Scaling-up Social Workers Skills

SCALING-UP SOCIAL WORKERS SKILLS FOR A MORE DEVELOPED HIV/AIDS PREVENTION AND INTERVENTION RESPONSES IN VIETNAM Introduction There are 260,000 Vietnamese infected with HIV 2006. A projection for 2010 puts the figure at 310,000. Of this figure, seventy-percent are thirty years old or below. There is an alarming trend that this is not confined to high risk populations. Considering that a greater part of those infected are young, it could also be said that HIV is a youth issue. Despite the fact that awareness to HIV is high among Vietnamese youth, knowledge on its specifics is low. Crucial information then for the youth should be disseminated. The manner on which it is disseminated should also be examined. Studies have shown that there is a dearth of evidence-based HIV education materials for the youth.

This needs to be address through

identification and adoption of best practices. Vietnam is at a critical crossroad as far as the fight for HIV and AIDS is concerned. Since by 2010 it is expected to achieve middle income status as a nation, various donors who provided the backbone of HIV/AIDS program would be withdrawing to countries below the middle income status. The development will provide a gap which if not addressed beforehand will impact negatively on the fight against this pandemic. Studies have shown that information advocacy is crucial as well as a developed social work approach to fight adolescent HIV and AIDS. The indicated gap left by international donors will have to be filled up by local resources as well as a more expanded role for the social workers is needed. We need to scale-up the social work responses in the micro- and macro- levels. There is acceptance that traditional approaches in dealing with adolescent related problems may not

achieve the projected result one has in mind. We have to identify what these best practices are and draw a plan that is updated and responsive.

Literature Review The Joint United Nations Program on HIV/AIDS (UNAIDS) 2008 Country Situation Report on Vietnam enumerated several challenges that the country is facing in its fight to prevent the spread of HIV/AIDS. UNAIDS reiterated the need to focus on prevention, harmonization of laws and policies with the newly enacted 2006 Law on HIV/AIDS Prevention and Control as it decried the lack of multisectoral response. It also recommended scaling-up of implementation of the harm reduction programs, addressing stigma and discrimination, strengthening the national surveillance system, gathering more data on key populations at higher risk, particularly men having sex with men (MSM) and sex workers (Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008). These recommendations are reechoes of previous UNAIDS reports. The only difference at this time is for implementors to seriously take heed since Vietnam is expected to achieve middle-income status by 2010. This would mean donors withdrawing support from national and provincial programs since government on its own has more national resources to respond to HIV and AIDS. There is a need then in light of new and critical developments to plan for the future of programs that are multi-sectoral in approaches and would impact greatly on the community. This has to be done in the face of a looming logistical problem. Coming up with viable programs would require a reexamination of HIV/AIDS situation in Vietnam from the perspectives of actively involved organizations and entities.

Deputy Chairman of the Vietnam Commission for Population, Family and Children described the HIV/AIDS situation in the country as follows: “The AIDS epidemic continues to take its toll on the world, in Asia, and more recently in Vietnam. All 64 provinces in Vietnam have been affected, and the country is facing a growing epidemic. More than 260,000 people are living with HIV. By the year 2010 this number will have grown to more than 310,000. With increasing numbers of men and women affected, the epidemic is no longer confined to high-risk groups. In fact, the majority of new infections are occurring through sexual transmission (Vietnam Commission for Population, Family and Children, 2006).” What is not highlighted clearly on the above is that the majority at risk are the young. From this context, HIV should be seen as a youth issue. According to the 1999 census, more than half of the population of Vietnam is below 25 years of age. Seventy percent of all reported HIV cases are persons below the age of 30. Considering these statistics, HIV/AIDS efforts must pay special attention to young people. The increased vulnerability among the youth could also be the contributed to their engaging in risky behaviors. This is further complicated by the fact that many of them do not understand the risks involving HIV and the measures necessary to protect themselves. Results from the recent Survey Assessment of Vietnamese Youth (SAVY) indicated that most of the youth (98-100%) are aware of HIV. Yet knowledge levels are incomplete or limited. Youth in the context of SAVY refers to persons between ages 14 and 25 years old. Most young people are also aware that condoms are very effective in preventing HIV and pregnancy; however attitudes to condoms are generally negative. There is a strong association of condoms with improper behavior. Only fifty-percent of young people used contraception during their first

