-week course with follow up. The HCMC AIDS Committee provides a house where the group meet weekly to review results and exchange ideas and experiences. The members visit other PHAs in their homes to providing them with information, medical and psychosocial care,  promote their mental health and create adequate conditions for their participation in broader society. Friend-to-Friend also assists in funerals and support to the families.

The Ho Chi Minh AIDS Committee also trains Friend-to-friend group members who have some educational background and are in good physical condition as social nurses. The three-month training course includes theory and practice of basic medical care, and knowledge and skills on how to provide psychosocial support to other PHAs. The AIDS Committee organized two of these courses, with 25 participants in 1997 and 35 in 1999. The social nurses work with health workers to provide care to PHAs at the health centre or in the homes of the PHAs.

At the end of 1998, Friend-to-friend had about 400 members, including family members,  from all parts of the city. A staff member of the AIDS Committee works permanently with the group and links its members' needs to the appropriate public authorities. Today the group offers many different services such as counselling, family care and support and a "buddy system". There is also a group of people who exclusively take care of those who died. Nowadays, psychosocial support is regarded one of the most essential needs of PLWHAs.

The questionnaire responses show very clearly intravenous drug users and sex workers with HIV experience more discrimination from friends, family and society compared to PHAs who are not involved in what society considers "social evils". Discrimination of drug users by neighbours reported by 73% compared to "others" with only 33%.  Their poor background might also contribute to a certain level of discrimination within the health-care system. This mirrors experiences in  other countries, especially Thailand, where municipal hospitals cannot meet the needs of the  increasing number of AIDS patients.

Though discrimination still exists, the overall percentage of people reporting discrimination has decreased considerably, from over 50% in previous years to 28% in 1997, and 8% in 1998, while family support has increased, also for intravenous drug users. Besides better information levels in society as a whole, and increased self-help activities, this might have contributed to the AIDS Prevention Act, passed on 31 May 31, 1995, which forbids discrimination against PHAs.

 Such self-help efforts must be strengthened and supported by more intensive training courses in home-based care where psychosocial aspects are also essential.

Le Truong Giang,  Standing Office of the HCMC AIDS Committee; Nguyen Huu Luyen, Preventive Medicine Centre of HCMC; Le Thuy Lan Thao, Standing Office of the HCMC AIDS Committee and Petra Narimani, VIA Regionalverband Berlin-Brandenburg e.V., Germany. AIDS Committee of Ho Chi Minh City, 59 Nguyen Thi Minh Khai,  Q1 - Ho Chi Minh City, Vietnam; Tel: +84-8-823-5050; Fax: +84-8-822-9152; e-mail: Medinet@hcm.vnn.vn or Pachcmc@netnam2.org.vn