Vietnam's new war - on Aids

Communism is no defence against a disease being spread by modernisation , Teresa Poole finds in Hanoi

IT WAS Wednesday night at the Young Couples Club in Le Mat district on the outskirts of Hanoi, and a small bush had been placed in a flowerpot on the floor of the hall, its branches decked out with flashing lights and flowers made from metallic paper. A young woman was picked from the audience, handed the microphone and told to choose from the flowers, among whose petals were pinned questions designed to test the nerves of the most robust public speaker.

"Can you tell us how to use a condom?", the woman read from her slip of paper with a look of mounting despair on her face. "It is very difficult to say..." she hesitated, to great merriment among the audience of 70 or so. "The district Women's Union has distributed condoms to many people..." She faltered. "There should be instructions inside the packet!" The hapless woman dived for her seat amid laughter.

The gathering was the monthly Young Couples Club meeting for the area, organised by the state-controlled Youth Union, and that night's quiz had focused on Aids prevention. Who was at risk from Aids? How was the virus transmitted? The tree answered all such questions. And the club members, mostly in their twenties and thirties, boldly recited answers.

Vietnam's fight against the disease needs much more than party games, however. These days, the "domino effect" in Asia is not communism but Aids, and Vietnam is in the front line, with the HIV-blighted nations of Thailand and Cambodia to the west and the drug-afflicted Chinese province of Yunnan to the north. The question is whether there is time to avoid an epidemic in Vietnam on the scale of Thailand, where an estimated 800,000 people are now infected out of a total population of 62 million. "Vietnam is on the brink," said one Westerner working on Aids prevention in Hanoi.

For most of the 1980s, Vietnam was virtually a closed country. Then, with economic reform, came rapid social change. Rural migrant workers poured into the cities, Vietnam's borders became increasingly porous, socialist controls started breaking down and the sex industry thrived. Four years ago it was hard to find a restaurant in Hanoi, but the city is now crowded with late night venues, embracing "Bia Om" (beer and cuddles), "Cafe Om" and "Karaoke Om". Two southern delegates to the Vietnamese Communist Party congress in June were sent home in disgrace after being discovered cavorting in such an establishment.

The government has responded to this "decadence" in traditional communist style, launching an "anti-social evils" campaign at the beginning of this year. Targets included prostitution and pornography, as well as foreign language signs and advertisements. In free-wheeling Ho Chi Minh City, 109 brothels were closed in the first six months of this year, said the official Saigon Giai Phong newspaper. But when sex workers are marched off to "re-education" camps, the government tries to "reform" them rather than convince them of the merits of condoms. Pessimists believe Vietnam is now lagging Thailand's HIV infection profile by only six years; optimists believe it is a decade. Either way, the next year or so will be crucial. About 4,000 people have tested positive, but officials accept the real number to be about 60,000, with 100,000 expected in 1997.

Compared with some countries, such as China, the Vietnamese government has been open to the need for public education. Large billboards on some Hanoi streets warn of Aids. A TV soap opera, in which two characters will be HIV positive, is being filmed. And in April 1995, when a party member and his wife became Hanoi's first official Aids fatalities, their deaths were reported in the state-controlled newspapers. "Even the cyclo drivers knew about it," said Dr Jamie Uhrig, at the UNAIDS office in Hanoi.

Vietnam's "mass organisations" are leading the official battle. Thus the Youth Union puts on plays for youngsters such as "Love in the Aids era" and "Miss Beauty", the tale of a country girl who comes to the city and is infected by HIV. In some cities the union has even opened "condom coffee shops". One Westerner working on Aids prevention said: "I think Vietnam has done a really amazing job in terms of getting information out. An eight-year-old in a village can list how people can get Aids. But people need more detailed information on what exactly `safe sex' is."

The elderly communist leaders at the National Aids Committee are struggling to accept the fact that, as one official admitted, "the tendency is for the young Vietnamese people to have earlier sexual relationships". While young, unmarried women have more than 100,000 abortions a year, sex education in schools remains very limited. "Vietnam's leaders admit the threat of HIV to development," said Dr Uhrig. "But people are unsure what new strategies are going to be a success in preventing the disease."

Health education for those most vulnerable is virtually non-existent in Hanoi. One Vietnamese non-government organisation, the Centre for Health Services and Aids Counselling, was running a pilot scheme teaching English to prostitutes in some Hanoi brothels, with Aids information and condoms thrown in for free. But its funding ran out last spring.

The man doing most to promote condoms in Vietnam isAndrew Piller, of DKT International, an American group promoting family planning and Aids prevention. This year DKT expects to sell about 30 million "Trust" and "OK" condoms in Vietnam. This is the key to halting an epidemic in Vietnam. Between 1987 and 1995, the annual number of condoms sold in Thailand increased from 10 million to 170 million. Last year in Vietnam, it was about 70 million, suggesting a faster take-up than in the early years of the Thai epidemic.

"If we continue to see an increase in condom use in Vietnam," said Dr Uhrig, "then there is a chance that the epidemic will not be as bad as in some neighbouring countries. But condoms have to be available everywhere alcohol and sex are available."