The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
Read More »
Thank you, Dr. Komatra for the kind introduction. I would also like to thank Professor Vicharn and the PMAC Secretariat for all your hard work in organizing the conference; the Royal Thai Government f... Show More +or their hospitality; Professor Rachata; Lincoln Chen and our fellow conference co-hosts and partners in JICA, USAID, WHO and the Rockefeller Foundation; and to my good friends, Dr. Suwit and Paul Farmer.Yesterday I was honored to share the Prince Mahidol award with a distinguished group of individuals who have spent many years fighting to end the HIV-AIDS epidemic. I accepted the award on behalf of a broad and diverse group of advocates who worked as part of a global movement to make treatment accessible to people everywhere, no matter their income or geography.Sadly, our work is unfinished. Millions are still becoming infected each year, and many are shut out of treatment because of inadequate services and frankly, discrimination. Yet a new generation of activists has joined the fight, and I am confident that in our lifetimes we will end the scourge of AIDS and unlock the potential of millions caught in its grip.When that happens, we will owe tremendous thanks to many people living with AIDS, health workers and activists in Thailand. They were early and visionary leaders in this fight.Thanks to their work, Thailand was the first developing country to mount a successful HIV prevention response. It reduced new HIV infections by over 90 percent, from 150,000 in 1990 to about 10,000 in 2013. This prevented a stunning 7.7 million HIV infections, and saved over $18 billion dollars -- a monetary return over 40 times the investment.Over 250,000 people are on AIDS treatment in Thailand, reducing HIV deaths by at least half. Yet AIDS still ranks high on the list of causes of premature death in Thailand, so there is more to be done in Thailand and globally – and we will continue working together until the last person living with HIV receives life-saving treatment.Thai health care policy makers, health workers and activists have shown a strong commitment to the poor and vulnerable. Thailand’s successful universal health care scheme, which includes AIDS treatment, commands global respect and influence.It’s easy now to look back at these amazing successes and think they were inevitable.Many of you in this room who lived through the early days of the AIDS fight know it was far from certain that we would ever succeed.In my first year of medical school we began to understand the devastation of the AIDS virus -- it seemed an impenetrable enigma. The epidemic threatened us like an approaching cyclone. AIDS was projected to kill tens or even hundreds of millions of people. It was an incomprehensibly large and complex public health challenge.Yet, more quickly than we could have ever imagined, we developed effective treatments. HIV activists attacked every link of the value chain for drugs and treatment, starting from nowhere until we had developed drugs that treated the disease. Tony Fauci was instrumental in the race to get drugs to market, from the first antiretroviral drug approved for the treatment of HIV in 1987, then single and double combinations of drugs, followed by David Ho’s pioneering work in the use of highly active antiretroviral therapy. Those infected went from just 28 weeks median survival to perhaps 50 years for a young person. A broad team effort in science and advocacy turned the world’s greatest public health crisis into one of the most extraordinary accomplishments in the history of public health and medicine.But when we thought about bringing those treatments to the poorest people around the globe, the mood changed. The conventional wisdom was that treating people with AIDS, in places like Thailand and elsewhere in the global south, was too expensive, too difficult, and offered slim prospects for success.In fact, some of the most important leaders in public health angrily opposed and even ridiculed our efforts, and talked about focusing on the next generation through an emphasis on prevention.Thankfully, many others saw the suffering and were compelled to act -- to act up. They had aspirations as high as the people living with HIV/AIDS everywhere in the world. Indeed, some of these activists were themselves living with HIV/AIDS.As a result, millions were treated, millions of lives were spared, and incalculable human and economic costs were avoided.The visionary leadership of Thai health professionals and activists saved lives here, and around the world. They showed us what was possible. People like Mechai Viravaidya – or Mr. Condom as he is known here – and my friend Dr. Wiwat Rojanapithayakorn, broke the taboos on talking about condoms and sex. Thailand’s commitment to treatment and prevention, and its integration within the universal health scheme, were prescient and spared many, many lives.Just as Thailand’s successes in AIDS prevention and treatment were not inevitable, neither was its quest for universal health coverage. In fact, it seemed quite unlikely at the time of its inception in 2001.A few years earlier, in 1997, Thailand’s economic bubble burst. Growth plummeted. The baht was devalued by 45 percent. Unemployment soared, and the stock market lost three-quarters of its value. The government committed to a $21 billion IMF bailout, and the imperative to stabilize the economy made it very challenging to propose