Sexual risk and bridging behaviors among young people in Hai Phong, Vietnam

Gender norms and sexual consent in dating relationships: a qualitative study of university students in Vietnam

Social norms surrounding sex and relationships remain gendered among young people in Vietnam, with men maintaining a privileged role in heterosexual relationships. This analysis explored how university students in Vietnam perceived prevailing gender norms, and how these norms influenced men's understanding of sexual consent in dating relationships. This analysis drew primarily on in-depth interviews with heterosexual men and secondarily from interviews with women attending two universities in Hanoi in 2018. Thematic analysis of the interviews revealed a broader narrative about how prevailing gender norms shape men's dating behaviour and beliefs about consent. Participants expected young men to be independent and decisive. Men were seen as free to initiate dating and sexual encounters. Some participants expected young women to be accommodating in dating relationships, although acceptable relationships for women were restricted, and premarital sex was a reputational risk. Most participants described cues for consent and non-consent for sex; however, dismissal of women's refusals, and normalised sexual coercion were common. Among university men in Hanoi, gender norms privileging men and growing expectations of premarital sex may be normalising sexual coercion in dating relationships. University educational programmes are needed to promote equitable gender norms, affirmative sexual consent and expanded definitions of sexual coercion.

Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living With HIV in Asia

BACKGROUND

Adolescents living with HIV (ALHIV) have poorer adherence and clinical outcomes than adults. We conducted a study to assess behavioral risks and antiretroviral therapy outcomes among ALHIV in Asia.

METHODS

A prospective cohort study among ALHIV and matched HIV-uninfected controls aged 12-18 years was conducted at 9 sites in Malaysia, Thailand, and Vietnam from July 2013 to March 2017. Participants completed an audio computer-assisted self-interview at weeks 0, 48, 96, and 144. Virologic failure (VF) was defined as ≥1 viral load (VL) measurement >1000 copies/mL. Generalized estimating equations were used to identify predictors for VF.

RESULTS

Of 250 ALHIV and 59 HIV-uninfected controls, 58% were Thai and 51% females. The median age was 14 years at enrollment; 93% of ALHIV were perinatally infected. At week 144, 66% of ALHIV were orphans vs. 28% of controls (P < 0.01); similar proportions of ALHIV and controls drank alcohol (58% vs. 65%), used inhalants (1% vs. 2%), had been sexually active (31% vs. 21%), and consistently used condoms (42% vs. 44%). Of the 73% of ALHIV with week 144 VL testing, median log VL was 1.60 (interquartile range 1.30-1.70) and 19% had VF. Over 70% of ALHIV had not disclosed their HIV status. Self-reported adherence ≥95% was 60% at week 144. Smoking cigarettes, >1 sexual partner, and living with nonparent relatives, a partner or alone, were associated with VF at any time.

CONCLUSIONS

The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.

Factors influencing engagement in premarital sex among Vietnamese young adults: a qualitative study

BACKGROUND

With the rising trend of sexual engagement among Vietnamese young adults in recent years, concerns were raised over the issue of premarital sex and its potential health consequences. In order to prevent such consequences and further promote health, an in-depth understanding of factors influencing young people to have premarital sex would be valuable.

OBJECTIVE

To generate a grounded theory explaining factors influencing engagement in premarital sex among Vietnamese young adults.

SUBJECTS

Vietnamese adults aged 18-24 who have voluntarily engaged in premarital sex (n = 18).

METHOD

The study was conducted using the grounded theory approach by Glaser. Purposive and theoretical sampling was used. Ten in-depth interviews and three additional focus group discussions were carried out. The interviews were audio-recorded and transcribed verbatim. Data analysis involved using the constant comparative method and open and theoretical coding. Sampling, data collection and data analysis happened simultaneously until theoretical saturation was achieved.

RESULTS

The grounded theory is constructed around six emergent themes: (a) desire as the 'direct cause'; (b) the facilitators; (c) social changes; (d) media; (e) peer and (f) absence of family. The latter four themes are 'indirect causes' that influence through desire and the facilitators.

