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Ly AT, Wilson PA, Parker CM, Giang LM, Hirsch JS, Pham T, Parker RG. Categorical dilemmas: challenges for HIV prevention among men who have sex with men and transgender women in Vietnam. CULTURE, HEALTH & SEXUALITY 2020; 22:1161-1176. [PMID: 31496368 PMCID: PMC7061063 DOI: 10.1080/13691058.2019.1662089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
In Vietnam, HIV continues disproportionately to affect men who have sex with men and transgender women, and the increase in HIV prevalence in these populations may be related to a lack of tailoring of current prevention approaches, which often fail to address social diversity within these populations. To effectively respond to HIV in Vietnam, it is imperative to identify sub-populations within the broad category of 'men who have sex with men' (MSM), a term which in Vietnam as in many other sites frequently subsumes transgender women. In this paper, we document the different categories used to describe people who engage in same-sex sexual practices and/or non-normative gender performances drawing on data collected via in-depth interviews and focus groups with a total of 79 participants in Hanoi. We identified over 40 different categories used to describe men who have sex with men and/or transgender women. These categories could be described as behaviourally-based, identity-based, or emic, and each carried different meanings, uses (based on age and geography) and levels of stigma. The categories shine light on the complexity of identities among men who have sex with men and transgender women and have utility for future research and programming to more comprehensively address HIV in Vietnam.
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Affiliation(s)
- An Thanh Ly
- Department of Global Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Caroline M. Parker
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
- Department of Social Anthropology, University of Manchester, United Kingdom
| | - Le M. Giang
- Department of Global Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Jennifer S. Hirsch
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Timothy Pham
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Richard G. Parker
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
- Institute for the Study of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Nguyen MXB, Chu AV, Powell BJ, Tran HV, Nguyen LH, Dao ATM, Pham MD, Vo SH, Bui NH, Dowdy DW, Latkin CA, Lancaster KE, Pence BW, Sripaipan T, Hoffman I, Miller WC, Go VF. Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial. Implement Sci 2020; 15:64. [PMID: 32771017 PMCID: PMC7414564 DOI: 10.1186/s13012-020-01020-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background People who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam. Methods Design: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs. Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months. Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm. Discussion Scaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation. Trial registration NCT03952520 on Clinialtrials.gov. Registered 16 May 2019.
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Affiliation(s)
- Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam.
| | - Anh V Chu
- University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ha V Tran
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.,University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Long H Nguyen
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - An T M Dao
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - Manh D Pham
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Son H Vo
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Ngoc H Bui
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Irving Hoffman
- Division of Infectious Diseases, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516, USA
| | - William C Miller
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
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Smith SL. Factoring civil society actors into health policy processes in low- and middle-income countries: a review of research articles, 2007-16. Health Policy Plan 2019; 34:67-77. [PMID: 30668676 DOI: 10.1093/heapol/czy109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 01/12/2023] Open
Abstract
Civil society actors have substantially increased their participation in global and national health policymaking processes since the 1970s. Civil society roles in shaping such significant global health milestones as the Doha Declaration on Intellectual Property Rights, the Framework Convention on Tobacco Control and the recently adopted United Nations Sustainable Development Goals are well documented, but knowledge of civil society actor influence on health policy processes in low- and middle-income countries remains fragmented. This study analyses 24 peer-reviewed research articles published between 2007 and 2016 to identify factors affecting civil society influence in the pre-implementation stages of the policy process. The articles reviewed span 13 health issues and more than 50 countries in four regions of the world. This body of work focuses on civil society as represented by formal groups, primarily domestic and to some extent international non-governmental organizations, but also social movements, professional associations and faith-based organizations, among others. The studies document several actor-centred and contextual factors that affect civil society actor power, commonly across stages of the policy process. Crucially, civil society actors were challenged to impact the process in countries that lacked participative norms and governing structures. When repressive conditions existed, regime changes and donors sometimes helped to open doors to participation. The power of civil society actors was enhanced when they joined strong epistemic networks and broader coalitions of stakeholders, were resourced, and framed issues in ways that resonated with national policies and political priorities. The synthesis offers guidance to practitioners on factors to consider in strategy development and points to several issues for further investigation by health policy analysis scholars, including the implications of issue (non)adoption by civil society actors and contestation dynamics among those with differing perspectives.
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Affiliation(s)
- Stephanie L Smith
- School of Public Administration, The University of New Mexico, Social Sciences Building, Room 3008, MSC05-3100, 1 University of New Mexico, Albuquerque, NM, USA
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Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access. PLoS One 2018; 13:e0195000. [PMID: 29614104 PMCID: PMC5882136 DOI: 10.1371/journal.pone.0195000] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Abstract
Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ (‘out,’ transgender, or effeminate MSM). Lower-income, ‘hidden’ MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.
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Gautier L, Ridde V. Health financing policies in Sub-Saharan Africa: government ownership or donors' influence? A scoping review of policymaking processes. Glob Health Res Policy 2017; 2:23. [PMID: 29202091 PMCID: PMC5683243 DOI: 10.1186/s41256-017-0043-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The "donor-driven" push for policies aiming at UHC raises concerns about governments' effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process. METHODS We conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. Thirty-five (35) results were retrieved. We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation. RESULTS The majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors' involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors' influence can successfully coexist. DISCUSSION Future research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State's coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors.
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Affiliation(s)
- Lara Gautier
- Department of social and preventive medicine, School of Public Health, Université de Montréal, Montréal, Québec Canada
- Public Health Research Institute (IRSPUM), Université de Montréal, Montréal, Québec Canada
- Centre d’Etudes en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Valéry Ridde
- Department of social and preventive medicine, School of Public Health, Université de Montréal, Montréal, Québec Canada
- Public Health Research Institute (IRSPUM), Université de Montréal, Montréal, Québec Canada
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