Mid-year review meeting of the National AIDS Programme

Venue: Thanh Hoa province

Dear Vice Minister of Health Nguyen Thanh Long,

Colleagues and friends,

It is a great pleasure to join you for this 2017 mid year review of the national HIV response and I wish to sincerely thank VAAC for the kind invitation and opportunity to share some messages on behalf of the development partners working on HIV.

This review comes at a critical time. Viet Nam has made impressive progress towards achieving the 90-90-90 targets and remains strongly committed to them. The nation's unabated leadership to fast track the HIV response is recognized regionally and globally. Reviewing progress, challenges and opportunities will help us jumping forward to reduce the gaps in services and solve difficulties.

The UNAIDS Global AIDS monitoring Report (GAM), to be launched just a week from now, will show progress, gaps to close as well as emerging issues and opportunities faced by countries towards achieving the 90-90-90 and ending AIDS. Global update and analysis is only possible thanks to efforts and data submitted by countries and we wish to appreciate all the work to prepare the country GAM report. The global report stresses that AIDS is not over and still a very serious epidemic and the importance of focusing on the right people, right location based on evidence, in a timely and innovative manner, widening the range of options for prevention, HIV testing and bringing user-friendly and quality services where they are most needed.

In the Asia Pacific region, a fast target was set of no more than 90,000 new HIV infections by 2020 which is only 2,5 years from now. Despite significant progress, the actual estimated trend indicates the region will still have about 290,000 new infections by 2020 - or 200,000 more than the target. In other words, we all need to redouble efforts to accelerate progress to meet the targets. Here in Viet Nam, the epidemic remains a serious public health threat. This is why Viet Nam remains among the special fast track countries for UNAIDS as well as PEPFAR and the GFATM. More than ever, political and financial commitments at all levels remain essential.

As we reflect on progress, it is always good to look back at past impact. A recent UN-supported impact analysis developed with VAAC estimates that between 2001 and 2016, nearly a half million infections were averted, a significant portion of which were due to the expansion of the HIV response in Viet Nam from the mid-2000s until now. Efforts and investments are paying off and need to now adapt to the evolving situation in terms of the epidemic's evolution, available innovative interventions as well as financial and human resources constraints and opportunities.

We now have better data including sub national estimates of the epidemic and gaps in the response showing a great diversity across provinces. Cross sharing and learning what is working the best to reduce the gaps is one of the benefits of this meeting.

Also, the latest data from Viet Nam indicate new infections among sex workers and people who inject drugs have declined thanks to effective programmes but there remains a need to also focus on partners of key populations and men who have sex with men. These groups increasingly benefit from some specific interventions which are promising if targeted efforts are sustained. Prevention including condoms, behaviour change counselling, but also needle and syringe and OSP remains essential and a good investment – we will need to find ways to sustain those efforts which are key to reduce new infections.

Treatment scale up also remains a priority both to save lives and reduce HIV transmission. Thanks to strong political commitment, a bold decision was made to ensure 100% health insurance coverage for people living with HIV and impressive progress has been made thanks to quick mobilization at all levels and especially at the local level. Social health insurance for people living with HIV becomes vital to sustain the delivery of HIV treatment services but also facilitates access to other health services and offers more sustainable financing for facilities. This is a complex transition and good communication at all level and with the community and especially patients is important. As done in some provinces already, finding solutions for some groups of people living with HIV who may face additional challenges to register for health insurance due to poverty or marginalization will ensure no people living with HIV miss ART and none is left behind. This transition to health insurance is seen regionally and globally as a very interesting and inspiring development and experience that can be useful for other countries in terms of service integration and a step towards financial sustainability. We very much look forward to update and discussion, lessons learned and solutions found in this meeting as well as how Development Partners can further support this transition.

The various innovations that are being introduced or piloted in Viet Nam such as for community and lay testing, self-testing, PrEP, differentiate treatment are also promising as widening the options for people to protect themselves from HIV, know their HIV status and enrol in and adhere to ART over time is what works best to fast track progress. We hope the successful lessons learned from those regular interventions and pilots will be put to scale to optimize their full potential in the coming years

A number of challenges and concerns but also solutions, renewed hopes and commitments are emerging to achieve our national goals. More than ever, at a time of complex transition and less external resources, effective coordination and further strengthening efficiency are essential to optimize the precious human and financial resources at all levels.

In terms of the broader political commitment and enabling environment, the National Assembly's support the national response through updating some key legal and policy framework (i.e. Law on HIV, Law on Drugs and Ordnance on Sex work) is a good opportunity to institutionalize new effective approaches and ensure sufficient resources at central, provincial and local levels.

Development Partners are committed to support national leadership and well-coordinated planning and reporting led by VAAC with all stakeholders, including partners, aligned around one plan at national and provincial level. Increasingly, resources will come from the national budget, including health insurance, so ensuring efficiencies through reducing any fragmentation and optimizing the use of available resources across the complementary projects supporting the national response is crucial. Conditions for the use of funds are also now stricter with for example unspent GFATM funds which could be lost for Viet Nam. If we do not coordinate well to maximize impact, we may continue to face some gaps for people who need HIV services, risk losing some of the gains especially during this transition time and not be able to reach the 90-90-90 and national goal for harm reduction. Missing that would imply even more complex and costly HIV response later. We hope to hear from you how we can work together for and support more effective coordination at provincial and national level.

Development Partners are proud to have contributed to the achieved progress and we know that, with continued strong national leadership and partnership, Viet Nam is well on the way to reach the 90-90-90. The Development Partners reiterate their strong support to the national programme and, in particular, for technical guidance and policy development, strategic information, innovative approaches, guiding service delivery, capacity building, working with communities and achieving more efficiency gains through effective coordination.

Together, let's focus on facilitating solutions - from planning and quantification to service delivery - from HIV prevention to ART adherence and viral load suppression in a sustainable manner.

We look forward to hearing the update and discussion especially with the provinces who are at the forefront, delivering services to the people who need them, with the MOH and VAAC precious guidance.

Thank you very much!