Human immunodeficiency virus (HIV) infection patterns and risk behaviours in different population groups and provinces in Viet Nam

The National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam.
Bulletin of the World Health Organisation (Impact Factor: 5.09). 02/2007; 85(1):35-41. DOI: 10.1590/S0042-96862007000100010
Source: PubMed


To study patterns and determinants of HIV prevalence and risk-behaviour characteristics in different population groups in four border provinces of Viet Nam.
We surveyed four population groups during April-June 2002. We used stratified random-cluster sampling and collected data concomitantly on HIV status and risk behaviours. The groups included were female sex workers (n = 2023), injecting drug users (n = 1391), unmarried males aged 15-24 years (n = 1885) and different categories of mobile groups (n = 1923).
We found marked geographical contrasts in HIV prevalence, particularly among female sex workers (range 0-24%). The HIV prevalence among injecting drug users varied at high levels in all provinces (range 4-36%), whereas lower prevalences were found among both unmarried young men (range 0-1.3%) and mobile groups (range 0-2.5%). All groups reported sex with female sex workers. Less than 40% of the female sex workers had used condoms consistently. The strongest determinants of HIV infection among female sex workers were inconsistent condom use (adjusted odds ratio [OR], 5.3; 95% confidence interval [CI], 2.4-11.8), history of injecting drug use and mobility, and, among injecting drug users, sharing of injection equipment (adjusted OR, 7.3; 95% CI, 2.3-24.0) and sex with non-regular partners (adjusted OR 3.4; 95% CI 1.4-8.5).
The finding of marked geographical variation in HIV prevalence underscores the value of understanding local contexts in the prevention of HIV infection. Although lacking support from data from all provinces, there would appear to be a potential for sex work to drive a self-sustaining heterosexual epidemic. That the close links to serious injecting drug use epidemics can have an accelerating effect in increasing the spread of HIV merits further study.

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    • "These studies were conducted in single locations or in a limited number of geographic regions and produced large variance on the measures of association. Previous studies have tended to focus on injection drug use and syringe sharing, but few studies have examined the role of non-injection drug use or reported a significant association between inconsistent condom use and HIV infection (Thuy et al., 1998; Tuan et al., 2007). In this study, we explore the extent to which FSW across Vietnam are at risk for HIV infection through unprotected sex and non-injection drug use and examine these effects in the context of the province and type of venue in which FSW work. "
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    ABSTRACT: Women who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified. We surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW. Compared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32-5.09) and 1.76 (CI 1.14-2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71; CI 0.52-0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00-40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection. Because injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    • "Sex with female sex workers is reported frequently in male IDU populations (Go et al., 2011). In border provinces of Vietnam, sex with female sex workers and casual sex partners was found to increase the likelihood of HIV infection 3.4 times compared with IDUs who did not have non-regular sex partners (Tuan et al., 2007). "
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    • "In contrast, HIV infection risk of the sex with casual partners was dose-dependent on condom use, where the people who have less condom use are more likely to be HIV positive. Studies in other countries have observed the association between sex with casual partners and HIV infection among IDUs [37]. These women may not have skills to negotiate for condom use, and even if the woman is aware of her HIV status, in casual relationships she may not feel responsible for preventing further transmission of HIV to this type of partner. "
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