new programs.Few people saw this as an auspicious time to advocate for universal health coverage for all Thais. Yet a handful of Thai visionaries had been dreaming -- and scheming -- for decades, and would not be denied.They had many opponents. Not the least of which was the World Bank Group. That’s right. The institution where I now serve as President was an outspoken opponent of Thailand’s aspiration to provide all of its people health coverage. The Bank and others said it was the wrong time for universal health, that it wouldn’t work, and that it was fiscal suicide.Another major opponent was the World Health Organization -- whose constitution says it exists for “the attainment by all peoples of the highest possible level of health.”Yes, I used to work at the World Health Organization, too.I’ve tried to imagine what those conversations must have been like.“I’m sorry Thailand, but when we talked about ‘Health for All’ by the year 2000, that was actually a typo. We actually meant Health for All by the year 3000.So, with powerful opponents like those, some might lose faith and walk away.Not the Thai people.The Thai people have a deep commitment to economic justice. They had worked for decades to provide universal coverage to their people. In fact, Thailand’s constitution guarantees the right of every Thai citizen to health care, even the poorest. By 2001, when Thailand introduced its universal coverage scheme, nearly a third of its people were still uncovered. Many of these were poor people whose families could be made destitute by a serious illness.It took civil society activists, as well as civil servants and health professionals, to build broad grass-roots support for reform. The Universal Coverage Scheme -- or UCS -- has remained a top priority through several changes in government. Thailand’s health professionals have made smart choices and used evidence-based decision-making to build a system that works for its people.Today, UCS provides comprehensive health services, and it has made the nation healthier and more productive. Within one year it added 18 million previously uninsured people to the rolls of the insured. As in many other nations, the integration of AIDS treatment and prevention has only strengthened the system’s breadth and effectiveness.One key reason for Thailand’s success was the acceleration of a two-decade-long shift of resources and health staff from urban to rural areas, where more of the poor and uninsured lived. Successive governments have provided strong and positive incentives for health workers to work in these previously undeserved areas, and to increase their motivation, skills and effectiveness. They even paid them more than their urban counterparts.We should acknowledge the contributions of Prawase Wasi, the great hematologist who established the rural doctors’ movement in Thailand and who wrote a seminal monograph entitled "The Triangle that moves Mountains". The triangle referred to three points of engagement that are critical in enacting reforms: wisdom, state, and society. This combination of forces certainly provided strong stewardship for universal coverage in Thailand.In the first 10 years of UCS, Thailand had strong GDP growth. This provided the fiscal resources for the reforms to survive and take hold. And this growth has been shared with the poorest. A recent study showed that over the past decade, among all Southeast Asian nations, Thailand is the only country that offers universal health coverage, and the only nation where lower income consumers have increased their share of total consumption.UCS is a gem beloved by the Thai people -- 90% of them are satisfied with it -- and their strong voices ensure it is funded and nurtured. And this despite the fact that when UCS was launched, Thailand had the lowest per capita income of any nation ever to achieve universal coverage.It’s not a perfect system. It faces growing pains as more people use its services; as people age; and as injuries from road accidents and non-communicable diseases like diabetes rise. This is normal. Managing health care systems is like tending a tropical garden. There will always be more weeds to pull, flowers to plant, and branches to prune. I have faith that Thailand will succeed in its pursuit of greater quality and equity in its health care. As it stands now, UCS is a remarkable, living legacy of many dedicated civil servants, activists and health workers, all who were committed to justice in health care.As I travel across the world, I tell the Thai UCS story as an example to other nations who aspire for the same results for their own people.I thank you, and congratulate you for your achievement.So, what are the lessons from the fight for AIDS treatment and universal health coverage?First, we’ve learned that investing in people is not just the right moral choice. It also results in real economic and political benefits. I have dedicated my life to demonstrating that not providing health, education, food, and social protection is fundamentally unjust -- and that it is also a bad economic and political strategy. The Lancet Commission on Investing in Health estimated that up to 24 percent of economic growth in low- and middle-income countries was due to better health outcomes. The payoffs are immense: health spending yields a 9 to 20-fold return on investment.And the Growth Commission, led by Nobel Prize-winning economist Michael Spence, reported that “No country has sustained rapid growth