Drug addiction has been a major cause of HIV, premature death and social disability in Vietnam. HIV/AIDS spread rapidly in Vietnam, with the first HIV infection detected in December 1990, and 116,565 officially reported cases over the next 16 years (December, 2006). However, estimates of the actual number of people living with HIV/AIDS are far higher and range from 218,000 to 308,000. Among these, 85 percent are thought to be males and 52 percent injection drug users (IDUs).

In the early 1990s, the epidemic of HIV/AIDS was confined primarily to older IDUs (primarily in the south), and ex-workers in An Giang Province adjacent to Cambodia. The epidemic of drug use among youth came relatively late to Vietnam, but in 1998 an explosive epidemic of HIV broke out in young drug users in Guang Xi province China, on the Vietnam border, which also included northern Vietnam. From 1990 to 2000, there was a 13-fold increase in the reported number of drug users. The actual number of IDUs in Vietnam is unknown, but is estimated to be around 128,000 to 183,000 individuals. HIV has spread at an increasingly faster pace in the early part of the 21st century, doubling between 2000 and 2005. The main route of HIV transmission among IDUs in Vietnam is sharing needle, syringes and injecting equipment. According to the Ministry of Public Security, by the end of the year 2010, there were about 170,000 known IDUs in Vietnam—and 30 percent of those users were living with HIV or were expected to become infected with HIV.

Before 2008, when Methadone Maintenance Treatment (MMT) was initiated, a drug rehab detention center was the only solution for opioid dependent individuals. There they received detoxification, education and were put on “labor therapy” for two to five years. Little to no counseling was available in the center. Relapse rates after release were high.

Addiction counseling was introduced to Vietnam in 2006 through a pilot transitional program to help individuals who are released from the detention rehab center to become integrated into the community and prevent relapse. The program was implemented by the Ho Chi Minh City Provincial AIDS Committee with support from the President’s Emergency Plan for AIDS Relief in Vietnam via the U.S. Agency of International Development. The development of this approach has been a collaborative effort between Family Health International and the World Health Organization’s Collaborating Center for Research on Research on Treatment of Drug and Alcohol Problems located at Adelaide University in Australia.

Addiction counseling has improved the quality of drug treatment outcomes by moving providers away from “telling and giving advice” to evidence-based practices. The approach is client-oriented and allows drug users to discuss what they feel would be the most suitable treatment option. Skilled drug counselors now offer care and support in the community for people who use drugs and for those who are 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.

The Expanding Need for Drug Counseling

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 requested information on 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. There is a need for drug counselors to offer the following services:

• Methadone counselors for MMT clinics. Vietnam is expanding MMT to 30 provinces/cities with more than 80,000 opioid dependents on MMT by the end of 2015. This leads to the need for 600 to 800 drug counselors for MMT clinics.

• Drug counselors for transitional programs and community-based drug treatment programs to serve recovering drug users and returnees from rehab centers.

• Counselors at the HIV outpatient clinic, and health educators with knowledge and skills in working with IDUs. It is considered as one component for other counselors working in the HIV/AIDS prevention, care and treatment.

Since addiction counseling is a relatively new concept to Vietnam, counselors face a demanding schedule, which requires working on weekends and holidays. There are a high number of drug users with complex psychosocial needs, and a lack of referral services are available. 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 aides and procedures appropriate for methadone counselors and case managers in the Vietnam setting.

A Critical Need

What is now needed is quality clinical supervision. David Powell has trained many counselors who can grow into the role of clinical supervisors. However, the current need is for an individual who can provide clinical supervision throughout Vietnam, modeling effective supervisory practices.

For additional information contact David Powell at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

David J. Powell, PhD, President, International Center for Health Concerns, Inc., is an internationally recognized lecturer, trainer and author. David has played a significant role in the development and operations of the Oya Bahadir Yuksel Rehabilitation Center.

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