sex. Mass media is most common source of information about HIV especially TV (Ministry of Health, General Statistics Office, UNICEF, and WHO, 2005). This lack of access by Vietnamese youth on relevant information on HIV/AIDS has contributed to the increased number of those infected. Lerdboon, etal studied HIV/AIDS Education in Vietnam come up with results not favorable to the current procedures and methods. They claimed that, evidence–based HIV/AIDS training and intervention programs and materials for youth are limited. The Ministry of Education and Training has made efforts to integrate reproductive health and HIV/AIDS education into school textbooks of related subjects (e.g., biology). However, the information is primarily knowledge based and delivered in a lecture style, with few or no materials related to skills building for practical application in youths’ lives. Moreover, these programs are most often constrained by a shortage of teaching aids and resources and limited teacher training, resulting in a low capacity among teachers to integrate and deliver the information in their classrooms. Within mixed-gender classes, youth are most likely hesitant to ask sensitive questions. In addition, because majority of teachers are females, male students are also less likely to ask questions outside of the classroom setting (Lerdboon, Pham, Green, & Riel, 2008). Considering the statistics on the youth and other information and being basically in a state of transition as far as international funding support is concerned, there is a need to identify what particular areas should be given priority by our social workers, non-government advocates and government key persons. The general consensus among stakeholders is the involvement of young peer educators in National Strategic Planning (NSP) and ensures interventions targeting at risk groups with like peers. Care Thailand paralleled each new project or program with its Living

with AIDS Project where involvement of the intended population group or youth in the process of designing and implementation of project activities was an essential factor. In addition the concomitant support of youth networks became a very effective way in involving the youth and reaching more others on a constant basis (Panitchpakdi, 2004). Raks Thai, a Foundation in Thailand described involving the youth as a long-term investment in social capital. Another strategy would be increase accessibility and acceptability of voluntary counseling and testing (VCT) services for young people: make them youth friendly and take the services closer to most at risk youth (MARA). Young people must know their status to protect themselves and their families. Peer education networks guided by social workers and other advocates are a basic need in all programs relating to HIV/AIDS prevention programs. In sum, we our future actions could adhere to the following framework: creating an enabling environment, promoting healthy behaviors, and increasing access to health services. Considering the framework in mind, the Botswana experience on sex workers is worth mentioning. Botswana has the highest rate of HIV prevalence in the world, with 38.8 percent of the population aged between 15 and 49 being HIV positive (UNDP, 2000). Among the high risk groups, women sex workers were prominent in the statistical profile.

Poverty and

unemployment drove these women to prostitution and to the HIV/AIDS risks.

Ntseane’s

research recorded a sex worker’s response as, “We don't like what we do but what else is there, not educated, having given up to finding a job, what would you do? We have no choice but to get money for what you would otherwise give for free and still risk HIV infection' (Ntseane, 2003, p. 24).”

The research further showed that the commonly referred to as “ABC’s” of prevention do not apply in Botswana’s sex workers since neither of them could abstain from sex nor be faithful to one partner when their work requires otherwise. Ntseane’s research enumerated the implications for HIV education and communication, namely: Education and communication remain critical components of what can be done to achieve behavioral change that will lead to the reduction of HIV/AIDS transmission. One, the focus of future HIV/AIDS education and training prevention intervention strategies, research showed that participants acknowledged that a lot was already being done on the HIV/AIDS epidemic but there was still room for empowerment activities. They particularly stressed the need for a focus on information and training on risks of sex work in the context of HIV/AIDS, as well as skill training for poverty- and unemployment-reduction activities. Community representatives emphasized a focus on training that deals with one's mindset, for example educating people on morals and ethical issues. They see information sharing and real consultation with all actors in the sex business as the most appropriate strategy. Based on these suggestions, the inclusion of adult education in poverty alleviation programmes makes sense (P G. Ntseane, 2005). What is recommended by the research is a target-specific and context-based program.. In line with the UNAIDS recommendations and other non-government stakeholders, the Vietnamese government has identified the following major steps to take up in its fight against HIV/AIDS. Its National Strategy Programs of Action calls for behavior change IEC, Harm Reduction, Care and Support, surveillance, access, and a host of other peripheral services. (Vietnam Commission for Population, Family and Children, 2006).

