® USAID I HEALTH POLICY - ~-~- INITIATIVE VIETNAM 

Results and Lessons Learned for SusfalnablfllY and Scale-up 
E'O!u_a.JiQD.JtMJ1i 
Nguyen Dinh CUMg 
Kieu Thanh Binh 
Doon Ngoc Doan Thanh 
Nguyen Thl Ngo<: Phung 
Bui Thi Tro Giang 
Technic". Advisors; 
Andrew Wo!dr.m 
Throdore M. Hommett 
Christine Ortiz 
Nguyen Ouy Tung 
Vu (ong Nguy<m 
Nguyen Tuan Phong 
Dong HaSon 
TABLE OF CONTENTS 
ACRONYMS ___ . ______ . __ . ___ . __ . ______ . ______ . ______ . ___ ___ _ ____________ . _ ..... __ .... 2 
EVALUATION Of THE 1~ CONDOM USE PROGRAM __ . __ . ___ . __ . ___ . __ _____ __ ._ ... . 1 
PROGRAM BACKGROUND __ . ___ . _._ ..... _. ___________ ___ ________________ . ___ . __ . __ ... 4 
EVALUATION METHODOLOGY _____ ••••••. __ . ___ . _______ _ _ • 
EVALUATION RESULn; . ______ . ______ .••• _._. _________ _____________________ ___ • __ • __ .. _ 6 
Imp'",menU,llon highlights lind chllllltng., ___ . ____ ______________ ___________ .. _..... 6 
In lll.l ",ffectlvltnt" lind project Impilc! _____________ . ___ . ______ . __ . _________ . ___ . ___ . 10 
Lessons learned lind Just.ln.blllt)' ____ . ______ ._. ____ ... _ .... _. _________ . __________ . 13 
CONCLUSION •••••• _._ ••.•••••••••••••••••••••••.•••••••••.••••••.•••.••.••.•••.••.••• 14 
RECOMMENDATIONS ................................................... _ . _____ _ . _ .... 14 
RKommend.tlon5 for progr.m Improvement . ...................................... 14 
RKommend. t!on5 for policy development .................. _____ _______ ___ ___ . .... _ 1 S 
BIBLIOGRAPHy ........................................................................ 16 
ACRONYMS 
lOO'11oCUP 
AM 
AIDS 
CDC 
""0 
EE 
'GO 
FHIl60 
"W 
"" 168S 
'0' 
'OU 
lG 
M'" 
MOLISA 
"" PATe 
" PHAO 
"" 
sn '" 
USAIO 
USAIDIHPI 
WB 
1 OO%Condom Us.e PTogram 
A"Giang AIOSAn()(I~Uon 
Acquired ImmuJ'lodeflciency Syndrome 
Center~ for DiseaseConlloiand Prevention 
Department for International ~ment 
Ente.-tainmenl btablishmenl 
Focus G,oupOiscussIon 
Family Health I Ilterna! iooal 
Female SexWorker 
Human Immo,mooefoclencyVl.U5 
Integrated Biological and ~hilviofal SU'Vf'iliance SUfVf'Y 
In-depth Interview 
Injerting Drug User 
CDC -life GAP 
Monitoring and Evaluation 
VietnamesE' MinlsuyofLabol', Invalids and SocialAffair1 
Provin<:al AIDSCente' 
Pwvincial HIV/AIDS andTubefculosls P1evention and(onl.oI Centre 
Pei!rEducator 
Institute ofPopulatioo. Health and Otovelopment 
ProvinCial People's Commlnee 
Population Services International 
Sexually Transmitted InfK lion 
United State$Agencyfo. International Development 
fiealth Policy Initi,ttive 
Wood Bank 
EVALUATION OF THE 100% CONDOM USE PROGRAM 
Results and Lessons Learned for Sustainability and Scale-up 
The USAID·funded Health Policy Initiative (USAIDfHPI) 100% CUP (100% Condom Use 
Program) Is an important harm reduction strategy being applied In An Giang province to 
reduce the transmission of HIV associated with commercial sex at entertainment 
establishments (££s), Including 
hotels, guest houses, karaokebars, 
and massage parlors. The program, 
which began In August 2009 In 
partnership with the An Giang AIDS 
Association (AAA), uses a classic 
100% CUP design informed by best 
practices from similar programs 
Implemented in Cambodia and 
Thailand to encourage and 
facil itate a mOre supportive legal 
environment for harm reduction I'ichHC !:Exp.~ .. ""ring"""*>ltGp !~CUPjnAnGjG"II'. 