CONCLUSION

The study has contributed a grounded theory that identified the factors and described their relationships in a comprehensive way. It suggested a need for a reliable source of information to be tailor-designed to suit young people. Additionally, the stigma of talking about sex needs to be reduced to allow for more open discussions on sex and sexual health.

High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City, Vietnam

In Vietnam's concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a 'bridge' of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam's largest cities, in 2013-2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0-27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2-47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across 'bridging' categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87-7.56), current opioid use (OR 2.55; 95% CI 1.02-6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46-19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These results indicate high HIV prevalence among male clients of FSWs, particularly among those with a history of drug use. Programs to expand HIV testing, drug-use harm reduction, and HIV treatment for HIV-infected male clients of FSWs should be considered as key interventions for controlling the HIV epidemic in Vietnam.

HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam

Background

In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time.

Methods

All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients’ records, and a structured questionnaire was used to collect social, demographic and economic data.

Results

Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education.

Conclusion

The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples.

Trial registration NCT01433601

Early sexual initiation and multiple sexual partners among Vietnamese women: analysis from the Multiple Indicator Cluster Survey, 2011

Introduction

Under current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases.

Design

A total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n=8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners.

Results

Early sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10–14 years (OR=5.9; 95% CI=1.9–18.8) at first intercourse; and aged 15–19 years (OR=5.4; 95% CI=4.0–7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong.

Conclusions

The study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life.

FACTORS INFLUENCING UNINTENDED PREGNANCY AND ABORTION AMONG UNMARRIED YOUTH IN VIETNAM: A LITERATURE REVIEW

Unintended pregnancy and abortion among unmarried youths arepublic health issues in Vietnam. This review aims to analyse factors influencing unintended pregnancy and abortion among unmarried youths using published and unpublished literatures. An ecological model was used as the conceptual framework with five levels of factors to guide the analysis. The intrapersonal factors include increasing permissive attitudes and practices of premarital sex, lack of knowledge on contraception, andlow self-efficacy among females. The interpersonal factors include poor communication among partners and between parents and youths on sexuality-related issues, and peer-influence. The organizational factors include inadequate sexuality education and sexual and reproductive health (SRH) services for youths. The contextual factors include gender inequality, cultural norms, and migration. The final level is lack of separate policy on youth SRH. The findings point out four major determinants of unintended pregnancy and abortion among unmarried youths, including: 1) cultural norms, which consider premarital sex is a taboo; 2) lack and inadequate quality of sexuality education in the schools; 3) lack of youth-friendly SRH services; and 4) no separate policy addressing youth SRH.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis

BACKGROUND

Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices.

METHODS

Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used.

RESULTS

Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk.

CONCLUSION

The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.

Sexual history taking in general practice: managing sexually transmitted infections for female sex workers by doctors and assistant doctors in Vietnam

Sexually transmitted infections (STIs) in Vietnam have been increasing. Control of STIs among female sex workers (FSWs) is important in controlling the epidemic. Effective STI control requires that physicians are skilful in taking sexual history for FSW patients. Three hundred and seventy-one physicians responded to a survey conducted in three provinces in Vietnam. The respondents were asked whether they asked FSW patients about their sexual history and information asked during sexual history taking. The respondents were also asked about their barriers for taking sexual history. Over one-fourth (27%) respondents always, over half (54%) respondents sometimes and 19% respondents never obtained a sexual history from FSW patients. Multivariable analysis revealed that factors associated with always taking a sexual history were being doctor, training in STIs and working at provincial level facilities. Physician’s discomfort was found to be inversely associated with training on communication with patients, seeing 15 or fewer patients a week, working at provincial level facilities. Issues in sexual history taking among FSW patients in general practice in Vietnam were identified. These issues can help STI control for FSW patients and need due attention in order to improve STI management in Vietnam.