without also keeping up impressive rates of public investment” in things like education, and health -- in addition to physical infrastructure. These investments in people don’t crowd out private investment; they crowd it in. New enterprises are born, and returns rise because workers are healthy and educated.The second lesson is that ambitious reforms require skillful balancing of competing demands; they also require continuous learning and adaptation, based on the best global knowledge and evidence. Thailand’s health workers’ and activists’ achievements in universal coverage and AIDS demonstrate important elements of what we at the World Bank Group are calling the science of delivery.They paid careful attention to all the factors that affected success -- everything from the cold chain for vaccines to financial management of their health system; from roads and electricity for clinics to girls’ education.Two days ago I visited Myanmar, which has just launched its own effort to achieve universal health coverage. Myanmar can learn from Thailand’s approach to effective health care reform.To achieve such complex reforms, an unforgiving focus on results is imperative.Good intentions alone are little use to a pregnant mother in a rural village. She needs an effective and stable health care system to give birth to a healthy daughter, to protect her from childhood diseases, and to help her child become an educated and productive member of her community. In addition, their leaders and health officials have to maintain a strong public commitment to delivering quality services, weaving through the political maelstrom, and fostering a change in behaviors which affects the health and livelihoods of everyone.The third lesson is that even a handful of committed people with vision have the power to change the world. Believing in the possibility -- but not the inevitability -- of a better world is the first step in achieving it.The global fight against AIDS was a triumph of a bold vision for fundamental human rights, combined with scientific progress, and global solidarity.Here in Thailand, through the tenacity and grit of thousands of health workers and activists, you showed all of us how to pursue a vision for health equity. You built movements that saved lives, changed your nation, and provided a contagious hope to millions.These lessons are universal -- and timeless.We can achieve great things, if we learn from history, and contribute to a lasting evidence-based wisdom.Our work is unfinished. Yet, as I look out at all of you here, I have an abiding faith that, together, we can build a world with greater opportunity…equity…and justice.Thank you very much. Show Less -
“Ending AIDS and Poverty”Your Excellencies and honored guests, ladies and gentlemen, colleagues and friends,As we look back on the history of this epidemic, it is hard to say that there is any o... Show More +ne moment when the tide began to turn. Because the truth is that we have been turning back the tide of AIDS, step by painful step, for 30 years.And at nearly every turn, it is the activists, and their communities, that have led the way.It was activists and communities who devised safer sex, promoted condom use, needle exchange and virtually all the behavioral prevention we use today.It was activists who transformed drug development and regulatory processes, and involved patients in clinical research, cutting drug approval times in half in the global north.It was activists in Durban in 2000 who began to push for access to antiretrovirals in the developing world and who kept pushing and are pushing still for them to be affordable and available to everyone who needs them, everywhere.And it was activists whose deep understanding of the communities most affected by AIDS has spurred a movement to promote the health and dignity of gay men, sex workers and drug users that has now reached every corner of the world.It was TASO in Uganda, ACT UP in the US, TAC in South Africa, Grupo Pela Vida in Brazil, the Lawyers Collective in India, the Thai Drug Users Network, and countless organizations like them that have woven together one of the most extraordinary movements the world has ever seen. Remember what ACT UP stands for: the AIDS Coalition to Unleash Power.This has been a movement that came together in anger, that thirsts for justice, that is fundamentally about unleashing the power of human solidarity, and that for 30 years has forged alliances to expand that solidarity and be ever more inclusive.A movement that has grown to include pioneering governments from Brazil to Botswana, UN agencies, visionary donors and donor countries, and groundbreaking NGO treatment programs; a movement that has led to efforts such as 3 by 5 and the creation of the Global Fund and PEPFAR.Thanks to this collective effort, we have seen remarkable gains in the fight. Prevalence has fallen steeply in many countries, new prevention strategies show great promise, and more than 8 million people are on treatment today. As we gather here in Washington, we look towards the end of AIDS as something that is actually within our reach, a vision that to me and many others here seems less idealistic, less outrageous, than 3 by 5 did, just a decade ago.Today marks the first time that a President of the World Bank Group has addressed the International AIDS Conference. I’m here because I know what this movement is capable of achieving. I’m here to bring you both a pledge and a challenge.I pledge that