This posting has been submitted by guest blogger David J. Powell, PhD, president of the International Center for Health Concerns, Inc., reporting from Vietnam.
Drug addiction is becoming a significant issue in Vietnam. It has been a major cause of HIV, premature death and social disability. HIV/AIDS spread rapidly in Vietnam from the first HIV infection detected in December 1990 to 116,565 officially reported cases 16 years later. However, estimates of the actual number of people living with HIV/AIDS are far higher and range from 218,000 to 308,000 (an estimated 85% are male). Injecting drug use accounts for 52% of reported cases of HIV/AIDS. According to the Ministry of Public Security, by the end of 2010 there were about 170,000 known IDUs in Vietnam, with 30% living with HIV or who will become infected with HIV.
Before 2008 when a methadone maintenance program was initiated, “rehabilitation” centers were the only solution for opioid-dependent individuals in Vietnam; they received detoxification and education and were put on “labor therapy” for two to five years. No counseling was available in these centers. Relapse rates after release were high.
Addiction counseling is a new concept, introduced to Vietnam in 2006 when it was applied in a pilot transitional program helping those released from the rehabilitation centers to integrate into the community and prevent relapse. The program was implemented by the Ho Chi Minh City (HCMC) Provincial AIDS Committee with support from PEPFAR (President’s Emergency Plan for AIDS Relief) Vietnam via the United States Agency for International Development (USAID). The development of this approach has been a collaborative effort between the global health and development organization FHI and the WHO Collaborating Center for Research on Treatment of Drug and Alcohol Problems located at Adelaide University in Australia, with funding support from PEPFAR via USAID and the Centers for Disease Control and Prevention (CDC).
Addiction counseling has improved the quality of drug treatment outcomes by moving providers to evidence-based practices. Skilled drug counselors now offer care in the community for people who use drugs and for those transitioning out of the rehab centers. Providing services in a community-based setting is more cost-effective than center-based interventions, and more people can access the services
One of the greatest impediments to expanding the capacity for community-based drug dependence treatment is the lack of skilled counselors. Many in the field have requested information about drug counseling in an easy-to-understand and practical format. Also, there has been no training or textbooks readily available in local languages or useful in local settings.
Effective management and supportive supervision is needed to ensure that case managers and counselors are fully integrated into the growing number of service providers that deliver addiction counseling in clinics and other community-based sites. While there are many existing examples of training curricula for clinicians in English, there is a paucity of training materials, job aids and procedures appropriate for methadone counselors and case managers in Vietnam.