Determinants of condom use at sexual debut among young Vietnamese

BACKGROUND AND AIMS

Condom use at sexual debut is associated with subsequent condom use and with decreased risk of sexually transmitted infections. There is a dearth of data on determinants of condom use at first sexual intercourse. We aimed to determine factors associated with condom use at first sexual intercourse before marriage among Vietnamese adolescents and youths.

METHODS

The study involved the analysis of data from the Survey Assessment of Vietnamese Youth, 2003, the first nationally representative survey of young people in Vietnam. The survey included 7584 adolescents and youths aged 14-25 years. In this study, data of 605 adolescents and youths who had engaged in premarital sex were analyzed for factors associated with condom use using descriptive analyses, and regression techniques, allowing for sampling weights, clustering and stratification.

RESULTS

Of 605 adolescents and youths who had engaged in premarital sex, 28.6% reported condom use at first sexual intercourse. Condom use at sexual debut was less common in females than males [odds ratio (OR)=0.15; 95% confidence interval (95% CI)=0.07-0.30] and less common in those who experienced peer pressure to engage in social higher risk behaviors (OR=0.57; 95% CI=0.32-0.99). Condom use was more common if a friend/acquaintance or a stranger/sex worker was the first sexual partner (OR=2.20; 95% CI=1.16-4.17 and OR=17.90; 95% CI=6.88-46.54) respectively, each compared with fiancé/boyfriend/girlfriend as first sexual partner.

CONCLUSIONS

These data suggest that approximately one in three unmarried Vietnamese youths used a condom at first sexual intercourse. Gender, peer pressure and the nature of the relationship to the first sexual partner were independently associated with condom use. These results can inform programs directed at preventing HIV and other sexually transmitted infections among young Vietnamese.

The Age of Initiation of Drug Use and Sexual Behavior May Influence Subsequent HIV Risk Behavior: A Systematic Review

Researchers examining injection drug users (IDUs) in drug treatment have been trying for decades to determine the optimal way to intervene to prevent the transmission and spread of human immunodeficiency virus (HIV) in this population. Although efficacious HIV risk reduction interventions are widely available, questions remain about what specific factors are most related to HIV risk behavior and defined as unprotected sexual activity and/or high risk drug use. This review involved an evaluation of the research literature in order to better understand the association between drug use and sexual behavior debut on HIV risk behavior. Findings suggest that drug use debut and sexual behavior debut may be related to subsequent HIV risk behavior. Evidence to date implies that intervening at an earlier age to assist youth to avoid or delay these high risk behaviors may be an additional means of reducing subsequent HIV risk.

Correlates of bisexual behaviors among men who have sex with men in El Salvador

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30-5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01-9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26-0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22-0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.

HIV-related risk behaviors among the general population: a survey using Audio Computer-Assisted Self-Interview in 3 cities in Vietnam

This study used a confidential survey method-namely, Audio Computer-Assisted Self-Interview (ACASI)-to gather data about HIV-related risk knowledge/behaviors among the general population in Vietnam. The study sample included 1371 people aged 15 to 49 years in 3 cities-Hanoi, Da nang, and Can Tho. Results indicated that 7% of participants had ever had nonconsensual sex, and 3.6% of them had ever had a one-night stand. The percentage of male participants reported to ever have sex with sex workers was 9.6% and to ever inject drugs was 4.3%. The proportion of respondents who had ever tested for HIV was 17.6%. The risk factors and attitudes reported in the survey indicate the importance of analyzing risk behaviors related to HIV infection among the general population. Young people, especially men in more urbanized settings, are engaging in risky behaviors and may act as a "bridge" for the transmission of HIV from high-risk groups to the general population in Vietnam.

