UH doctors slow AIDS in Vietnam


POSTED: Sunday, March 08, 2009

HO CHI MINH CITY, Vietnam » Just five years ago, Vietnamese-American researcher Dr. Thuy Le visited hospitals here and observed HIV/AIDS patients kept in locked wards and left without treatment to die.

“;HIV was a death sentence,”; said Le, who will join the University of Hawaii medical school this summer as an associate professor. Doctors were reluctant to treat AIDS patients because of the stigma attached to the disease and because little could be done, she said.

That's starting to change, said Dr. Tuan Huynh, a medical lecturer at the University of Medicine and Pharmacy in Ho Chi Minh City, who is working with Hawaii AIDS researcher Dr. Cecilia Shikuma to train Vietnamese military doctors on AIDS treatments.

Antiretroviral drugs, which revolutionized AIDS treatment in the United States 20 years ago, are now being used in Vietnam. The results are dramatic.

“;Dr. Shikuma brings a lot of hope to people here,”; said Huynh.

The drugs, generic versions of the original antiretroviral treatments, cost about $50 a month in Vietnam, a huge sum in a country where the average income is just more than $100 a month. They are being provided free through U.S. Presidents' Emergency Fund for AIDS Relief, or PEPFAR.

Shikuma, a professor in the UH John A. Burns School of Medicine, is working with doctors in military hospitals in Hanoi and Ho Chi Minh City on the use of the drugs and how to deal with side effects of the treatment.

“;You watch people who are wasting away and about to die and six months later they are gaining weight and going back to work,”; Shikuma said.

Shikuma and Huynh said two patients they saw last month at the hospital are symptom free now but were on the verge of dying when Shikuma last visited.

“;They are very happy,”; Huynh said. “;They believe they will survive.”;

As part of the project, 16 doctors from Vietnam traveled to Hawaii and Bangkok to learn the protocol for use of the drugs. Those doctors, in turn, train other doctors in Vietnam. Dr. Shikuma also travels to Vietnam twice a year to consult on cases and update the doctors on new developments in HIV/AIDS treatment.

The World Health Organization estimates Vietnam had 263,000 people living with HIV in 2005 and that AIDS caused about 14,000 deaths.

Patients are still largely injection-drug users, sex workers and men who have sex with men, Shikuma said. But the World Health Organization says there were signs the epidemic was beginning to spread outside of those groups.

Since 2004, Vietnam was one of 15 focus countries receiving AIDS treatment and prevention funds from the U.S. government through PEPFAR to fight spread of the disease. Hawaii plays a small role in the much larger PEPFAR effort in Vietnam through the U.S. Pacific Command and the Center for Excellence in Disaster Management and Humanitarian Assistance at the Tripler Army Medical Center.

Most of the $89 million spent in Vietnam last year was distributed by the U.S. Agency for International Development and the Centers for Disease Control.

The Center for Excellence works with the Vietnamese military and funded about $3.5 million in projects last year, including the care of 350 patients — service members, veterans and civilians — at military hospitals; 171 patients are getting the antiretroviral treatment.

Tanya Do, acting program manager in Vietnam for the Department of Defense PEPFAR program, said the U.S. government also is helping to build, equip and train staff for four blood screening labs in Hanoi, Danang, Ho Chi Minh City and Can Tho. They also provide training to Vietnamese military on AIDS prevention, help to establish voluntary testing and counseling centers and work with the government on reducing the stigma of AIDS.

This year, the Center for Excellence also will begin training Vietnamese border guards on AIDS prevention.

There's another benefit to the partnership between the U.S. Pacific Command and the Vietnamese military in fighting AIDS — improved relationships and trust, said Dr. Tom Crabtree, a senior medical advisor to the Center of Excellence.

“;It allowed us to make contacts and develop some personal and professional relationships,”; Crabtree said. “;Medicine is a proven way to open relationships. We speak the same professional language even if we speak different languages.”;

Hawaii has played a role in that, Crabtree said.

“;We are an Asian culture as much as we're an American culture,”; he said. “;Hawaii has been critical in developing our Asia-Pacific relationships.”;



This report was supported by the Project for International Health Journalism Fellowship Program as part of the Henry J. Kaiser Foundation's Media Fellowship Program.