the World Bank will work tirelessly with all of you here to drive the AIDS fight forward until we win.And I challenge you to join me in harnessing the moral power and practical lessons that the AIDS movement has produced to speed progress against that other global scourge, poverty.As the leading global development institution, the World Bank is concerned with all aspects of development, all the dimensions that are united in the eight Millennium Development Goals. We know that development challenges are interdependent. And yet our approaches to these problems often remain fragmented, limiting our vision and our results. That’s why the idea of bringing lessons from AIDS to poverty reduction is crucial. By breaking down siloes between these two efforts, we begin a process that will go much farther. Ultimately we’ll multiply the flows of knowledge and experience across all development sectors, accelerating progress on education for all, maternal and child health, environmental sustainability, and so many of our other goals.Let me describe how the World Bank is applying its distinctive strengths to AIDS.The World Bank’s mission is to build prosperity and eradicate poverty in countries around the world. The Bank supports countries with financing, but also with knowledge and analytic capacities that are often just as important. In 2000, under President Jim Wolfensohn, the World Bank worked with many of you here to put the first billion dollars on the table for AIDS. Today, in health, the World Bank’s comparative advantage is in systems building. Our health sector strategy is focused on supporting countries to create health systems that deliver results for the poor and that are sustainable. We also help countries build social protection systems that can mitigate the impact of events like economic shocks and catastrophic illness, including AIDS, on families and communities.As an example of our health systems work, the World Bank is helping governments implement performance-based financing, which gives local health facilities financial rewards when they increase delivery of essential services and improve quality. In Burundi, after a performance-based financing model was introduced nationally to strengthen the AIDS response, the number of HIV-positive pregnant women receiving antiretrovirals for the prevention of mother-to-child transmission increased by 65 percent in just one year.We know that HIV is more than a medical problem. AIDS has devastating economic and social impacts on individuals, families and communities. That’s why social protection is also a critical piece of a comprehensive AIDS response. Every year, worldwide, 150 million people are forced into poverty by increased health expenditures and lost income due to illness, including AIDS. To date, the Bank has helped 40 countries scale up social safety-net programs, including health insurance schemes, old age pensions and cash transfer programs that supplement the incomes of poor families. Our goal is for all countries to be able to implement basic social protection programs tailored to their specific needs.Success in the AIDS response depends on partnerships. On a very personal level, I am committed to strengthening the World Bank’s multilateral alliances with UNAIDS and the Global Fund; our partnerships with UN technical agencies, including WHO and UNICEF; and our collaboration with PEPFAR and other bilaterals. Moreover, strong partnership with civil society that delivers results for the poor will be a signature of my presidency. We’ll build on the lessons of the Bank’s MAP initiative, which recognized that civil society voice is critical to make programs work for poor and vulnerable people.In 2008, the overall proportion of people in the developing world living on less than $1.25 per day was 22 percent, less than half of the 1990 figure. The Millennium Development Goal of halving the incidence of extreme poverty has been reached. But today 1.3 billion of the world’s people still live in absolute poverty. This is intolerable. We can and must end absolute poverty in our lifetime. To do so, we’ll need to share know-how across the boundaries of institutions and development fields. And we’ll need to use that know-how to build systems that can sustainably meet human needs.The AIDS fight has shown the world how to turn the tide of a massive assault on human life and dignity. We have a responsibility to ensure that lessons from AIDS inform and improve our efforts to tackle other social goals, above all poverty eradication. In some places, this is already happening. Governments and their partners are applying AIDS knowledge and resources strategically to beat the epidemic and simultaneously drive a broader anti-poverty agenda. Rwanda has used AIDS money and technical expertise from the World Bank, the Global Fund and others to build up its widely admired health insurance system, the mutuelles, and to expand secondary and vocational education. In Rwanda, AIDS resources are contributing to the strategic investment in human capital that has helped drive the country’s remarkable economic progress. From being an exception, this approach can become the rule. This will be a leap forward in our capacity to build systems and deliver results. As Rwanda shows, successful countries have tackled AIDS as a systems problem. They’ve responded to the epidemic by strengthening delivery systems for key social goods, and they’ve integrated those systems to address people’s needs