• Adams Louis Phan and Dr Tran Lê Viet Thanh of G-Link tell patients to “be strong like a cactus”. Photo by Jeremy Smart. (Jeremy Smart)
With cuts to foreign aid used to subsidise HIV testing, and stigma still prevalent in the healthcare system, support for LGBTQ people in Vietnam has become even more critical. In response, independent clinics have stepped up to bridge the gap. Elizabeth Beattie recently met the teams at G-Link and Men’s Health Vietnam, two organisations working to change healthcare for LGBTQ patients and attitudes along the way.
By
Elizabeth Beattie

28 Nov 2017 - 11:58 AM  UPDATED 28 Nov 2017 - 12:00 PM

In Ho Chi Minh City’s District 10, a short walk away from the ferocious roar of main-road traffic, G-Link operate a clinic where they provide healthcare, education, and support for LGBTQ people. In contrast to the chaos outside, G-Link is serene. Behind a circle of rainbow planters, a receptionist mans the desk and greets patients. Motorbikes - which grunt and weave outside - lay silent, parked neatly in the foyer.

Foreign affairs assistant and project coordinator Adams Louis Phan and medical director Tran Lê Viet Thanh offer a tour of the premises. Upstairs from their townhouse-style offices, against the low Ho Chi Minh skyline, we view the clinic’s rooftop garden where hundreds of carefully tended cacti are flowering in the relentless sun.

Le Minh Thanh, the director of G-Link, was the first to introduce the plants to the clinic. Now whenever staff meet a new patient, they give them a cactus, as a message to be resilient in spite of adversity.

“The cactus grows in the very hot desert,” Phan explains, picking up one of the heavy ceramic pots.

“We say to them ‘Be strong like a cactus. Survive’.”

“There are some cases where the patients cannot afford the treatment fee.”

Established in 2009 as “a small self-help group”, G-Link grew into a social enterprise the following year. Now they are the first gay-led healthcare provider in Vietnam.

A large part of the organisation’s work is in education, support, and encouraging people to get tested for HIV or STIs. Donated equipment makes HIV testing possible, with the clinic sending samples to partner laboratories for analysis. While HIV rates are dropping in the country, this is not the case within the population of gay men, heightening the importance of targeted testing.

In Vietnam, official statistics report that 205,000 people are living with HIV, but as the country transitions from a low-income to a lower middle-income country, foreign aid has been declining. While the government continues to roll out health insurance as a means of offering free treatment, the insurance itself will still cost patients.

According to official announcements, the government aims for 100 per cent coverage by 2020, but local organisations have questioned whether this will be financially possible without aid. Another dangling question is what will happen to those who cannot afford insurance.

In order for individuals to be eligible to receive health insurance, they must hold identity documents. Speaking to Asia News Network in July, Duong Minh Hai, head of HCM City HIV/AIDS Prevention Centre’s care and treatment department, said that there are close to 1,000 HIV patients without necessary documentation in HCM. Hai referred to this as “the greatest challenge yet to be addressed”.

It is challenges such as these that have made G-Link more determined to provide support and care to those who may fall through the cracks or simply cannot access care.

The organisation recently launched another regional clinic to meet the underserved LGBTQ community who are unable to travel to Ho Chi Minh City.

“There are some cases where the patients cannot afford the treatment fee or the testing fee, so we always willing to support those LGBT members,” Phan says.

Through translation, Dr Tran Lê Viet Thanh tells me that G-Link are the first private clinic Vietnam with permission to offer PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis), medication which help to reduce risk of HIV.

“We are just in the piloting period, but the results are quite good. Right now there are about 200 patients that are coming to our clinic each month,” he says.

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Healthcare perpetuating stigma

Through translation, Dr Thanh explains that for LGBTQ individuals, mainstream healthcare services - seldom equipped for non-heterosexual patients - can be a source of shame.

“Right now in Vietnam there is still a lot of stigma and discrimination based on sex in the healthcare settings.

“A lot of patients, when they come to our clinic, share that they [had] bad experiences of stigma and discrimination in the attitude of the nurse or doctors, so they feel disrespected.”

Donn Colby is a Senior Clinical Research Physician at the Thai Red Cross AIDS Research Center. He says that there can often be anxiety associated around seeking healthcare for gay men in Vietnam.

“Many gay men might use public health clinics, but will not reveal their sexual orientation or sexual behaviour because of fear of discrimination, and therefore will not receive the health services or counselling that they need to fully protect themselves from HIV infection,” Colby explains. 

“Finally, some services such as hormone treatment or gender reassignment for transgender individuals, or screening for some sexually transmitted infections that gay may or more at risk for, are simply not a priority and are not available in the public system.”