Adolescents Living with HIV: An Indian Profile

Purpose. Although there have been studies on the presence of Human Immunodeficiency Virus (HIV) among the adult and even pediatric population, the adolescent population has been neglected. The main objective of this study was to understand and describe the profile of adolescents accessing the Integrated Counseling and Testing Centre (ICTC) at a tertiary healthcare centre in north India. This was a retrospective analysis of the data collected where, in addition to the analysis of the presence of HIV among the target population, a comparative analysis of HIV-positive and negative individuals was also carried out. Methods. Counselors at the ICTC of All India Institute of Medical Sciences recorded responses of the patients, and pre- and posttest counseling was performed appropriately. Also, HIV testing was performed using rapid tests (EIA) and ELISA. Both pre- and posttest counseling was performed for most of the patients. Also, the data collected from 2005 to May, 2011 was then retrospectively analyzed using various statistical tests, such as, Chi-square test and odds ratios. Results. Out of 979, 84 tested HIV positive. Discrimination at multiple levels was observed.The 10–14 years age group was 0.56 times more likely to be HIV positive than 15–19 year old. HIV serostatus was strongly associated with risk behavior (P = 0.003) with heterosexual transmission being the most common. Conclusion. These findings highlight the profile of adolescents in India and their equation with HIV on demographic and psychosocial levels.

Evaluation of three adolescent sexual health programs in ha noi and khanh hoa province, Vietnam

With an increase in sexual activity among young adults in Vietnam and associated risks, there is a need for evidence-based sexual health interventions. This evaluation of three sexual health programs based on the Protection Motivation Theory (PMT) was conducted in 12 communes in Ha Noi, Nha Trang City, and Ninh Hoa District. Inclusion criteria included unmarried youth 15–20 years residing in selected communes. Communes were randomly allocated to an intervention, and participants were randomly selected within each commune. The intervention programs included Vietnamese Focus on Kids (VFOK), the gender-based program Exploring the World of Adolescents (EWA), and EWA plus parental and health provider education (EWA+). Programs were delivered over a ten-week period in the communities by locally trained facilitators. The gender-based EWA program with parental involvement (EWA+) compared to VFOK showed significantly greater increase in knowledge. EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex. Sustained changes are observed in all three interventions for self-efficacy condom use, self-efficacy abstinence, response efficacy for condoms, extrinsic rewards, and perceived vulnerability for HIV. These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents.

Sexual behaviour of Croatian blood donors as a threat to the health of blood recipients

BACKGROUND

In this cross-sectional study we assessed the prevalence of the various blood safety sexual risk behaviours among blood donors from East Croatia and the possibilities for improving the present blood donor screening procedure.

MATERIALS AND METHODS

The study included 423 blood donors of both sexes who completed a specially designed anonymous questionnaire immediately after their blood donations. The questionnaire contained questions on demographic data, sexual preferences, and possible sexual risk behaviours in the period before the blood donation.

RESULTS

The study revealed that the most common forms of sexual risk behaviour among Croatian blood donors had been irregular condom use during sexual contacts with new partners (294/423; 69.5%) and five or more sexual partners during the lifetime (213/423; 50.4%). More male than female subjects had had five or more sexual partners during their lifetime (p<0.0001). Compared to married donors, single subjects more frequently reported sexual contacts without using a condom with their new partners in the period from the last blood donation (p<0.0001) and also in the period of 1 month before current blood donation (p=0.0060). A larger number of younger than older subjects had practiced different types of sexual intercourses during the lifetime (p=0.0002) but more older than younger subjects reported irregular use of condom on sexual contacts with a new partner during their lifetime (p=0.0231).

CONCLUSION

Blood donors who were involved in various forms of sexual risk behaviour represent a serious threat to the health of blood recipients. In this respect a new approach to blood donor screening procedure with additional questions on sexual behaviour in anonymous donor questionnaires would improve the safety of transfusion treatment in East Croatia.

