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Lin C, Nguyen DB, Nguyen L, Nguyen TT, Li L, Minh Giang L. Navigating cultural and gender aspects of stigma among women living with HIV in Vietnam. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38478464 DOI: 10.1080/13691058.2024.2318428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/09/2024] [Indexed: 04/21/2024]
Abstract
Women living with HIV often face intersecting challenges of stigma and gender inequality. In Vietnam, this issue is potentially exacerbated by the patriarchal culture. From December 2021 to March 2022, we conducted in-depth interviews with 30 women living with HIV in Hanoi to better understand their experiences and the coping mechanisms to navigate HIV stigma, cultural beliefs and gender norms. The interviews explored various topics including women's social and family roles in Vietnam, HIV-related beliefs, stigma and its impact on one's health and coping strategies. Participants reported stereotypes that assumed that women living with HIV had either engaged in sex work or behaved promiscuously. These stereotypes render them vulnerable to judgement and discrimination owing to widespread expectations of female virtue. As a result, women living with HIV often enacted non-disclosure and self-isolation to avoid stigma. This self-stigmatisation negatively impacted their healthcare-seeking, employment opportunities and ability to fulfil traditional family-caring roles. Conversely, many participants exhibited resilience with the support of family and peers. Overall, the complex interplay between gender, culture and HIV stigma underscores the importance of developing culturally appropriate, multifaceted approaches to engaging family and peers, modifying gender-based discriminatory social practices and enhancing women's self-efficacy and empowerment in Vietnam.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Diep Bich Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Lynn Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Trang Thu Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Li Li
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California, Center for Community Health, Los Angeles, CA, USA
| | - Le Minh Giang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Ha T, Givens D, Nguyen T, Nguyen N. Stigmatizing Attitudes toward People Living with HIV among Young Women Migrant Workers in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6366. [PMID: 35681951 PMCID: PMC9180544 DOI: 10.3390/ijerph19116366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 01/19/2023]
Abstract
Despite intensive HIV education and prevention efforts in the past few years, stigmatizing attitudes toward people living with HIV (PLWH) remain a major barrier to HIV prevention and treatment efforts in Vietnam. The purpose of this study was to examine the prevalence of stigmatizing attitudes regarding HIV and identify correlative factors that impact the perceptions of PLWH among a heretofore overlooked demographic in Vietnamese society: women who are migrant workers in designated industrial zones (IZs). A cross-sectional study was conducted among 1061 women migrant workers aged 18 to 29 from January 2020 to November 2020 in Hanoi, Vietnam. Stigmatizing attitudes toward PLWH were measured using a four-item scale. Multiple logistic regression was conducted to examine the factors associated with stigmatizing attitudes. Our findings indicate both substantial levels of stigma persisting among this demographic group as well as the influence of important mitigating factors on the expression of HIV-related stigma. Over seventy-six percent (76.2%) of the participants reported having at least one of the four stigmatizing attitudes. Greater levels of stigmatizing attitudes toward PLWH were significantly associated with lower HIV knowledge, lower levels of education, and identifying as Kinh (the ethnic majority in Vietnam). Additionally, this study found that questions framing HIV infection through a familial lens were significantly associated with lower rates of stigmatizing responses. The high overall levels of stigmatizing attitudes toward PLWH among the study participants suggests that there is an urgent need for the development of culturally appropriate interventions and outreach education activities to reduce stigmatizing attitudes toward PLWH among women who are migrant workers working in the IZs in Vietnam. This study adds to both the existing literature and current efforts and policies around HIV in Vietnam by empirically suggesting that familial-based messaging may be a powerful potential narrative for interventions addressing HIV-related issues such as stigma.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - David Givens
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Trang Nguyen
- Institute of Social and Medical Studies, Hanoi 100000, Vietnam; (T.N.); (N.N.)
| | - Nam Nguyen
- Institute of Social and Medical Studies, Hanoi 100000, Vietnam; (T.N.); (N.N.)