inter~ntions at the local level. It is a Photo:Dong Ito s.... 
collaborative program between local authorities (health, police and other provincial 
government agencies), EE owners/managers and sex workers, as well as organizations 
delivering outreach and condom provision programs (fHI360, PSI, the World Bank (WB), and 
COC-lifeGAP) that promote the use of condoms for l00%ofcommercial sexual acts In 100% 
of the EEs in the inter~ntion sites. 
Over the year<;, EE-based harm reduction interventions for female sex workers (FSWs) a~ 
received the attention and support of numerous programs and projects. These inter~ntion 
programs were previously considered to be in conflict with the Ordinance on Prostitution 
Prevention and Control, which States that the possession of condoms is evidence of 
Involvement in illegal commercial sex activities. Since the enactment of the HIV/AIDS Law In 
2006 and the promulgation of Decree 108 in 2007 guiding the implementation of this 
HIV/ADS law, the legal environment for conducting harm reduction activities has become 
much mOre supportive. However, local level acceptance and implementation of these 
national policies has been a slower process. In An Giang, positive participation by the local 
authorities and all other stakeholders has facil itated an environment conducive for the 1 00% 
CUP. 
PROGRAM BACKGROUND 
The l00%CUP in An Giang province is being implemented at two sites: long Xuyen city and 
Chau Doc district. Selection of the intervention sites was based on provincial HIV/AIDS 
prevention priorities as both d istricts have many EEs, a relatively high rate of HIV and Sexually 
Transmitted Infections (STls), and various existing peer outreach condom promotion 
programs. 
The program was designed to promote solid cooperation and coordination between the An 
Giang Provincial HIV/ AIDS and Tuberculosis Prevention and Control Centre (PATe), the police, 
and the AM. with an explicit link to various implementing partners and a technical advisory 
board for program implementation. 
Members of the advisory board 
included experts fromthe provincial 
departments of Health, Public 
Security, labor, Invalids and Social 
Affairs, and Culture, Sports and 
Tourism. 
Within t he frameworkof the project, 
capacity building is used to improve 
theawareness, knowledge and skills 
of the program participants, and 
includes relevant agencies such asthe police and ownersfmanagersof EEs. 
After two years of implementation at pilot locations, the program aimed spe<ifically to have: 
• More than 90% of EE OwnerS agreeing in writing to join the 100% CUP and actively 
participating in the program; 
• More than 90% of FSWs reporting consistent condom use during all sexual acts with 
clients; 
• MOfethan 9O%0f male clients reporting that they could not obtain sex from an FSW 
withouta condom; and 
• Improved capacity of local partners to manage the intervention. 
EVALUATION METHODOLOGY 
The objective of the 100% CUP evaluation was to measure the program's achievements 
against its objectives, extract leHom learned to improve the model. and provide 
recommendations for other province<; to implement the 100% CUP. More specifically, the 
evaluation aimed to amwer the following studyquestions: 
i) How was the program Implemented to achieve the established objectives in An 
Giang?and; 
ii) Howcould An Giang's l00%CUP besustained,adapted.andscaled up in Vietnam? 
The program evaluation is being conducted in two stages. The first stage (the subject of this 
summary report) uses qualitative and quantitative analyses to evaluate the implementation 
process and non·quantitative program objectives. Qualitative information was derived from 
in·depth interviews (lOis) and focus group discussions (FGOs) with all stakeholders involved 
in the program Including: FSWs, EE owners, police officers (collaborators), project officers, 
staff of implementing partners. and the Provincial People's Committee (PPC). Quantitative 
Information was derived from program monitoring .eports. 
