I’ll take you back again in time, to Vietnam, a week ago last Thursday, when we awoke in the port city of Hai Phong. There is a lot of HIV infection in Hai Phong, much of it in the IDU and sex worker communities. I’d been sent to speak at the Dong Khe Ward in the Ngo Quyen district to about a 100 people living with HIV/AIDS, their families, people from their support groups and local ASOs and NGOs. Both the people and the local government in Hai Phong are working hard to control the AIDS epidemic there. As Vietnam is a recipient of PEPFAR funds, we were really curious to speak with local people at NGOs to see if the funds we being put to use in a way that would benefit those living with HIV.
Quyhn picked us up in the van and we drove to a locked courtyard around a string of saffron-colored buildings that housed both a community center (where local officials of the communist government convened) and a kindergarten. We’d been told that it was a new thing for an American to be invited to speak in such a setting and that the local government had to approve my visit. Throughout my time in Vietnam, given America’s history with the country, I feared feeling unwelcome. The opposite was true. The Vietnamese, if largely unfamiliar with Americans (as few travel there, especially into the hearts of the cities—most who come head to the gorgeous beaches or backpack or bicycle through the rural areas), are very open to having us in their country. Partly, this is because most of the population is young (many of the people who would be older today were killed in the Vietnam war) and partly this is because the war with America was only one of several wars waged in past centuries. Still, as the daughter of a U.S. Marine and the niece of two uncles who fought in Vietnam, it was strange to be, for example, sailing across Ha Long Bay, near the Gulf of Tonkin, knowing that a mere thirty three years ago we still had troops stationed in Vietnam. Maybe I was just projecting, but despite the friendliness of Vietnam’s youth, I did feel that some of the few older people I encountered were, understandably, not too thrilled to see us walking their streets.
Something I’ve felt over and over on this trip is how important it is for Americans—who, because of the nature of our large country that borders only two others—must make a significant voyage to get far enough away geographically and culturally to reflect back on our culture. It’s so helpful to travel away from our country—and our press—to get a different perspective on who were are and how we’re perceived in the world. I know I had an American-centric view of the world; that view has been totally obliterated by this trip and by weeks of watching foreign press, from the truly independent BBC to arguably less independent mass media vehicles in Vietnam and Australia. (Just last night, we were watching the local Australian news coverage of the American news coverage of Beyonce’s tumble down the stairs. They were making fun of how prevalent the story was in the American evening news. Personally, I think Beyonce’s great—and she’s a supporter of people with HIV/AIDS so I was just really glad she didn’t break her neck. I agree, however, that there are probably more critical stories we can focus on in the news.)
To make a gross over-generalization of how people in the three countries we’ve visited on this trip see us, the Taiwanese seem to want to be like Americans, the Vietnamese aren’t aware of who or what we are and the Australians seem far less enamored with Americans than we are with them.
Taiwanese people strive to be more western, particularly American, in their dress and attitudes. They re-create the “best of America,” giving it a modern feel and a good scrubbing up. “New York” is the name of one of their biggest shopping malls in the heart of Taipei’s shopping district and the luxury boutiques in Taiwan 101 (the world’s tallest building) simulate a mini Madison Avenue. The Vietnamese are cautiously open about the many changes that are happening around them and I think have little awareness or care for the west. They’re too busy making a living and trying to improve the quality of their lives. Some efforts made by the communist government to facilitate the burgeoning development in that country (like giving the control of individual plots of rice—and the harvests they produce—back to their owners) feel strangely capitalistic to the people who (whether, given the choice, they would have initially have chosen to do so or not) are used to the government dictating much of their lives. We were told that further south, in places like Ho Chi Minh City (still called Saigon by those who live there), the Vietnamese people are more progressive and more interested in adapting to more modern ways of living. Australia seems a utopian society. Once societal outcasts (many of Australia’s original settlers were members of the penal colonies established here by the British), the Australians have created (at least if Sydney is any indication of other parts of this continent/country) an incredible lifestyle and culture. I will admit I perceived the Australians to be a rogue-ish, rugby-playing, surf-riding, outback-loving wild crew. No one drinks Fosters here. Both the rugby and the Australian rules football are fast-moving, highly strategic games that make American football look thuggish, and the culture (and architecture and physical setting) of Sydney combines what feels to me like the best parts of New York, London, San Francisco and Hong Kong, in a fastidiously clean, well-organized, highly civilized and indescribably beautiful urban setting surrounded by deep blue crystal clear water. Americans are not well-loved the world over and it is very enlightening to know that we are not the still center of the moving world and that there’s much we can and should learn from people and cultures that are so different from ours. Frankly, it’s humbling for this American to see how we are seen by others in lands far away.