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Kayesa NK, Shung-King M. The role of document analysis in health policy analysis studies in low and middle-income countries: Lessons for HPA researchers from a qualitative systematic review. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2020.100024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Nong T, Capoccia V, Mulvey KP. Facing the future of substance use disorders treatment in Vietnam - A case study for international development and cooperation. J Subst Abuse Treat 2021; 134:108401. [PMID: 33865690 DOI: 10.1016/j.jsat.2021.108401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
Vietnam made progress transitioning from a criminal justice to a health treatment response for substance use disorders (SUD) in recent years. This case study describes the evolution of Vietnam's SUD treatment system from 2005 to 2020 to understand and learn from the phases of its development. The case study is based on data from a predesigned interview guide for 47 respondents, literature and policy desk review and direct experience of the authors. Vietnam saw remarkable growth of opioid use disorder (OUD) treatment from 2005 when methadone was unavailable, to 2020 with 335 methadone clinics in all 63 provinces serving more than 52,200 patients. The growth in OUD treatment accounts for much of Vietnam's success managing its HIV epidemic for which injection drug use was a major vector. An unintended consequence, however, focused only on OUD as a strategy to address HIV and was unable to address multiple substances. Most elements of a modern evidence and community-based SUD treatment system exist in Vietnam; however, they are siloed and influenced by multiple government administrative jurisdictions. Faced with rising amphetamine and persistent alcohol use, the path ahead for Vietnam involves a choice between a reliance on compulsory rehabilitation centers or a plan to broaden the scope of substances and treatments, and further integrate with Vietnam's commune-based primary health system.
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Affiliation(s)
- Thuong Nong
- The Heller School for Social Policy and Management, Brandeis University, 415 South St MSC 035, Waltham, MA 02453, United States of America
| | | | - Kevin P Mulvey
- Center for Substance Abuse Treatment, SAMHSA, 5600 Fishers Lane Rockville, MD 20857, United States of America
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Montenegro Martínez G, Carmona Montoya A, Franco-Giraldo Á. [Models for public health policy analysis reported in scientific publications]. GACETA SANITARIA 2020; 35:270-281. [PMID: 31982213 DOI: 10.1016/j.gaceta.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/27/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To summarize public health policy models reported in studies published between 2002-2017. METHOD Using MesH vocabulary, we systematically searched articles in English, Spanish and Portuguese in the PubMed, Scielo, Jstor, ProQuest and Google Scholar data-bases. The quality of the articles was assessed using the tool for understanding a qualitative study by CASPe. RESULTS A higher proportion of scientific studies were conducted in the African continent. The policies relating to health care were most frequently investigated. Walt and Gilson's model and Kingdon's multiple streams framework were more frequently reported. CONCLUSIONS The articles set out the public policy analysis model, but not the approach to guide it. A more robust theoretical body needs to be built to enable discussion about the approaches and models for the analysis of public policies. Its distinction is relevant, since it can order methodological proposals for the study of policies.
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Affiliation(s)
| | | | - Álvaro Franco-Giraldo
- Grupo de Investigación GISCO, Fundación Universitaria Autónoma de las Américas, Medellín
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Khodayari-Zarnaq R, Mosaddeghrad AM, Nadrian H, Kabiri N, Ravaghi H. Comprehensive analysis of the HIV/AIDS policy-making process in Iran. Health Res Policy Syst 2019; 17:69. [PMID: 31324185 PMCID: PMC6642503 DOI: 10.1186/s12961-019-0466-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background A huge number of people living with HIV/AIDS lives in developing countries. Thus, strengthening health systems in these countries is a prerequisite for improving disease prevention and care. After three decades of HIV/AIDS policy-making in Iran, conducting a comprehensive analysis on the policy process seems to be essential. In the present study, we aimed to analyse the HIV/AIDS policy-making process in Iran from 1986 to 2016. Methods This was a theory-based, multi-method and retrospective study. Interviewing of key informants and review of policy documents were concurrently conducted to identify and include further key informants (39 participants) and documents in the study. Framework analysis was used to analyse data. Results The mean age of participants working in HIV/AIDS policy-making was of 48 years and participants had a mean of 14 years of working experience. Findings were categorized as contextual factors, content of HIV/AIDS policies, actors involved in the policy process, and evidence use in the policy process. Contextual effective factors on the HIV/AIDS policy-making process were categorized into five major themes, namely situational factors, structural-managerial factors, socioeconomic factors, political and legal factors, and international factors. The HIV/AIDS phenomenon in Iran was identified to be deeply rooted in the culture and traditions of society. The HIV/AIDS policy content has, recently, been crystallized in the national strategic plans and harm reduction policies of the country. The policy process has been conducted with a solely governmental top-down approach and is now suffering from poor evidence and lack of sufficient consideration of contextual factors. Conclusions There is a great need for change in the approach of government towards the issue and to increase the participation of non-governmental sectors and civil society in the policy process.