Gender, Alcohol Consumption Patterns, and Engagement in Sexually Intimate Behaviors Among Adolescents and Young Adults in Nha Trang, Viet Nam

A randomly selected cross-sectional survey was conducted with 880 youth (16 to 24 years) in Nha Trang City to assess relationships between alcohol consumption and sexual behaviors. A timeline followback method was employed. Chi-square, generalized logit modeling and logistic regression analyses were performed. Of the sample, 78.2% male and 56.1% female respondents ever consumed alcohol. Males reporting sexual behaviors (vaginal, anal, oral sex) had a significantly higher calculated peak BAC of 0.151 compared to 0.082 for males reporting no sexual intimacy (p < .0001). Females reporting sexual behaviors had a peak BAC of 0.072 compared to 0.027 for those reporting no sexual intimacy (p = .016). Fifty percent of (33/66) males and 30.4% (7/23) females report event specific drinking and engagement in sexual behaviors. Males reporting 11+ drinks in 30 days had more sexual partners than those reporting 1 to 10 drinks (p = .037). Data suggest different physical and psychosocial mediators between alcohol consumption and sexual behaviors by gender.

Parent-youth communication and concordance between parents and adolescents on reported engagement in social relationships and sexually intimate behaviors in Hanoi and Khanh Hoa Province, Vietnam

PURPOSE

Parent-child communication is associated with positive outcomes for youths' engagement in sexual behaviors. Limited data are available regarding parent-child communication in transitional countries. We present data from Vietnamese parent-youth dyads on parent reproductive health (RH) knowledge, comfort of communication, frequency of talk, and discordancy between youths' reported and parents' perceptions for engagement in relationships and sexually intimate behaviors.

METHODS

The cohort included 185 randomly selected parent-youth dyads in four communes in Hanoi and Khanh Hoa Province. Descriptive and comparative analysis included chi-squared tests, independent samples t-tests, and ANOVA. Linear regression analysis was used to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy.

RESULTS

Seventy-six percent of parents and 44% of youth were female. The mean age of youth was 17.2 years. The mean score for parental "RH knowledge" was 24.74 (SD, 3.84; range, 15-34). Lower parental RH knowledge was positively associated with lower levels of education (F = 2.983; df, 184; p = .014). Data indicate a linear model in which knowledge is related to "comfort" (β = .17; p = .048), and "comfort" to frequency of "talk" (β = .6; p < .0001). Frequency of "talk" is not related to parents' discordant perceptions regarding their child's reported involvement in relationships (β = .002; p = .79) or sexual touching (β = .57; p = .60).

CONCLUSIONS

Parent and youth in Vietnam are engaged in limited communication about RH. There is a need for more data to assess the effect of these communication patterns on youths' engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.

HIV risk and prevention behaviours, intentions, perceptions and knowledge among youth in Goa, India

In order to examine the association between HIV/AIDS knowledge and perceptions, and risk intentions and behaviours among adolescents in Goa, India, cross-sectional data from 942 youth were collected and assessed. The prevalence rates in the past six months for fighting, smoking, drinking and drug use were 16.5%, 3.8%, 17.8% and 1.1%, respectively; 5.2% acknowledged ever having engaged in sex. Prior risk involvement was significantly correlated with future risk intention (odds ratio [OR]: 9.7-19.7), and those involved in one risk behaviour were more likely to engage in other risk behaviours (OR: 1.3-23.5). The findings suggest the importance of targeted interventions for youth engaging or intending to engage in risk behaviours and universal interventions regarding basic facts and skills for all youth in Goa.

Individual, familial and extra-familial factors associated with premarital sex among Bangladeshi male adolescents

Background: A national survey found that more than one-tenth of unmarried Bangladeshi adolescents were sexually experienced and much of this experience involves high-risk behaviours such as unprotected sexual intercourse with commercial sex workers. However, very few studies have explored the factors that contribute to premarital sex among Bangladeshi adolescents. Methods: Data are from the 2004 Adolescent Reproductive Health Communication Midline Survey, a national survey in Bangladesh. Multivariate statistical methods were applied to identify risk and protective factors for premarital sex among Bangladeshi male adolescents. Results: Among 1048 unmarried males between ages of 15 and 19 years, 12.8% reported ever having had sex. Multivariate analyses demonstrated that, in terms of the self system, having plans to study in the future were associated with a lower risk of engaging in premarital sex (odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.25–0.59) while knowledge of reproductive health and life skills did not have a strong influence. Strong influences of both familial and extra-familial system were observed. Respect for parents’ values and beliefs about sex was associated with decreased odds of premarital sex (OR = 0.39; 95% CI = 0.26–0.59). ‘Ever talked with friends about sex-related issues’ was associated with threefold increased odds and an increase in peer influence score was associated with increased odds of premarital sex. Conclusions: These results demonstrate that premarital sex among Bangladeshi male adolescents was influenced by numerous factors, and they should be taken into account in programs aiming to delay the age of sexual debut.

