OVERCOMING BARRIERS TO SHI FOR HIV CARE & TREATMENT

Ho Chi Minh City, December 2017

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Hien* first learned he had HIV nearly 10 years ago, but has never been on consistent treatment before. He avoided visiting public clinics, despite their offering free antiretroviral therapy (ART) through the US President’s Emergency Plan for AIDS Relief (PEPFAR). As an aspiring makeup artist, Hien feared he might be recognized and potential clients deterred by his HIV status. Instead, he has paid for treatment out-of- pocket through private clinics. “Whenever I had money, I bought medicine, but when I didn’t have money I would stop. I wasn’t working, so I had to borrow money and I didn’t want to raise suspicion by borrowing too often,” explained Hien. But after 10 years of sporadic treatment, Hien’s health began to fail. Six months ago, he came across the Vietnam Network of People Living with HIV (VNP+) and its cofounder, Mr. Phong, when searching for a better way to pay for ART. Together with the U. S. Agency for International Development (USAID)’s Sustainable HIV Response from Technical Assistance (SHIFT) project, they are working to enroll Hien in social health insurance (SHI) and ensure his continuous access to ART.

While HIV is a chronic condition requiring lifelong treatment, ART enables patients to lead healthy lives and significantly reduces the risk of transmission. Historically, HIV treatment in Vietnam has been offered free-of-charge through international aid. However, the country’s rise to a middle-income economy has prompted donors to begin reallocating resources elsewhere. Through projects like the USAID SHIFT project, PEPFAR is helping the Government of Vietnam strengthen and expand its SHI program as the primary vehicle for local ART financing. SHI currently reimburses qualified facilities for the cost of health examinations, basic laboratory tests and opportunistic infection management, and will expand to include antiretroviral medicines starting in January 2019.

These efforts are particularly crucial in Ho Chi Minh City, where more than 30,000 PLHIV live, one third of which lack SHI. Many HIV patients still do not know where and how to purchase SHI cards. Others lack formal identification papers required to enroll. To address to these practical challenges, USAID SHIFT has partnered with civil society organizations like Legal Aid and VNP+ to get PLHIV the help they need to enroll in SHI.

USAID SHIFT is working with VNP+ to offer individualized counseling and assistance to overcome barriers to SHI enrollment. Together they have developed explanatory brochures, a booklet and video clips on SHI; mounted outreach efforts at offsite events; and are operating a hotline and social media page for online counseling. They have trained healthcare providers and community-based supporters to guide HIV patients through each of the steps required to obtain and use an SHI card. With project support, VNP+ is responding to both direct PLHIV queries and requests for assistance from facilities.

In Hien’s case, he does not have the updated residence paperwork required to enroll in SHI in HCMC, as his hometown is in the north of the country. The standard protocol in Vietnam when migrating to a different province is to bring the family’s residence book to the police office to register the new location. Hien’s family does not know his HIV status, and have been reluctant to give him the very valuable residence book without a clear explanation. Yet without an updated residence card, Hien cannot complete his SHI enrollment. As part of meeting patients where they are and giving them real and actionable support to surmount obstacles, Phong is helping Hien process an absentee residence card without having to disclose his status to his family until he is ready to do so.

These efforts have made progress in getting people like Hien enrolled in Social Health Insurance; as of January 2018, 85 percent of people living with HIV in HCMC are now enrolled, compared to 55 percent the year before, amounting to nearly 10,000 new patients. Yet, enrollment is just the first step. The next step is to make sure PLHIV can successfully use their SHI cards to reimburse HIV-related costs, including antiretroviral drugs in 2019, and addressing fears surrounding stigma and confidentiality in public facilities.

For Hien, the counseling has offered him more than just assistance in enrolling in SHI: “VNP+ is the best thing that has happened to me. Joining this network may give me stable treatment for the first time in my life, but it gives me a community and hope. I hope to have lifelong, uninterrupted treatment so I can keep working and enjoying life.”

*The success story subject’s name has been changed to protect privacy