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Affiliation(s)
- Rahim Khodayari-Zarnaq
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Mohammad Mosaddeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Kabiri
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, Iran University of medical sciences, Tehran, Iran.
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Ishimaru T, Wada K, Hoang HTX, Bui ATM, Nguyen HD, Le H, Smith DR. Nurses' willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam. Environ Health Prev Med 2017; 22:9. [PMID: 29165125 PMCID: PMC5664450 DOI: 10.1186/s12199-017-0614-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 03/04/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study examined the factors associated with nurses' willingness to care for patients infected with human immunodeficiency virus (HIV) or hepatitis B or C virus (HBV/HCV) in Vietnam. METHODS A cross-section of 400 Vietnamese nurses from two hospitals were selected using stratified random sampling, to whom a self-administered questionnaire was administered which included demographic items, previous experience with patients infected with HIV or HBV/HCV, and their attitudes toward these patients. Data was analyzed using descriptive statistics and multiple logistic regression. RESULTS The lifetime prevalence of needlestick or sharps injury whilst caring for a patient infected with HIV or HBV/HCV was 9 and 15.8%, respectively. The majority of participants expressed a willingness to care for patients infected with HIV (55.8%) or HBV/HCV (73.3%). Willingness to care for HIV-infected patients was positively associated with being 40-49 years of age and confidence in protecting themselves against infection. Regarding HBV/HCV infection, willingness to care was positively associated with individual confidence in protecting themselves against infection. CONCLUSIONS This study revealed that Vietnamese nurses were somewhat willing to care for patients infected with HIV or HBV/HCV, and this was associated with individual confidence in protecting themselves against infection and with negative attitudes towards HIV and HBV/HCV. Establishing a positive safety culture and providing appropriate professional education to help reduce the stigma towards infected patients offers an effective way forwards to improve quality of care in Vietnam, as elsewhere.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand.,Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Wada
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Huong Thi Xuan Hoang
- Department of Infection Control, Faculty of Nursing, Thanh Tay University, Hanoi, Vietnam
| | - Anh Thi My Bui
- Department of Hospital Management, Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Hung Le
- Dong Da Hospital, Hanoi, Vietnam
| | - Derek R Smith
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Goldsamt LA, Clatts MC, Le G, Yu G. Injection and sexual risk practices among young heroin users in Hanoi, Vietnam. DRUGS (ABINGDON, ENGLAND) 2015; 22:166-172. [PMID: 25995608 PMCID: PMC4435536 DOI: 10.3109/09687637.2014.979765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Epidemiological data in Vietnam shows high HIV prevalence rates among injection drug users, especially in urban centres. However, there are limited data on specific practices used to prepare and inject drugs or on sexual practices among Vietnamese injectors. A street-based cross-sectional interview was conducted with 862 heroin injectors in Hanoi, Vietnam, to collect such data. Variability was seen in both injection and sexual risk, with 12.9% of current injectors reporting at least one unsafe method of drug sharing and 57.1% reporting unsafe sex in the past 30 days. These risks were strongly associated with those who engaged in unsafe injection significantly more likely to engage in unsafe sex (69.4% vs. 55.3%) and those engaging in unsafe sex significantly more likely to engage in unsafe injection (15.7% vs. 9.2%). These findings highlight the overlap of injection and sexual risk practices among Vietnamese heroin users and suggest the need for strong, broadly targeted HIV prevention activities among this population.