The project that I have in mind will focus on scaling up the response skills of HIV/AIDS social workers of Vietnam in practicing social work with adolescents. The social workers are very crucial not only on the counseling aspect for persons living with HIV/AIDS (PLWHA) but as articulately by the National Association of Social Workers (NASW), the unique perspectives and breadth of social work practice provide systemic linkages between the social work profession and the social entities that affect adolescent development. Adequately meeting the needs of youth means engaging all systems— individual, family, and the broader community—in efforts to prevent problems and promote health and well being. To meet the needs of young people, it is important for social workers to demonstrate a fundamental knowledge and understanding of adolescent development and the critical role of biological, psychological, and social systems (National Association of Social Workers, 2003). More specifically the care of HIV/AIDS suffering children (and youth) requires high quality synchronization and combination of health and social services with taking account on special needs of these PLWHAs (Botek, 2006). The need for a more enhanced social work system and empowered social workers/advocate is reinforced by Krisberg when he stated that the functions of an advocate include interventions on both a micro and macro level. Social workers providing case management services can help clients by assisting them with the disability determination process. Macro level social workers can affect change by lobbying for increased funding from varied sources to assist in the treatment of clients with HIV/AIDS and prevention efforts (Krisberg, 2006). Lobbying for change could be directly or indirectly either through consultations with peer educators networks or institutionalizing high-profiled such as World AIDS Day, AIDS Candlelight Memorial, and other HIV-prevention related national

events. Micro level interventions may encompass the counseling process of both the PLWH and his/her family, friends. This may also include providing assistance or inputs in peer education syllabi or even in the education curricula.

All these in consideration would require a viable impact assessment tool necessary to validate evaluation and monitoring or vice-versa. The Family Health International (FHI) boast of the AVERT model which they claimed can be used to estimate the impact of prevention interventions, such as those that focus on increasing use of condoms, improving treatment of sexually transmitted infections (STIs), or changing sexual behaviors, on the reduction of primary HIV transmissions through sexual intercourse over a given time period. Various types of computer models of the AIDS epidemic have been devised for various purposes (Thomas Rehle, Saidel, & Mills, 2001). It is also indicated that the AVERT model answers the need for less complex models in a manner consistent with the availability of local program data which means that data requirements are considerably less extensive than those for more sophisticated simulation models. Project Purpose The general objective of this project is to identify the areas of social work responses in Vietnam against adolescent HIV/AIDS, examine such responses vis-à-vis actual impact and in comparison with identified best practices, come up with a viable skills enhancement program for social workers dealing with adolescent HIV and AIDS and PLWHA. To realize this, the following specific objectives are necessary:

1.

Conduct interviews and gather additional empirical data and statistics on social work interventions in Vietnam particularly dealing with adolescents and HIV/AIDS;

2. Identify different modes of social work approaches, styles, and gather data relevant to their impact among adolescents; and

3. Develop a social work plan inclusive of a restructured training curricula for social workers engaged in HIV/AIDS prevention among the youth.

Bibliography Botek, O. (2006). Social work with HIV/AIDS suffering children in Cambodia. Trnava University: Trnava University. Joint United Nations Programme on HIV/AIDS (UNAIDS). (2008). 2008 Report on the Global AIDS epidemic. Mexico City: UNAIDS. Krisberg, K. (2006). Changes for Ryan White Act as HIV/AIDS Evolves in U.S. Nation's Health , 1-14. Lerdboon, P., Pham, V., Green, M., & Riel, R. (2008). Strategies for Developing Gender-Specific HIV-Prevention for Adolescents. AIDS Education and Prevention , 384-398. Ministry of Health, General Statistics Office, UNICEF, and WHO. (2005). Survey Assessment of Vietnamese Youth. Hanoi: Ministry of Health. National Association of Social Workers. (2003). Standards for the Practice of Social Work with Adolescents. NASW. P G. Ntseane, P. G. (2005). Addressing Poverty, Unemployment, Gender, Inequality in Southern Africa:An Alternative Strategy for HIV/AIDS Prevention for Sexworkers in Botswana. Gaborone. Panitchpakdi, P. (2004). No Time to Lose. Bangkok: Raks Thai Foundation. Thomas Rehle, E., Saidel, T., & Mills, S. (2001). Evaluating Programs for HIV/AIDS Prevention and Care in Developing Countries. Research Triangle Park: Family Health International. Vietnam Commission for Population, Family and Children. (2006). HIV/AIDS in Vietnam. Hanoi: Vietnam Commission for Population, Family and Children.