2015 Student-Faculty Fellows Program: Trinity University
Effects of Declining International Aid on NGO HIV/AIDS Program in Vietnam
Mentor: Alfred Montoya, Department of Sociology and Anthropology
Students: Dima Alhourani’16, Dana McLaughlin’17, Faith Ozer’15, Nikita Viswasam’15
This research project investigated how declines in PEPFAR (US President’s Emergency Plan for AIDS Relief) funds, which make up a significant portion of all HIV/AIDS prevention and control funding in Vietnam, have affected the operations of governmental and non-governmental organizations there. The loss of these funds, resources which have allowed Vietnam to build and scale-up a comprehensive apparatus for the combat of HIV/AIDS, including the free provision of antiretroviral therapy (ART) for HIV positive citizens since 2005, is seriously compromising the ability of local organizations not only to sustain the positive gains made by PEPFAR in Vietnam against HIV/AIDs in the past decade, but furthermore, is threatening to reverse them. Local organizations are finding themselves in the uncomfortable position of having to make decisions about compromising or cutting HIV/AIDS programs. We examine how these reductions in funding have affected these organizations’ messaging, structure, service provision and health outcomes/impacts through ethnographic fieldwork among PEPFAR partners, community stakeholders, and clients of these services, in Ho Chi Minh City.
My ethnographic observations, array of interviews, and overall exposure to the Vietnamese public health sector have placed significant emphasis on the role of the active audience in the context of media studies research. The media messages, attitudes, and rhetoric that operate within the postmodern and neoliberal Vietnamese civic culture rely on how the target audiences interpret and internalize the information about HIV preventative measures or options for treatment. As is the case for most qualitative communication studies, the focus of my research was not driven by the desire to predict what certain messages or modes of communication were most impactful. Instead, I found that by focusing on understanding the cultural context, and the interwoven power dynamics between the two parties involved, I was able to decipher how the dominate HIV/AIDS public ideology and narrative in modern Vietnam has been impacted by the reduction of PEPFAR funding.
As the funding for both small community based organizations and larger government run treatment clinics and medications programs continues to diminish, the prioritization of preventative education initiatives. These cuts will extend from reducing the one on one peer education/counseling program, elimination of printed brochures with HIV information, and limiting digital networking programs to connect members of the infected community. In favor of treatment services, the preventative outreach measures have already been dramatically reduced. Furthermore, the personnel previously responsible for organizing these patient support networks, distributing preventative information, and maintaining public awareness about the current state of HIV/AIDS prevalence will no longer be staffed, particularly at smaller organizations. This is just one of the many shortcomings that is a reality for the current HIV/AIDS situation in Ho Chi Minh City, and across Vietnam.
Although our research was confined to this major city, our analysis of the present condition of HIV/AIDS response aimed to understand how small community organizations and the Vietnamese Ministry of Health will move forward post-PEPFAR funding. As we continue to process the information from our research, both individually and collectively, we will continue to consider how the next five years of HIV/AIDS response efforts in Vietnam will develop despite the drastic changes in funding climate and the persistence of neoliberal cultural ideologies.
Our research this summer gave me the unique opportunity to delve deeper into HIV/ AIDS related programs in Vietnam and confront some of their hard realities. It has allowed me to establish connections and deepen my understanding of what used to be a foreign place. This research opportunity has cultivated my critical view of current international aid and development practices, and allowed me to attach faces, names, and locations to examples I would otherwise only theorize. It reaffirmed my decision to pursue graduate studies in International Development, and strengthened my passion for this topic. I will use this experience as a strong basis to understand and remain critical of development practices, ultimately for their improvement and for the sake of social justice.
The withdrawal of international players has left a gap in the services provided by HIV/ AIDS related programs in Vietnam, which neither the government nor the organizations themselves are completely filling. Recipient organizations both governmental and non-governmental were affected differently by the diminishing international funds. However, there were overarching changes that many of our visited sites shared, such as: human resource restructuring, shift of cost to patients (clients/members), and the reduction of services. Further research will focus on synthesizing the collected data and drawing further connections between the different cases and sites. It will also be examining the use of funds, the impact of cuts on the longevity of the organizations, and the quality of their services, building on official documents and related literature for support.
This research spanned multiple public and non-governmental organizations (NGOs) across Ho Chi Minh City, drawing from interactions with over a dozen individuals, including local student translators. Through a combination of interviews and participant observation we were able to build relationships with local HIV workers in multiple NGOs targeting a range of at risk groups, participants, professionals working within the Provincial AIDS Committee (PAC) and a large network of doctors, directors and volunteers. Throughout this research, being able to compare and contrast the way that HIV/AIDS is conceptualized across my areas of experience – both in South Africa, San Antonio, Texas and Vietnam – has made my view of illness more comprehensive. I will emphasize the skills and knowledge attained from this experience as I apply to Masters of Public Health (MPH) programs across the country and as I continue along this career path.
Upon the completion of our fieldwork, I began the process of transcribing and analyzing the 130 pages of handwritten notes I took over the course of the trip. My analysis entails the reorganization of reoccurring ideas and topics from each individual interview and grouping them by theme while assessing their relevance and applicability to our topic as a whole, while specifically relevant to the way PEPFAR’s defunding has affected patient care. I am making progress with this step of my writing and am nearing the halfway mark and will continue to do supplemental research, gathering existing literature on current funding while also fact checking and contextualizing quotes and experiences. I am finding that an analysis of public-government versus private programs of care, education and organization around HIV is imperative to understanding the way the nation’s communist government structure and socialist health care system effect the way HIV is approached. Discourses of responsibility – for funding, for lives – scientific understanding, diplomacy and economic obligation and capability intertwine throughout the data to define HIV’s existence and current reality in Vietnam, and much like the virus itself, its definition within society has changed and mutated with time. After my analysis is complete and I have organized these themes, I will relay my general findings to the group before further developing my ideas into the research draft.
In four weeks, our field research took us to directors, administrators, educators, healthcare professionals, and community health workers across two private clinics and five local organizations involved in the provision or regulation of HIV services with some association to PEPFAR, spanning seven districts in Ho Chi Minh City, Vietnam. The greatest impact of this research on my experience has been from the sum of the individuals we engaged with through the course of our interviews, including the student translators. I have gained confidence in the ability to develop professional working relationships with members of an international community at the local level and reinforced my goal of pursuing graduate studies in international public health towards community health program development. I also gained valuable exposure to the daily operations of nongovernmental health services that collaborate with international partners. The individuals I have met serve as models for those I seek to collaborate with in my future professional activities. This research experience had aided my decision to make international HIV/AIDS services a central focus of my graduate specialization and future public health practice.
Completed field research concerning the state of community health workers in NGOs operating HIV/AIDS programs in Ho Chi Minh City involved the case studies of two private clinics and three non-clinical service organizations, and additional interviews with two members of the Ho Chi Minh City Provincial AIDS Committee and two former PEPFAR program officers. Community health workers were found to have three primary roles in service provision in the organizations studied: voluntary counseling and testing (VCT), peer education of the three population groups in Vietnam with the highest HIV risk (injection drug users (IDU), commercial sex workers (CSW), and men who have sex with men (MSM)), and methadone maintenance treatment (MMT). PEPFAR was found to contribute a significant amount of funding in the salaries of organization staff members, and staff positions are among the first to be cut as part of the cuts targeting direct service delivery (DSD) funding, leading to plans of staff reduction, retraining, reassignment, and integration by organizations. Further research will add developments of community health worker activities throughout the timeline of PEPFAR entrance and exit and in relationship to funding by the government of Vietnam and other funding sources post-PEPFAR.