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Affiliation(s)
| | - Michael C. Clatts
- School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - Giang Le
- Center for Research and Training on HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
| | - Gary Yu
- College of Nursing, New York University, New York, NY, USA
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Hirsch J, Giang LM, Parker RG, Duong LB. Caught in the middle: the contested politics of HIV/AIDS and health policy in Vietnam. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2015; 40:13-40. [PMID: 25480849 PMCID: PMC4352397 DOI: 10.1215/03616878-2854447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drawing on the changing landscape of responses to HIV in Vietnam, this article describes the key players and analyzes the relationships between global players and local interests, including both the omnipresent state and an emerging civil society presence. We discuss the critical importance of timing for policy intervention and the role of health policy in shaping the broader social terrain. The interventions of external actors such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund were instrumental in improving both policies and programs at a critical juncture, when the national responses to the epidemic had been ineffective. At the same time, those global interventions met resistance and led to unintended consequences, both welcome and unwelcome. Furthermore, the looming specter of donor withdrawal and the very gradually emerging national ownership raise many questions about capacity for scale-up and sustainability of the significant achievements to date. Further monitoring and in-depth analysis of the Vietnamese responses to the HIV epidemic in the next few years or so, we contend, have the potential to provide unique insights into the challenges faced by developing countries caught in the complex webs of health politics and policies at both the global and the national levels.
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Affiliation(s)
| | - Le Minh Giang
- Center for Research and Training on HIV/AIDS, Hanoi Medical University
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Ahmed T, Long TN, Huong PT, Stewart DE. Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis. BMC Public Health 2015; 15:32. [PMID: 25631330 PMCID: PMC4324409 DOI: 10.1186/s12889-015-1404-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Tanvir Ahmed
- School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia.
| | - Thanh Nguyen Long
- Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam.
| | - Phan Thi Huong
- Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam.
| | - Donald Edwin Stewart
- School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia.
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Ahmed T, Long NT, Huong PTT, Stewart DE. HIV and Injecting Drug Users in Vietnam: An Overview of Policies and Responses. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tran DA, Shakeshaft A, Ngo AD, Mallitt KA, Wilson D, Doran C, Zhang L. Determinants of antiretroviral therapy initiation and treatment outcomes for people living with HIV in Vietnam. HIV CLINICAL TRIALS 2014; 14:21-33. [PMID: 23372112 DOI: 10.1310/hct1401-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study explores patient characteristics that are significantly associated with very late combination antiretroviral therapy (cART) initiation (CD4 count ≤100 cells/mm³) and examines the association between patient characteristics and treatment outcomes, CD4 recovery, and mortality. DESIGN Data were obtained from the clinical records of 2,198 HIV/AIDS patients in 13 outpatient clinics across 6 provinces in Vietnam. METHODS Multivariate logistic regression and Cox proportional hazards regression were used to identify patient characteristics that are significantly associated with very late cART initiation and to measure relationships between patient characteristics and treatment outcomes. RESULTS Very late cART initiation was significantly associated with being male compared with female (odds ratio [OR], 0.36; 95% CI, 0.23-0.58), becoming HIV infected through injecting drugs (OR, 2.13; 95% CI, 1.09-4.14), and having opportunistic infections at cART initiation (OR, 1.69; 95% CI, 1.02-2.86). Being male (female vs male: hazard ratio [HR], 0.45; 95% CI, 0.20-0.98), very late cART initiation (timely vs late: HR, 0.18; 95% CI, 0.04-0.72), low baseline body mass index (BMI) (HR, 0.95; 95% CI, 0.92-0.98), and later baseline WHO clinical stage (WHO clinical stage IV vs combined group of stage I and II: HR, 5.70; 95% CI, 3.90-7.80) were significantly associated with death, whereas being female compared with male (HR, 1.51; 95% CI, 1.14-1.99) and timely cART initiation (HR, 35.45; 95% CI, 13.67-91.91) were significant predictors of CD4 recovery. CONCLUSIONS Timely testing of patients for HIV, increasing use of CD4 count testing services, and starting cART earlier are essential to reduce mortality and improve treatment outcomes.