comprehensively.Building systems is what the World Bank does best. We have decades of experience making systems work for all, but especially the poor. I want the Bank to lead the world in joining systems knowledge with clear moral values to help countries solve their toughest problems.Two features of the AIDS fight with clear lessons for poverty work are openness and innovation. The countries that have achieved the greatest successes against AIDS have been open about their epidemics. They have shared information widely, challenged stigma, and encouraged public debate. They have refused secrecy and dispelled irrational fear. There are many lessons here for the way we fight poverty. As we at the World Bank continue to tackle corruption, increase transparency and freely share our data, we’re taking these lessons from the AIDS fight ever more fully on board.Looking back over the last 30 years, we see that the AIDS response has generated continuous innovation. From the acceleration of drug approval protocols to task shifting within medical teams. From fixed-dose drug combinations to the hiring of accompagnateurs to deliver community-based services.We’ll need more innovation in the years ahead to finish the fight against AIDS. As President of the World Bank, I want to infuse that same appetite for innovation into the struggle for inclusive economic development. I’m convinced that if the practical know-how and the spirit of the AIDS movement can be brought to the poverty fight, there is no limit to what we can achieve.On the front lines of the 3 by 5 initiative, I saw daily how HIV implementers were generating innovative solutions to practical problems: from supply chain management to human resources to creating space for community voice in program evaluation. But have we done enough to organize, analyze and apply this knowledge? Have we brought it to bear in every setting where it could be transformative? All of us here know that a difficult fight against HIV lies ahead. We have come to Washington because we are determined to win that fight. We see our task through the lens of solidarity that has inspired the most ambitious AIDS activism and that we all feel today in this room. From the start, as they fought this epidemic, the activist pioneers knew they had to tackle the structural forces of prejudice, social exclusion and economic injustice. Their ambition to end unjust human suffering was as vast as the suffering itself. All of us here today must be just as ambitious.The AIDS movement has rekindled values that show the kind of global development we’re striving for: development grounded in solidarity, courage, respect for the dignity of all people, and an unrelenting demand for justice.If we unleash the power of these values, we can overcome any obstacle in the fight for economic and social justice. If we unleash the power of these values, we can leave to our children a world free of poverty and AIDS.We can end AIDS. We must end AIDS. The challenge we face is great. But as I look out at all of you today, I can actually see the end of AIDS. Thank you, let’s make it happen. Show Less -
Could you please introduce your self and your current job?My name is Nguyen Thanh Lam, a peer educator in Da Lat city. In general, my key tasks are to provide information and educate drug users and fe... Show More +male sex workers so that they can understand the risky behaviours to prevent themselves from HIV infection and transmission. With my facilitation, the injection drug users know how to have safe injection and use clean cylinders. I share with them some leaflets and instruct them how to clean cylinders. I warn them not to share cylinders and needles with others. For female sex workers, we provide them with condoms and instruct them how to use condoms properly to prevent HIV infection and transmission risks.Could you tell us how you became a peer educator?During my youthhood, I was elated and dissipated with my friends. However, later when I was awakened , I recognised that the life had been better and better, the people in a modern trend were becoming more “truthful, honest and beautiful”. By that time, I received a training invitation from health staff under the LifeGap programme and I did not understand what peer education meant. However, having met with health staff, thought about my past of elated and dissipated life and being curious, I decided to attend the training. After that training in 2005, we understood the meaningfulness and objectives of peer education. I thought that if my community did not implement this programme, my peers would have disadvantages. We are the persons who know and understand better than anyone else how miserable and hurtful we are. Therefore, I should take the responsibilities and do tasks to make a small contribution to the effort of the whole province.When doing the job of a peer educator, what have your family or neighbours said or if they are against your activities?Generally speaking, when I decided to work as a peer educator, I explained the objectives to my family and they are tolerant. However, due to the limited understanding and awareness of local people or neighbours or families of people living with HIV/AIDS, they sometimes discriminated and stigmatised us. After a long period of time, they better understood, regconised the importance (of my job). They advocated for and supported (my job), especially the provincial HIV/AIDS center as well as the epidemic prevention and control