HIV risk behaviours and determinants among people living with HIV/AIDS in Vietnam

There is a potentially high risk of HIV spreading from people living with HIV/AIDS. We conducted a cross-sectional study to examine HIV risk behaviours and their determinants among people living with HIV/AIDS. Eighty-two percent had been sexually active. Sex with multiple partners was reported by 20% and consistent condom use by about one third. More than half of the participants (52%) reported having injected drugs during the previous month, and 35% of those had shared needles and syringes. Voluntary HIV testing and having received condoms or injection equipment from the local HIV prevention program, were found to be significantly associated with fewer HIV risk behaviours. Having learned recently about personal HIV status, multiple sex partners, low educational attainment and young age were found to be associated with higher HIV risk behaviours. Giving high priority to targeted preventive and support programmes is likely to be a highly cost-effective strategy.

Clients of female sex workers as a bridging population in Vietnam

Understanding bridging behaviors of clients of female sex workers (FSWs) is important for projecting and intervening in the spread of sexually transmitted infections in Vietnam. The goals of the study were to determine HIV/STI prevalence amongst different bridging groups, identify factors associated with being potential and active bridgers, and assess the association of drug use and unsafe sex with HIV and/or STI prevalence. In April, 2007, 292 clients were anonymously interviewed at sex venues in a two-stage time-location cluster sampling survey, followed by HIV, syphilis, and HSV-2 testing. Based on condom use with both high-risk (FSWs) and low-risk (wives/girlfriends) sexual partners, clients were classified as unlikely, potential, or active bridgers. The majority of clients were potential or active bridgers (55.8%) who had a significantly higher prevalence of herpes simplex type 2 (HSV-2) (21% and 33%, respectively) than unlikely bridgers (8.7%). HIV seropositivity was 4.4-fold (95% CI 1.1-17.1) higher among those who were HSV-2-positive. Clients of FSWs may be playing a major bridging role in transmitting HIV and sexually transmitted infections (STIs) in Vietnam. An observed synergistic interaction between drug use and condom slippage/breakage emphasizes the importance of proper condom use, particularly among drug users.

The characteristics of sexual behavior and extent of condom usage among sexually active Croatians from Eastern Croatia

OBJECTIVE

To determine the extent of condom usage as a method of protection from sexually transmitted infections (STIs) among sexually active individuals obliged to present for periodical health examination at the Institute of Public Health for the Osijek-Baranya County, in Osijek, eastern Croatia.

MATERIAL AND METHODS

During February 2004, a cross-sectional questionnaire survey was conducted. The research tool was an unidentified 20-item questionnaire addressing the sexual behavior of study subjects and their partners and methods of protection from STIs. Descriptive statistics and χ(2) - test were used for data analysis.

RESULTS

The response rate was 84.2% (278/330). A total of 278 subjects, 96 (34.5%) males and 182 (65.5%) females, 167 (60.1%) married and 111 (39.9%) single, mean age 31.3±8.4, age range 18-52 years were enrolled in the study. Study results revealed 22.3% (62/278) subjects to have had two or more sexual partners over the one-year period and the use of condom was reported by 40.3% (25/62) of those subjects.

CONCLUSIONS

The obtained results point to the need for additional education on protection from sexually transmitted infections and on risky sexual behavior, with special reference to the role of condom usage in the prevention of these diseases and their detrimental effects on the reproductive health of sexually active individuals.