In Hai Phong, we were ushered into a room that had no windows and several slowing circulating ceiling fans. There was a low glass table with what looked like a child’s porcelain tea set, surrounded by low leather couches. Several serious looking men came in and were introduced as members of the local communist government. With the help of our wonderful translator and interpreter (those are two distinct skill sets), we thanked the officials for hosting the meeting. There were incredibly warm and cordial. They were eager to talk about fighting HIV/AIDS in their city of Hai Phong (the third largest in Vietnam) and after leading me to a large room filled with people living with and affected by HIV/AIDS, gave me a lovely introduction and listened intently while I talked freely about fighting HIV/AIDS stigma and discrimination. As I spoke, five- and six-year-old children who were playing at recess in the neighboring courtyard crowded around the window, screeching and laughing and pointing at the big blonde American woman talking about sex and condoms…
The questions were pointed and tough and the audience really wanted to know the U.S.’ impetus for granting Vietnam PEPFAR dollars. They questioned whether it was merely a P.R.-move on behalf of America or if we were truly interested in helping out in Vietnam. I confessed to not knowing the rationale behind the PEPFAR pledge in Vietnam but suggested that as long as the funds were making their way down to the people and providing people the medical services and treatment they needed, it might not matter about why the funds were dispersed, only that they were. I did say that our country has great interest in helping to stop the spread of AIDS worldwide. President Bush’s recent pledge of additional PEPFAR funds brings the fund to 30 billion. No other country has matched that level of financial commitment. Of course, there are questions about how those monies are allocated and the types of programs they support, but it was encouraging to hear the First Lady’s recent comments about re-evaluating the portion of funds to be used for abstinence-only prevention (particularly in countries where the infection rate is already really high and prevention’s no longer an option for many living there). Then, there’s the question about why we’re giving so much abroad when funds are still desperately needed at home. In Vietnam, there is a big concern that the monies given are applied in the right way and that the people living with HIV/AIDS actually benefit from the grant. Like in so many countries, just giving the money is only the beginning. Though the socialist government of Vietnam provides healthcare and ARVs to all who need it, the country, still largely in development, needs what so many others do too: a healthcare system that works, qualified people to administer the healthcare system and to treat patients, including offering on-going counseling and support and monitoring patients in treatment, access to testing sites (both for diagnosis and for follow-up lab work), clear instructions/prescriptions to help people understand how to take the medicines, food and clean water to take with the medicines (I’ve heard a lot about how hard it is to take the meds on an empty, upset or only partially-full stomach. Adherence, and therefore, lack of resistance to drugs, is helped by adequate food supplies and clean water…), incentive to continue treatment (in the form of improving lab results) and support to combat the fear of stigma and discrimination.
One brave man stood and talked about living with HIV. He questioned how Americans got drugs. It’s amazing—so many people in Asia perceive that we have no issues with AIDS in America. They are shocked to hear that we have had 40,000 new infections for the last 5 years (of reported data) and amazed to know that people are dying of AIDS in the U.S. Another stat that blows them away is the rate of infection in the District of Columbia: 1 in 20.
After the talk, I met with more members of the local communist government and while I am aware that they are politicians first and foremost, I was encouraged by our work that morning. It felt good to be part of an effort to work with others—as different as they may be in their ideologies and political stances—on this problem that truly, as a global humanitarian crisis, deserves to be addressed regardless of the cultural and political barriers that may seem to stand in the way of a worldwide, unified attack on AIDS.
Later that afternoon, we traveled back to Ha Noi to meet with the UNAIDS technical working group at the Vietnam Women’s Museum and heard more about the local efforts to fight AIDS, and I felt the strong determination of the people to make a difference. I think there is significant political will in Vietnam and I think the officials understand the need to openly and vigorously battle AIDS. The country handled their outbreak of bird flu deftly; as a result, that epidemic was contained. When you have the government’s will, and the funding, even if the system is far from perfect or still in development, more can be done than if either or both of those things are missing.
That evening, the U.S. Ambassador to Vietnam, Michael Marine and his wife, Carmella, hosted a lovely reception for us at the embassy. Many of the people I’d met, as well as some I’d encounter the next day when I spoke at the La Thanh Hotel to about 75 members of advocacy groups in Hanoi (hosted by the Center for Study and Applied Sciences in Gender, Women, Family and Adolescents), attended and we had a chance to speak one-on-one about the work they are doing. I met three remarkable HIV-positive women who are working with the sex workers and educating them about condom use and how to negotiate asking for it with clients. The ambassador gave a fantastic speech and it was great to see his conviction in fighting HIV/AIDS in Vietnam.
Finally, the next day, we finished the Vietnam leg of our tour with the aforementioned talk in the morning and a web chat with readers of Tien Phong, Vietnam’s newspaper for youth (check it out at tienphong.com.vn). It’s amazing, though the language and cultures I am encountering are all so different, the questions about HIV/AIDS remain the same no matter where you are in the world.
Here are some pictures from the web chat. Note the statue of Ho Chi Minh in the background…