team in Da Lat. With regard to the local authorities, at the beginning it was very difficult, but later when they understood the objectives and knew that I did the job with my whole heart, without much income, then they were very much helpful and supportive.When doing the job of a peer educator, do you have any rememberable memories that you would like to share?In peer education, due to the unique conditions of the city and the province, we haven’t got any support projects or programmes, so we defined the objectives of supporting our own relatives and friends first, because we live with them and know they are in pitiful circumstances. Among more than 50 trained people, only 12 people were recruited and we worked very actively and effectively during the LifeGap project. However, it was terminated in 2007. In that photo, about 4 – 5 people died and it was me who cleaned their death bodies and arranged the funerals for them with the assistance of health staff. At present, there are still many of them suffering difficulties in their lives, in life something should be lost, but not, while something else needed and not prepared to be lost has been gone. For example, one of my friends, he is now in the critical period, but has not received ARV treatment, and he is now seriously sick in both black and while meaning. His body carries the century disease, and physically, he has one leg longer than the other. He has a bad luck continuously, his house was collapsed, he is survived but all assets have been destroyed. Other depressing damages occurred when his animal stock was destroyed by typhoons and floods. He is now in a critically difficult situation. With our capacities, we cannot do any thing for him except giving him some verbal encouragements and small gifts. Anyway, it is very difficult and we are very worried and sorry. That is a bit painful memory.When you work with other peer educators and know different stories as you have shared, have you ever feel hopeless and do not want to continue your current job?We have different reflections, worrisome and thoughts, but we don't think that is the full picture, we have to think how to move forward, encourage our brothers to live to come over, to do whatever beneficial to the society, that is better than a normal person doing nothing. That is our life goal.What have you done for the society that you are proud of?From what we can see it is obvious that the HIV/AIDS centers, mass media, culture and information agencies are organising communication campaigns with different forms of panos, billboards and public art performance competitions to improve the public awareness, while we are, the sex workers, injection drug users, responsible for helping improve the awareness and implementing harm reduction interventions among us. We have advocated and distributed clean cylinders, instructed how to clean cylinders and warned them not to share cylinders and injecting objects. With female sex workers, we distributed condoms, instructed them how to use properly and advised them not to have sex without being protected as requested by their clients, they must always use condoms when having sex.When doing the job, have you had any cases or rememberale memories that you find difficult to approach and challenging that you were discouraged and wanted to give up?In general when having difficulties, I have to try to handle. While doing my job, I have many in-depth memorable stories, but more specially in recent time at a hot spot of sex trading, I met a sex worker who is deaf and mute, with our limited capacities we could not explain and educate this person. We had to seek the assistance from the school for people with disability and they were willing to support us with interpretation when they know the objectives of our activities. With the interpretation, we told the client how to use condoms, where the condoms can be provided and who distributes. For those people who do not want to use condoms, we advised the client absolutely disagree to have sexHow do you find your activities are meaningful to the communityPeer communication activities in Lam Dong province are very meaningful. We all understand that we have disadvantages and limited awareness/education, therefore there are many miserable lives. We have tried to advocate, educate and approach them step by step, then they sooner and later improve their knowledge and know how to prevent themselves from high risk behaviours and help other brothers access to ARV treatment free of charge provided by the Government.As a peer educator, do you see any changes to yourself and in your life?Of course, working as a peer educator, recently I have seen my personal benefits diminishing due to decreased incomes. Second, I have invested myself in this job, but in order to fulfill my wishes and responsibilities I have to accept it and have careful expenditure plan to cover my daily expenses. .How is about your mental life? Is it different?Mentally, I feel very comfortable. After working days and meetings with brothers, helping them understand the issues, and then I feel very happy when coming home. When the conditions are not allowed, for example bad weather or no campaign, I cannot approach them, I am very worried about uneducated peers and inaccessible areas if they know how to reduce harms. However, I have certain plans to approach them and conduct peer education.Do you think you will be engaged in this job for a very long term or just for a certain period of time?With regard to this question, we all defined at the very beginning that we will try our best to contribute if we still have capacities, energies and there are social needs. However, at the same time, we have trained a younger generation , i.e collaborators who later on will continue our duties. I myself has committed that if my health is good and the conditions are appropriate, I keep trying to complete my duties in coming time.Thank you very much. Show Less -