While Vietnam has improved in the past few years in terms of recognising the growing epidemic of HIV, Colby says that within the LGBTQ community, more support is still required.

“I think that there is still a blind spot at the highest levels of the Ministry of Health in terms of recognising the true number of LGBT people in Vietnam, which they underestimate, and in seeing the overall trend in the HIV epidemic away from the groups that represented most HIV infections in the past, namely intravenous drug users and female sex workers, toward the different groups that will represent the majority of new HIV infections in the future, which are MSM or gay and bisexual men.”

“That blind spot results in under-funding of services for the LGBT community such that even with recent increases in funding, the proportion of HIV prevention funding that targets MSM and transgender women in Vietnam is less than the proportion of new infections in the country that these groups represent.”

Prioritising this healthcare and combating the stigma which commonly surrounds those who identify as LGBTQ is something G-Link view as an essential part of their mission. Phan says it is also important to improve “the image of gay men” in Vietnamese society, noting that changing attitudes requires education and understanding. 

“I just want to say that we’re just like you, we’re normal people, the only thing we’re different from you is our sexual orientation. That’s all.”

“We’re just humans, we want to be loved, to be respected, to be treated like everybody else. I think that is the biggest, the only thing, our community needs in Vietnam, and around the world,” he says.

“This is the reason why G-Link was born. This is our mission, our mission is to bridge the gap between our community and our society, and we want to combat the stigma and discrimination. That is what we are doing right now.”

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‘What? There is only girl and boy’

Not far from G-Link, in the crook of a winding, leafy, residential street, sits Men’s Health Vietnam (MHV). The clinic, that makes the bulk of their revenue through providing mainstream outpatient care to men, is also known for providing clinical care to LGBT people. Some of their services include gender reassignment surgery, HIV and STI testing, and mental health support.

Despite its pristine white walls, MHV is far from austere – “Shake it Off” by Taylor Swift is piped through the audio system while small rainbow flags are positioned in each of the rooms. The staff at reception smile warmly.

It’s very important for the clinic to be welcoming, explains Ân Hoai, who works in marketing.

Those who do walk through the doors may have already experienced a great deal of hardship or stigma.

While staff concede the government in Vietnam “officially” supports LGBT people, when it comes to societal understanding, there is still a long way to go.

“We have a long history of traditionalism, when I [say] the word ‘LGBT’ to my grandma and grandpa, they said ‘What? There is only girl and boy’. They don’t know anything about different [gender identities],” Bách Xuân, who works in marketing at MHV, explains.

Even the tucked away location is a consideration for the patients; while neighbourhood businesses bustle and shirtless men and colourfully dressed women toil outside, calling out as they work, MHV is a calm sanctuary away from the frantic city pace.

Xuân says that many LGBTQ patients are cautious about coming to the clinic.

“I think they are very shy to meet people, so our organisation is not easy to find so that they can come and no one will find out.” 

Dr Hai Haong says that it’s important for the wider population to understand that homosexuality occurs naturally within the population.

“LGBT is normal, we have to accept that it develops within society,” he says. One way of doing this is educating others at a primary school level. He says at the moment, MHV spend a lot of time educating people and dispelling false information garnered from the internet. The organisation believe that education is key – both within the LGBTQ community and beyond. 

For Hoai, the goal of the organisation comes down to human rights.

“LGBT and other people, we live on the same earth. We have the responsibility to care and it’s not a separation about gay or transgender...We need to view every single person equally,” he says.

“We try to contribute another view, that LGBT are normal people, who equally deserve happiness.

“It’s good to be here and contribute my work to help everyone to understand more about LGBT and provide more information for them and encourage them to come out. Because it’s normal.”

As well as providing medical care, MHV collaborate with other like-minded organisations, including Viet Pride, in order to hand out condoms and offer free HIV testing at events and organisations. Through this outreach, they also bring their positive message.

After my interview with MHV’s staff concludes, the group step outside for a photo. Hoai pulls me in to join them. They hold up their thumb and index finger, as casually as Americans hold up ‘the peace sign’.

“It’s a heart,” Hoai explains, showing me how to make the shape too.

“For love,” he adds with an infectious smile as the shutter clicks.

The symbol is a reminder of what G-Link and MHV are both striving for – essential healthcare in one of the world’s most populous countries, and the freedom to love.

While aid cuts and ingrained attitudes impose rocky future for the LGBTQ community in Vietnam, these organisations continue to work to improve the process so others don’t have to experience the hardship they, their friends, and patients have been through. Through their tireless work, they are seeing the immediate impacts of support, they tell me. Now they just have to wait for legislation, and for the healthcare system to catch up.