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Affiliation(s)
- Dam Anh Tran
- National Drug Alcohol Research Centre, The University of New South Wales, Sydney, Australia Kirby Institute, Sydney, Australia. d.tran@
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Giang LM, Hirsch JS, Parker RG, Vasquez EE. Social and policy dimensions of HIV and AIDS in Vietnam. Introduction. Glob Public Health 2014; 8 Suppl 1:S1-6. [PMID: 24003891 DOI: 10.1080/17441692.2013.797484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Platten M, Pham HN, Nguyen HV, Nguyen NT, Le GM. Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam. BMC Public Health 2014; 14:265. [PMID: 24649918 PMCID: PMC3994540 DOI: 10.1186/1471-2458-14-265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 03/12/2014] [Indexed: 11/21/2022] Open
Abstract
Background The success of HIV care strongly depends upon skills of the healthcare worker. Vietnam has a punitive history towards HIV and even though this has changed recently, persons living with HIV are still facing discrimination. The objective of this paper is to assess the gaps in knowledge of HIV and factors associated with discriminatory attitudes towards persons living with HIV among medical students in order to improve medical training. Methods In a cross-sectional quantitative study using a structured questionnaire, 200 final-year medical students at Hanoi Medical University were approached for data collection in May of 2012. Descriptive statistics (percentages) were used to present four HIV knowledge tests. Linear regression models were examined to highlight factors that are associated with general attitudes towards HIV and attitudes towards HIV in a clinical setting. Results Although students performed overall well in the knowledge category of HIV discrimination and stigma, there were several gaps in knowledge of HIV, including the categories of HIV-related basic sciences, prevention, and care and treatment. Knowledge of stigma and discrimination was a significant positive predictor of General non-prejudicial attitude to HIV and AIDS (β = 0.186, P < 0.01) and Non-discriminatory attitude to HIV and AIDS at work (β = 0.188, P < 0.01). Training on methadone treatment was found to be a significant positive predictor (β = 0.168, P < 0.05) while family size was negatively associated (β = -0.170, P < 0.05) with General non-prejudicial attitude to HIV and AIDS. Conclusions The study suggests a need for incorporating HIV training into the core curricula for medical students. As persons who inject drugs carry a proportionately high burden of HIV in Vietnam, it is also important to include methadone training for students.
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Affiliation(s)
| | | | - Huy V Nguyen
- Department of Health Management and Organization, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Dao A, Hirsch JS, Giang LM, Parker RG. Social science research on HIV in Vietnam: a critical review and future directions. Glob Public Health 2013; 8 Suppl 1:S7-29. [PMID: 23906241 DOI: 10.1080/17441692.2013.811532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Social science research can enhance the response to Vietnam's growing HIV epidemic by capturing the country's rapidly changing social and political context. The present paper reviews the published, peer-reviewed and English-language social science literature on HIV in Vietnam in order to identify critical theoretical and substantive gaps, while laying the groundwork for future research. We found four broad foci for work on the social context of HIV and AIDS in Vietnam: the cultural meanings and social relationships that shape Vietnam's HIV epidemic; stigma and discrimination; social inequality and structural violence as contributors to HIV risk; and, finally, how broader global and social systems shape Vietnam's HIV epidemic. We signal the particular need for additional research on the effects of the media on attitudes towards HIV and AIDS, on social movements, and on health systems, as well as on a number of other key areas. Work along these lines, in addition to more effective communication of policy-relevant findings to those responsible for the development and implementation of policies and programmes, will strengthen Vietnam's response to HIV and AIDS.
