AIDS is a four-letter wordespecially in Vietnam. Hardly talked about and barely tolerated, HIV/AIDS is on the upswing in the Southeast Asian country and shows no signs of slowing.
Vietnam remains a country with a biting stigma attached to HIV; poverty and fear of alienation keep many who contract the virus from seeking proper treatment. In a country that shuns its HIV-positive population, the Bickford-Land Clinic is a haven.
Debbie Davis and Brenda Wolfe founded the Bickford-Land Clinic in Ho Chi Minh City, Vietnam in August of 2006. The clinic offers physical and mental health services for about 30 people, mostly children and families, affected by HIV.
Wolfe is an HIV clinical nurse specialist at Chicago's Mount Sinai Hospital, where she directs the HIV services program and researches pediatric AIDS. She says it's been a long-standing dream to work in international HIV treatment and prevention. Davis owns a tax services business and considers her work completely unrelated to the field of HIV.
They're both fond of travel, and a one-week trip through Vietnam in 2004 put them face-to-face with a need for HIV care they did not expect. They had stumbled upon a problem bigger than both of them, and together they sat down to find a solution.
Friends for at least a decade and now partners in business, Davis and Wolfe are quick to emphasize one another's contributions to the creation of Bickford-Land Clinic. Wolfe used her network at Mount Sinai to contact physicians and pharmacists in Vietnam with experience treating HIV/AIDS. Davis researched organizations in Vietnam that focused on helping mothers and children with HIV; she found no such group.
"We had hoped to partner with an existing organization there but we found there was nobody to partner with," said Davis, the clinic's director of social services.
Wolfe and Davis did track down one woman in Vietnam who took care of a few HIV-positive kids, mainly to "keep these children out of orphanages." But she lacked the resources to provide thorough care for the children; they saw a physician only every few months, and the woman kept their records on note cards. Wolfe and Davis realized she was doing the best she could and decided they'd take over from there.
Hesitant to open their doors to government control in a Communist country, Davis and Wolfe decided the clinic would function most effectively as a private organization. They found a westernized clinic that had opened three months prior where they could rent space and contract their services. Using U.S. guidelines, Wolfe trained Vietnamese doctors to become specialists in treating HIV-positive children.
"The government is aware that we're functioning and they could shut us down at any point in time," said Wolfe, the clinic's medical director. "However, they know we're doing good work."
The World Health Organization estimates a 0.5 percent adult HIV prevalence rate in Vietnam as of 2007, though limited information is available about the number of infected children under 15. Reports from groups like Family Health International suggest Ho Chi Minh City, where the clinic is located, is the center of the epidemic.
Many Vietnamese people consider AIDS strongly linked with prostitution, and the government has informally grouped it with prostitution and intravenous drug use in its list of "social evils." HIV/AIDS education and awareness were near non-existent until a United States-sponsored education program launched in Vietnam in 2003.
Davis and Wolfe say the stigma is not only present, but obvious, especially when they compare Vietnamese attitudes with those in other countries. Wolfe recalls one visit when a cab driver started chatting with her about what she was doing in Vietnam. When she told him, he stopped talking and said he only spoke Vietnamese.
"Vietnam was very slow in Southeast Asia in even recognizing HIV, so the growth rate was just extraordinary," Davis said. "In Thailand, you go there and the cab driver gives you a condom."
Patients come to the clinic mostly by referral from churches; the stigma against HIV drives people away from hospital-based clinics and towards private care for confidentiality reasons, a need Davis says the LGBT community can understand even in the United States. Bickford-Land only accepts patients who are infected with the virus because large-scale testing efforts cost too much.
The clinic's approach to HIV care is holistic: mind and body, Wolfe explains. A part-time staff of fivea physician, dentist, nurse, social worker and assistantprovide medications, physical exams, mental health services and dental work.
"It was almost impossible for these kids to receive dental care because no dentist was willing to work with them in the past," Davis said. " [ A dentist told us, ] 'We will bring dental services to you. If our paying customers find out there are HIV children in our waiting room, we will lose our customers.' The stigma is a real problem."
As another service, the clinic allows families affected by HIV to borrow $50 in business loans to start a business and rebuild their lives. Wolfe said the program has created many success stories, from the man who wakes up at 4:30 every morning to work at the bed-and-breakfast he started to the women who make a living selling jewelry.