First of all, could you please introduce briefly yourself?I am Le Thi Hong Yen. I was born in 1980. My hometown is Binh Dinh province; however, for living conditions, I have moved to Vung Tau and have... Show More + been living there for 12 years now.You are a senior peer educator in Ba Ria Vung Tau. Could you please tell me how you have become a peer educator?When I first moved to Vung Tau, I rented a room next to a karaoke restaurant. In my free time at home after work, I often talked to some women who worked there. One day, by accident, there was some female peer- educators who used to work there came and talked about HIV/AIDS. I listened to them from the beginning until the end. I felt something very interesting, there were many things that I did not know about. I felt excited to learn about them so I approached them and asked them how I could join them as I found it so interesting. And thanks to their introduction, I joined the program in such an accidental way.You started the peer educating activities by chance, so what’s your most rememberable memory during the time you work as a peer educator?Yes, when we started working as a peer educator, the Law on HIV/AIDS prevention and control was not available, so we faced with a lot of difficulties. The people that we approached were not cooperative and they were strongly against our activities because their jobs are quite sensitive. I would like to tell you one rememberable story. One day, as of our plan, one of my friends and I went by bike to a location about 7km far away from our residential place. When we arrived, the owner of the restaurant was strongly against us. They did it this way. After I came into, said hello and introduced myself, the owner said: “No, go away, there’s nothing to do with you here. There’s nothing here. You are barking at the wrong trees”. I was still hesitant to leave, thinking that it’s no use communicating this way; it’s better to send them some relevant documents and leaflets for them to read in advance. While I was standing, opening my bag to take some leaflets out, they let a big dog out. It was like a buffalo calf not a dog. That was the biggest dog that I had seen during my 30 years. My colleague screamed out and turned pale. I was so scared. Then a man who seemed to be the owner’s husband came home. Seeing that we were so scared, he left his vehicle nearby and shouted at the dog. Then he asked and we introduced ourselves to him briefly. I was thinking that it was not the right time to talk as they were in anger and annoy. I asked for his approval to leave some information packages there as that was our job. We explained him that we just came there in the spirit of sharing and disseminating the information. I gave him the information packages and told that the information were just for him and his staff for their reference. I also told him if it was possible, we would come back again. That was an unforgettable story that I will remember forever. I still remember about the dog. It was such a big dog, much bigger than I could imagine.So while you are on duty, have you ever felt that you are hesitant and afraid of approaching those people? And what is your feeling when you first worked on this?When I first joined the program, I was also trained; more or less I was mentally prepared by the management board about the reactions of those people, and even their unacceptable words. In general, we must be mentally prepared. I was also ready, but many times, I was still shocked. Because, some people are discontented with their lives, so they do not care about what they say. I have met some cases like that.Could you please tell about a case that you found it difficult to approach and what did you do then?There was a case that I did not plan to approach, but happened when I was working for my brother’s café. There was a girl, who came to the café everyday. But with my observations, the way she dressed and behaved, I could tell 70% exactly what her job is. She came for a coffee quite often. At the beginning, I just behaved like a staff with a customer and in a good manner. Then when I tried to approach and explain a bit about my job, she strongly reacted. She was annoyed when knowing that I knew her job. In general, those people often have strong reactions. They asked me why I kept thinking that way, which meant to offend them, etc. Initially, I did not say a word about the communication materials that I had planned to deliver to her. I was just pretending that I knew some girls of also doing that kind of job. Then she wanted to learn from me some information to protect herself. After that we were closer, she shared all about what she had been thinking and afraid of. That was the most difficult client of mine, also the most successful case that I have handled.Have you ever felt that your work is so difficult that you do not want to be a peer educator anymore?Yes, as I told you about the dog. After that meeting, my friend and I were just walking with our