The second stage will assess behavioral outcomes from surveys to be conducted in 2012, 
Including the Family Health International (FHIJ60) Integrated Biological and Behavioral 
Surveillance Survey (IBBSI and Population Services International iPS!) surveys of FSWs and 
male clients. Table 1 provides a summary of the number and type of respondents involved in 
the qualitative data collection. 
'0 SUbjK Ii Long Xuy. n Chau 00<: Tota' city district 
, 
, Non-participating EE owne" , , 
, 
• Restauranl·based FSW, • , , 
, 
• Provincial authoritie, , , 
, 
• PATe staff , , 
, 
" Pee, educato" (lG, FHI360) , 
Limitations ofthls evaluation methodology include: 
• Difficulties in ascertaining the project's contribution to outcomes due to other HIV 
jnter~nlions operating In the samea,ea; 
• Lack of a baseline assessment to provide comparison data; 
• Dissimilar quantitative data collection methods used by different partners (FHIJ60, 
PSI) which limits data analy<;is; and 
• Possible inaccuracies in information provided during In-depth interview<; and focus 
group discussions due to the semitivlty of the issue<; being dlo;cussed. 
EVALUATION RESULTS 
Implementation Highlights and Challenges 
Overall, theevaluation found the following results for the 1 OO%CUP in An Giang: 
Program approach and operational organization: 
• The program has succeeded in establishing and maintaining links among various 
participating partners. The program worked with all partners to develop and 
regularly update a map and list of targeted EEs in the sites. including hotels, guest 
houses, karaoke bars and massage parlors. 
• The 100% CUP has consolidated cooperation between local sectors and mass 
organizations, as well as technical support from the PAlC, especially EE owners' 
involvement and commitment to have condoms available at their establishments. 
• The 100% CUP was acknowledged for its important role in linking harm reduction 
interventions in An Giang such as the PSI condom social marketing program, FHI· 360 
women's health clubs for FSWs and the FH136O. CDC Life-GAp; and WB peer education 
programs. 
• A persistent chal lenge has been coordinating the various condom provision 
programs. The project reached an agreement that the provision of free condom 
brands should be limited to street sex workers, while EEs should offer only partially 
subsidized Or non·subsidized condom brands. However, this agreement has not yet 
been fully implemented (some free condom brands are still available in EEs through 
WB and FHI360 peer outreach programs). In order to carry out PS"s Total Market 
Approach for condom provision and fully implement the agreed An Giang market 
segmentation, it will be necessary to further improve coordination among the 
various implementing partners. 
Developing a supportive legal environment: 
• The positive attitude and support from the PPC have helped create and maintain an 
effective legal framework for coordinating interventions targeting FSWs. Provincial 
authorities, including the PPC and the Departments of Public Security and Culture. 
Sports and Tourism, have issued and implemented a series of legal documents 
demonstratingstrong multi·sector support for the 100% CUP and, despite initial 
reluctance, many police officers have participated positively and come to support 
the public health objective<; of the 100% CUP. The program has also helped other 
harm reduction programs in the area O\If'rCOme barriers in the perception of harm 
reduction inter~ntions. 
Role and participation of the police: 
• The results of the intervention show the pivotal role of the police force in 
implementing the 1 OO%CUP, although accepting their role and participation In harm 
reduction activities has not been easy for them. Police officers were initially reluctant 
to act as collaborators because it was a shift from arresting EE OwnerS who made 
condoms available in their 
establishments, which has 
traditionally been considered 
proof of providing prostitution 
services, to agreeing, and even 
reminding, Hs to ensure 
condoms are readily available. 
Once the initial paradigm shift 
occurred in the perception of 
the police force and they 
became active participants in 
the program, police officials Phoro: Km. Thonh ainh 
felt mOre confident. This is a positive and significant change within the police force 
regarding harm reduction for controlling and preventing HIVIAIDS. As a result, the 
police force is now mOre actively supporting local HIVIAIDS prevention and control 
activities. The police now proactively conduct regular supervision visits to EEs to 
ensurethey are adhering totheir program commitments. 
