HIV Home Visits

Today we set out early in the morning for the countryside of Quang Tri province to call upon 3 of the HIV patients under Di Dien's watch. On the way there we learned that she has 95 HIV/AIDS patients assigned to her and that about 1/3 are on anti-retroviral treatment (ARVs). As a primary care provider of sorts she does not dispense ARVs; the patients must make the trek into Hue once a month to the dispensary at the main hospital. Rather she serves more as a case manager for the patients and their families, periodically checking in on them to ensure that they have the food and water and shelter necessary to comply with their ARV regimen. The standard ARV regimen in Vietnam consists of three medications which must be taken twice a day with food and water; if a patient misses doses the virus can rapidly develop resistance to the medications, rendering them useless. The same is true of anti-tuberculosis regimens (a four drug combination), and about 10% of patients with tuberculosis in Vietnam also have HIV.

Patients are referred to her from the Infectious Disease Unit of Hue Central Hospital after they have been diagnosed with HIV. She and her staff of volunteers conduct an initial home visit to assess the living situation upon discharge. They look for things such as whether there is running water, a clean cooking area, and a separate latrine from the house, or whether the patient even has a house at all. If the living situation is deemed unsafe or unsanitary they argue the case before their board of donors and try to relocate the patient. They also assess the health of the family members, who may or may not have contracted HIV themselves, but are disadvantaged by having a relative with this still stigmitized and often debilitating disease. They check to see whether the children of the family are in school. They provide financial and emotional support for the family, even after the person with HIV dies. All in a day's work for Di Dien.

Of course if she finds a person too sick to stay out in the province, she brings them back with her and admits them to the hospital. Fortunately this did not happen today, although we did visit one young one man with HIV and TB who was recently discharged after she had found him very sick on her last visit. We met him on the side of the road, because his father is currently not allowing him in the house. He showed us his ARV and TB medications, kept in a small baggy in his pocket. Di Dien was very concerned about his situtation and will be working to secure stable housing for him. We also visited a woman widowed after her husband died of AIDS. She and their 3 children (thankfully uninfected) and the grandmother all sleep together on one bed in the simple 2 room structure, although they do have a mosquito net. The cook over an open fire but they do have running water and a proper latrine 20 feet from the house. Much better off than many I met in Tanzania all those years ago. They even have their own local drugstore of sorts - check out this guy on his bike selling an aray of sundries to the tunes of his boombox. He just rolled right on by while we were standing on the path in the middle of the rice fields!

In addition to getting to see the patients in their homes (or lack thereof), today was also an amazing opportunity to see more of the rural countryside. The guidebooks talk about how difficult it can be to get away from the coastline and visit the rural villages nestled in the mountains and foothills of Vietnam. In some cases tourists simply are not allowed by the government. The lack of good roads or anything in the way of a restaurant or hotel is also prohibitive. Standing in the shadows of the rolling green hills which separate Vietnam from Laos today was yet another privledge we were afforded in our roles as part tourist, part family.