"HIV isn't the end of your life or the end of your world," Wolfe said. "We've helped them get on their feet and they're very happy and healthy."
For HIV-positive women who want to have children, the clinic offers birth education services about how to keep from transmitting HIV to their baby. With proper care, Wolfe says, the risk of mother-to-child transmission of the virus is just one percent. She and Davis believe women have the right to have children if they so desire, and they're helping HIV-positive women to do it safely.
Part of this process simply comes down to testing; stigma and poverty in third-world countries stand in the way of many women getting tested for HIV. But knowing a woman's HIV status can make all the differencethat's part of the reasoning behind the Illinois Perinatal HIV Prevention Act, a law mandating pregnant women be tested for HIV unless they decline. Birth procedures may change drastically if a woman is HIV-positive, and simply knowing a pregnant woman is positive can help lessen the risk she'll have an HIV-positive baby.
"If you can identify whether the mother is HIV-positive, there's really no reason to have a child with HIV anymore," Davis said. "In third-world countries, just to get these women tested is such an extraordinary thing."
Wolfe says she's sure there are services available for Vietnam's LGBT population, but Bickford-Land Clinic serves a different group of people. Women and children constitute much ( if not all ) of the clinic's clientele, but it's not because of dangerous sexual practices or drug use. High prostitution in Vietnam contributed to the country's fast-growing HIV rate, she speculates, and many women have had to suffer because of choices their husbands made.
"There are more women and children now that are getting infected because of the husband's earlier escapades out of marriage," Wolfe said. "You're seeing a newer population of infections in women and children, and it's not because of their habits. It's their innocence and trust in the man that they're with."
Four times a year, the clinic staff takes the kids out just to be kids. They'll take field trips to the park or plan family parties, complete with snacks, lunches and drinks. The staff meets in person as often as possible too; Wolfe explains it's an important part of both the HIV/AIDS field and of Asian culture to establish trusting relationships with one another.
The clinic is funded by 5 Loaves 2 Fishes Foundation, a United States nonprofit created solely to support Bickford-Land. Money's been tight since the clinic's "angel funder," whose donation established the organization, had to leave the group a year ago ( Wolfe serves as the foundation's president while Davis is its treasurer ) .
There's also funding available from the U.S. Centers for Disease Control and Prevention set aside specially for international HIV clinics, but Wolfe and Davis expect that will run out soon. As a result, they're paying for much of it themselves.
"We've been able to maintain, but we have not been able to expand into something run internationally wide," Wolfe said. "When we started, [ we took ] five new kids a year. We've had to put a cap on that. … We'd love to find some funding. That's what we're struggling with right now."
Fundraising events with friends, family and the community have also helped keep the clinic in business. For example, Davis and Wolfe set up a 5 Loaves 2 Fishes Foundation stand at Chicago's Northalsted Market Days on Aug. 13 and 14. They planned to take donations and sell scarves, jewelry, silk purses and other "souvenirs" from Vietnam, some handmade by the patients themselves.
The two rely on mileage donations to visit the clinic at least yearly, and they often ask donors for Costco gift certificates to cover vitamins and other basics. Davis and Wolfe used to visit the clinic in Vietnam more often, but it's not financially possible anymore.
"I continue to have meetings with my staff to make sure kids are doing well," Wolfe says. "Whether I'm there or not, I'm with my staff 100 percent of the time."
With dreams in mind of one day expanding the clinic, Wolfe and Davis plan to continue going it alone. Creating and running Bickford-Land has become as much a part of their lives as their daily routines in the United States.
Wolfe's work at Mount Sinai has helped minimize the number of babies born with HIV, with the last positive born in 2004. She says the joy of a bringing an HIV-negative child into the world is universal.
"You get fulfilled by the fact that you can tell a woman, 'Yes, you can have a baby.' You can tell families their child is HIV-negative," Wolfe says. "The greater AIDS movement is trying to provide a greater quality of life … [ and ] we're trying to provide the opportunity for families to grow."
For Davis, whose job keeps her working outside of HIV/AIDS, the experience is humbling.
"You see such extraordinary need," Davis says. "It makes your life seem so small in comparison."
For more information or to donate to 5 Loaves 2 Fishes Foundation, visit their website at www.5and2.org .