• Howe~ , there are still contradicting opinions that make the participation of police 
officers diffrcult. Some offrcers have indicated that the required regular program 
reports are a burden and they do not believethey are essential. 
• This evaluation J'IOtes that some collaborators (police) have u5<"d their authority to 
force EE OWnerS to participate in the program and then ched the availability of 
condoms to make Sure the EE is complying with the program. There ha~ not b~n 
any formal sanctions (for example fines) against EEs violating the terms of their 1 00% 
CUP commitment but a number of owner<; said that some police officers used the 
commitment as an instrument to threaten and punish establishments where 
condoms were not available. The evaluation also highlights differing opinions on 
whether there should be sanctions at all. Many program manager<; pfOpo5<" sanctions 
as a strong Incentive forcompliance, but some police and local authorities still believe 
they should not be imposed at present. An important lesson learned from the 100% 
CUP in An Giang is to encourage EE OwnerS and their employ~s to participate in the 
program voluntarily by rais ing awareness, thereby allowing them to realize the 
benefits of participation. 
Role and participation of entertainment establishment owners: 
• Many of the EE OwnerS interviewed responded positively to the program and said 
that participation has provided opportunities to cooperate and share information 
through meetings and workshops. 
With the support of the .-----------------, 
collaborator network of 
commune police officers, the 
project was able to enlist 
almost 100% of the EEs at 
which commercial sex acts 
may OCCur to participate in the 
program. Figure 1 shows the 
proportion of EEs enrolling in 
the program. Most of the 
owners (10 out of the 13 
interviewed) responded 
PktUf. J: _ing wirh EE OW"",.. 
Plooro: /Imt Thanh 8inh 
positively regarding the program because they are now able to publicly supply 
condoms. rather than providing them"under the counter". 
-
CHAUDOC 
Aug-{)9 AfK-09 F.t>-IO Mar-' O ... ug-1O /o,pt·l0 Fob·11 Apr-I I 
Fig"n 2: h"~nfd~ of EfJ ~1t"'I'H I" I~ CUP, .. r wltlclt com",.,.;'" J." ""'1 <KCur 
• Howe~,. an owner ~ ~ignalure alone does not indlca!e a change in awareness Or 
whether participation was voluntary. Some OWnerS were reluClant to join the 
program andlor haVf' indicated that signing the commitment was merely a way to 
placate the police, To some extent, the commitment to display and provide condoms 
generated some concern for EE owners/manager! related to their customers' 
perception of the service<; provided, especially where those establishments do not 
offe, sexual services.There were C35<"S where ownersof family karaoke clubs or barber 
shops would not s,gn the commitment, arguing that their custome,s would not need 
condoms since no sexual services were offered. 
Capacity building and training to Improve EE staff knowledge and skills: 
• The attitudes of EE owners and their sense of re<;ponsibility toward their employees 
have likely been improved through the program's awareness rais ing activities, as 
evidenced by increased condom availability and owners al lowing employees to 
obtain periodic screening for STls and treatment as ne<:essary. The lOis and FGOs with 
13 EE owners revealed that many owners bought condoms themselves to ensure 
availability, and some have supported their employees In requiring clients to use 
condoms even when the client offers larger payments for sex Without protection. 
• Promoting condoms in EEs has created an environment that enables employees to 
take part in activities to control HIVfAIDS including access to STl screening and 
treatment, discussions about HIVfAIDS prevention and protection and the correct 
use of condoms. and sharing lessons leamed on persuading sexual clients to use 
condoms. 
• Although the evaluation indicates clear changes in stakeholder perception and 
capacity, it also shows the need for improved descriptions of and planning for 
capacity building within the pfOgram frameworK. mainly related to Individual skills 
and program management. One implementing partner staff member noted that, 
"Capacity for joint implementation has improved, yet still needs to be enhanced." 
Initial effectiveness and project Impact: 
• Findings from lOis have shown that the knowledge and behavior of FSWs and their 
clients related to preventing HIV infection through condom use impfOved. 