bicycles nearly 2 km, saying nothing to each other. She might think about giving up as I was. I felt tired of it. I then met with my team leader and the management board. They also guided us how to deal with such situations. That was the only time that I thought I would give up. For all other cases later, I was fine. I am used to it.You might have approached many cases, targeted groups and people. Which one you see as a success story and you are proud of yourself?My targeted groups are female sex workers. At the beginning, the knowledge of these groups about HIV is very blur, many of them understood nothing about this, and even about condoms, when I delivered to them they asked me what they were. There were cases that were at the age of 15 or 16, as young as my younger sisters, when they saw condoms they felt embarrassed. Since then I have always tried my best to do this job. Now many “sisters” understand the importance of having knowledge of HIV prevention and control measures to protect themselves.Could you please tell me a specific case?Many, but for a specific case, that is the women in the café I shared earlier. In general, when we pay a visit to a restaurant, a karaoke or a massage facility, we often talk to a group. Some restaurants have some dozen of women joining the talk. For the first times, there were difficulties, but later they treated us as their sisters. They joined the talk comfortably and joyfully. They are more courage to share their own stories such as: “what wrong if I am already infected, or what should I do now”? I am very glad to know that they have understood and self studied how to protect them.When approaching those clients, what is the most important thing to gain their trust?I think it is intimacy, it means that I come to them as a sister and a friend, not a person who bring them knowledge, more as a sister and a friend. Therefore, in first meetings, I often do not talk about that issue, I ask “when did you come here or how are you”… in general, I ask questions as friends. For some first meetings, we just had such simple conversations and arranged for the following appointments.After a long period of time working as a peer educator, have you ever thought about your job that is meaningful to yourself and to the society?First of all, thinking about myself, I would say I have a better luck than other sisters, it means that I have been trained. In general, “my professional” is better than the others’. Before, I did not understand any thing about HIV, I was very scared when hearing about it, but now I am no longer scared because I understand it. I understand and know how to protect myself first. That is the first benefit. Then it is also beneficial to my family, communities, friends and society. For the society, I do not dare to say something like about my responsibility to the society, but I want to contribute a small part of my effort to reducing the prevalence rate in my community, not for the whole country or the province. I do not dare to say that, I just mean the reduction of HIV cases in the community where I am living in.When doing the job of a peer educator, what have your family or neighbors said or if they are against your activities?For this question, I would like to tell you a bit about my own story. When I first came here, I stayed with my sister and brother-in-law. At the beginning, when my brother-in-law knew that I was joining the programme, he was working for a joint-venture, his knowledge was limited and he strongly disagreed with my job: “if you do that job, I will not allow you to visit us and stay here any more”, my brother-in-law said. After that I still visited my sister when he was not at home. For each visit, I pretended forgetting some leaflets about HIV in his house. I am sure that my brother had read to see what was written in there. After some times, I left there some leaflets with different contents, he read, for the following visits, I came when he was at home and he did not have any reaction to my job, and I know he allowed me to do this job.Recently you must have thought about your activities with the community. What do you think about your activities could contribute to the community?The first contribution is what the programme has delivered, that is knowledge for all people, for those who have not accessed to the knowledge of HIV/AIDS. Second, the harm reduction interventions conducted by the programme for example provision of condoms or cylinders in my community has been implemented.Do you think that you have to come over your own difficulties to continue doing this job?I have already decided. From the first days of difficulties I was helped by other experienced brothers and sisters, the project management unit also paid close attention and share a lot, and I have decided to do this job as long as the programme exists. I hope that the programme will not be completed soon because there are still many people having not accessed to this knowledge, for example new migrants from rural areas, I am afraid that they do not understand and it is not good.If there is an advice or a message to your clients, what would you like to say?I would like them to learn about HIV at anytime and in anywhere, learn to understand, to know and to protect themselves and try to cooperate with me (us), help us better approach other new targeted groups who have not had opportunities of reading or watching or listening to HIV/AIDS information.Thank you very much. Show Less -