• limited qualitative data suggests that the availability of condoms in Eh contributes 
to the Increased use of condoms by FSWs and their clients. but verification of such 
conclusions must await further !BBS, FSW and cl ient survey data that should be 
available later In2012. 
• According todata gathered through the program's monitoring system, almost 100% 
of the targeted EEs In (hau Doc and long Xuyen reported maintaining and increasing 
the availability of condoms, as shown In Figures 3 and 4. 
F~b lO May·lO Aug·lO N",,·lO Feb-ll Apr·11 
• F .. lly ... budi_ • PSI (Pa rtlally . .. b.idind) • No n ... b.idizad 
-----.J 
Flg .. ,e J: ".anld~ of pd.ti<:lpdrlng Ef.ln '''dOl Do<: by condom P'o~/sI"" ."",a. 
- =--------1I--c~ 
-
F.t>-l0 May-IO Aug-IO N<w-IO b-ll ""'-11 
• f ully ... lniclin d • PSI (Partia lly ."b. idi1..d1 • No n . .. b.idi1. d 
Flgu,e 4: PefU"'d~ of PdfrH:ip<lll"g fE,I" Long XuyM by cond<>m provl.lon '<lurc" 
• All 13 FSWs Interviewed said they Were no longer concerned about condom 
availability be<ause they are now available everywhere, including hotels and guest 
houses. 
• Figures J and 4 show the increased avai lability of both partially subsidized (socially 
marketed) and non-subsidized (full ,etail pfice) condoms at EEs in both Chau Doc and 
Long Xuyen since the 100% CUP has been implemented, However, fully subsidized 
(f'ef!) condom brands are still 
available in many EE~ indicating 
pOD. compliance with the 
condom provision agref!ment 
betwef!n implementing partners 
and the need for improved 
coordination, Many hotels and 
guest houses are purchasing 
Number One condoms from PSI 
at partially subsidized prices and 
then placing them in the rooms 
and at re.::eption desks where 
PictUf' 4: A plGc, of c<Nttlom' poution in , ..... h<>uH 
_to: I(iou ThGnh Sinh 
customers may access them fref' of charge. It would be even betterto encourage 
hotels and guest houS<"s to rely mOre on unsubsidized condom brands for customers 
to purchase Or that could be included In room charges. 
• Figures 5 and 6 show the specific location of condoms in targeted EEs. The vast 
majority of EEs in both Chau Doc and Long Xuyen had condoms available at the 
reception desk and a smaller percentage had condoms in individual rooms. Over time 
this percentage Increased mocie,ately to 40-45% In Long Xuyen but remained 
relatively stable at 30-40% in Chau Doc. It is important to develop strategies to 
substantially increase the pefcentage of EEs that pfOvide condoms in the rooms. 
Figure 5 shows that EE owners in Chau Doc noticed that condoms available in tOilets 
from May to October 2010 were not used, so decided to make mOre condoms 
available at the reception as of November. Condoms must be both available and 
accessible, which means both easily visible and usable bycustomers. 
Nov-09 Feb-' 0 May-,O Nov-lO Feb-lO Apr-" 
_ At ,«eptiono.,k _ In room _ In t",let _ Available at lea" <>ne !>ace in tm, EE 
_ At ,«eptiono.,k . 'nroom • In t",let • Available at lea" <>ne !>aceinthe EE 
Lessons learned and sustainablllty: 
The following important le~~om have been learned from the of the evaluation of 100% CUP 
implementation in An Giang province: 
• Commitment and ~upport from local authorities i~ essential for the succe~~ful 
implementation and ~usta nability of harm reduction interventions. Harm reduction 
interVf!ntion~ in general, and the 100% CUP in particular, are now on the provincial 
agenda and have received strong pport from the PPC in An Giang. Deci~ions and 
steering documents from the PPC, police force and other relevant departments and 
sectors provided impe u~ for the program as well as both a theoretical and practical 
basi~ for the effective implementation of the l00%CUP. 
• A mu ~ec r approach and tram parent sharing of information on harm reduction 
are vital in raising community aWareneSS and promoting the responsibil ity for 
coordination among partner~.1t i~ also important to have a local agency~erving as a 
focal point forthecoordlnation of partners. 
• Improved aWareneSS among EEowne ~ increases the sustainabilityof the 100% CUP 
and complements effective implementation and strengthened regulatiom. 
• A strategic advocacy plan comprising a series of necessary step~ i~ important to 
garnering support for program implementation. 
• Best practices should be documented and shared among implementing par ner~ at 
alileveis for the future pan~ion of the 1 00% CUP to other province~. 
• Selecting the An Giang AIDS A~~ociation (AAA) to implement the 100% CUP was 
appropriate for ~usta nabllity reasom becau~e the association is a competent, well 
known professional social organization in the province. Its organizational and 
technical capacity was further strengthened through the 1 OO%CUP Implementation, 
and the a~sociation will be able to assume an expanded role in the future. 
• DeVf!lopment and implementation of a re~ults based monitoring and evaluation 
system facilitates the supervision of project activities, targeting reSOurCeS and 
monitoring results. Baseline data are also very Important for project planning and 
evaluation. 
• Changes in attit de~ and practice among coliabora Of~ and sta eho der~ are the 
sustainable results of hi~ program. An Giang province is currently preparing a plan to 
continue the program and the PPC and PATe have agreed to provide ongoing 
support. 
CONCLUSION 
• After two years of implementation, there has been a notable change in the awareness 
of harm reduction interventions among local authorities, se<tors and unions In An 
Giang, especiallywltnin the police force. Asa result, the program has received positive 
support f.om the PPC as well as direct, positive participation from the police, and has 
created an effective means to enable joint interventions among programs targeting 
groups at high risk of transmitting HIV and STls. The program has proven to be 
reliable, effective and efficient and EE OwnerS have committed to ensuring condom 
availabi lity after USAID support for the program ends. 
• Despite overcoming their initial lack of awareness, some police officers, including 
collaborators. still remain hesitant to participate.5ignificant efforts have been made 
to affe<t behavior change among the police force however, existing attitudes are 
deeply ingrained. Therefore, awareneSS raising activities need to be conducted 
regularly and continuously. The reluctant relationship between EE owners, the police 
and local authorities has improved, yet some OwnerS still feel pressured into 
participating In the program. 
RECOMMENDATIONS 
The recommendations below are given based on the findings from the evaluation and 
include (i) recommendations to improve the ongoing program in An Giang and (ii) 
suggestions for developing relevant policies to support the future Implementation and 
expansion of the model. 
Recommendations for program Improvement: 
• Work with the police. EE owners, other collaborators and stakeholders to provide 
encouragement and incentives to participate and comply with the program and de· 
emphasize enforcement mechanisms that may result in resistance and reluctance. 
• Strengthen collaboration between different sec to rs, partners, and mass 
organizations, clarifying and consolidating the roles of each to avoid the police force 
dominating monitoring and enforcement efforts. Alternatives include establishing a 
supportive multi·sectOf supervisory group comprised of a health official, an official 
from the provincial Department of Culture. Sports andTour;sm, and a police officer. EE 
owners and FSWs should also play continued and increasing roles in implementing 
the lOO'1b CUP. Finally, the project should expand the roles of and cooperation with 
mass organizations and Self·Management Boardsat sub-village (hamlet) level. 
• Regularly review and update maps and lists to ensure the appropriate ongoing 
selection of targeted EEs. 
• Enhance the management capacity and coordination among related partners in the 
1 00'Ib CUp, including national government agencies and partners at central level. 
• Provide opportunities for EE OwnerS to m~t and share information to encourage 
active participation and thedeslre to make posi i~ contributions to the community. 
• Provide formal job descriptions for collaborators to enSure their competency and the 
1 00'Ib CUP's relevance to the community. 
• Support the ongoing shift towards a total market approach, moving from 
distributing fully subsidized condoms to selling partially subsidized and non￾subsidized condoms to the EE owners to be offered to clients via appropriate 
mechanisms. 
• Implement strategies to ensure the availability of condoms in all Individual rOOmS at 
EEs.This may include adding non-subsidized condom brands tothe"mini·bar" in each 
rOOm Or incorporating the cost of condoms into the rOOm charge and providing them 
with the tOiletries in the bathrooms. 
• Guarantee that condom~ are both readily available and ea~ily acce~~ib e in all EE~ by 
en~uring ~ufficient ~upply from reliable ~o",ce~ while al~o maintaining adequate 
~upefVi~ion. 
• See opportunitle~ to reach out toother igh ri~ gfOup~ in the community, ~uch a~ 
~treet fSW~ and clien ~, MSM and male ~ex worker~, in addition to the wrrently 
targeted FSW~ employed through E~. 
Recommendations for policy development 
• The 100% CUP ~hould be adjusted and further piloted in other localiti"..; to obtain 
additional evidence and experience before being ~caled up throughout the country 
to gain further in~ig t into difference~ between feqions. 
• le~son~ learned from the An Giang l00%CUP should be shared at the local as wel l as 
national levels. Ba~ed on these experiences,the Ministry of Health can develop 
national implementation guidel ne~ for the 100% CUP aimed at ~tandardizing and 
institutionalizing thi~ typeof intervention. 
• USAID/HPI ~hou d work with the Mini~triesof Health, Public Security, Culture. Sports 
and Touri~m, and labor, Invalids, and Social Affairs to develop an inter-ministerial 
Cirwlar for the 1 00% CUP and advocate for ~ inteqration into national and provincial 
stra eqie~ to prevent and control HIVIAIDS in Vietnam. 
• USAID/HPI also need~ to work with the Mlni~tryof labor, Invalid~ and Social Affairs on 
new laws, action plans, and technical guideline~ on sex work that focu~ mOre on harm 
reduction than puni~hment . 
• The Department of Culture, Sports and Tourism should make condom availability one 
of t he criteria in assessing a nd c ert ifyin g th e q ua lit Y of hotels and guest houses. 
• An Giang province should maintain its political commitment to implementing the 
100% CUP model, which should be developed and inteqrated into annual its social￾economic development plans in the form of resolutions Or directives to ~upport 
further implementation. 
• Guarantee that condom~ are both readily available and ea~ily acce~~ib e in all EE~ by 
en~uring ~ufficient ~upply from reliable ~o",ce~ while al~o maintaining adequate 
~upefVi~ion. 
• See opportunitle~ to reach out toother igh ri~ gfOup~ in the community, ~uch a~ 
~treet fSW~ and clien ~, MSM and male ~ex worker~, in addition to the wrrently 
targeted FSW~ employed through E~. 
Recommendations for policy development 
• The 100% CUP ~hould be adjusted and further piloted in other localiti"..; to obtain 
additional evidence and experience before being ~caled up throughout the country 
to gain further in~ig t into difference~ between feqions. 
• le~son~ learned from the An Giang l00%CUP should be shared at the local as wel l as 
national levels. Ba~ed on these experiences,the Ministry of Health can develop 
national implementation guidel ne~ for the 100% CUP aimed at ~tandardizing and 
institutionalizing thi~ typeof intervention. 
• USAID/HPI ~hou d work with the Mini~triesof Health, Public Security, Culture. Sports 
and Touri~m, and labor, Invalids, and Social Affairs to develop an inter-ministerial 
Cirwlar for the 1 00% CUP and advocate for ~ inteqration into national and provincial 
stra eqie~ to prevent and control HIVIAIDS in Vietnam. 
• USAID/HPI also need~ to work with the Mlni~tryof labor, Invalid~ and Social Affairs on 
new laws, action plans, and technical guideline~ on sex work that focu~ mOre on harm 
reduction than puni~hment . 
• The Department of Culture, Sports and Tourism should make condom availability one 
of t he criteria in assessing a nd c ert ifyin g th e q ua lit Y of hotels and guest houses. 
• An Giang province should maintain its political commitment to implementing the 
100% CUP model, which should be developed and inteqrated into annual its social￾economic development plans in the form of resolutions Or directives to ~upport 
further implementation. 
USAIO's HEALTH POLICY INITIATIVE VIETNAM 
...... ltd 1I00I
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