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Affiliation(s)
- Amy Dao
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Edington C, Bayer R. When grammars collide: Harm reduction, drug detention and the challenges of international policy reform efforts in Vietnam. Glob Public Health 2013; 8 Suppl 1:S75-91. [PMID: 23363324 DOI: 10.1080/17441692.2012.763045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Throughout the 1990s, a dramatic rise in HIV prevalence rates among drug users in Vietnam attracted the attention of international observers concerned about the prospect of a more generalised epidemic. Vietnam subsequently became the target of extensive funding and advocacy which sought to introduce needle exchange and methadone in a country where drug use was considered a 'social evil', and drug users were subjected to what international observers viewed as draconian incarceration measures. What were the goals of proponents of harm reduction when they came to Vietnam? How did they perceive the state of prevailing approaches to drug users in the context of the Vietnamese HIV epidemic? How did they understand the strategic challenges they faced and the dilemmas they had to confront? Based on in-depth interviews with international harm reduction proponents working in Vietnam, this paper explores the encounter of two grammars of harm reduction, one based on broadly accepted international approaches, the other rooted in Vietnam's own history and politics. From this encounter a set of policies and practices characterised by needle exchange and methadone maintenance emerged, as well as an extensive network of closed centres where tens of thousands of drug users are currently detained.
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Affiliation(s)
- Claire Edington
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Pham HN, Protsiv M, Larsson M, Ho HT, de Vries DH, Thorson A. Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study. BMC Health Serv Res 2012; 12:474. [PMID: 23259923 PMCID: PMC3548727 DOI: 10.1186/1472-6963-12-474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022] Open
Abstract
Background Like in many other low- and middle-income countries, the recent development of an HIV epidemic in Vietnam has led to a growing need for prevention, treatment, care, and support services for people living with HIV (PLHIV). This puts greater demands on the national HIV services, primarily on health workers, which increases the importance of their job satisfaction and working conditions. This study describes health worker perceptions and explores the factors that influence job satisfaction and dissatisfaction of health personnel working on the HIV response in Vietnam. Spector’s job satisfaction model was used as the theoretical framework for the study design and analysis. Methods The study employed a qualitative design with 7 focus group discussions and 15 semi-structured interviews with health workers, purposively selected from national and provincial organizations responsible for HIV services in 5 cities and provinces in Vietnam. Data were analyzed using a hybrid approach of theory-driven and data-driven coding and theme development using qualitative analysis software. Results HIV services are perceived by Vietnamese health workers as having both positive and negative aspects. Factors related to job satisfaction included training opportunities, social recognition, and meaningful tasks. Factors related to job dissatisfaction included unsatisfactory compensation, lack of positive feedback and support from supervisors, work-related stress from a heavy workload, fear of infection, and HIV-related stigma because of association with PLHIV. An adjusted Spector’s model of job satisfaction for HIV service health workers was developed from these results. Conclusion This study confirmed the relationship between stigmatization of PLHIV and stigma experienced by staff because of association with PLHIV from families, colleagues, and society. The experiencing stigma results in additional work-related stress, low self-esteem, poor views of their profession, and lower income. The study shows the importance of actions to improve staff job satisfaction such as pay raises, supportive supervision, stress management, stigma reduction and workplace safety. Immediate actions could be the provision of more information; education and communication in mass media to improve the public image of HIV services, as well as improvement of workplace safety, therefore making health workers feel that their work is valued and safe.
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Affiliation(s)
- Ha Nguyen Pham
- Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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Tran DA, Shakeshaft A, Ngo AD, Rule J, Wilson DP, Zhang L, Doran C. Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics. PLoS One 2012; 7:e51289. [PMID: 23240013 PMCID: PMC3519823 DOI: 10.1371/journal.pone.0051289] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/01/2012] [Indexed: 11/18/2022] Open
Abstract
In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm(3) CD4), late initiators (100-200 cells/mm(3)) and timely initiators (200-350 cells/mm(3)). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam's treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.
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Affiliation(s)
- Dam Anh Tran
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, the University of New South Wales, Sydney, Australia
| | - Anh Duc Ngo
- School of Population Health, the University of South Australia, Adelaide, Australia
| | - John Rule
- School of Public Health, the University of New South Wales, Sydney, Australia
| | - David P. Wilson
- Kirby Institute, the University of New South Wales, Sydney, Australia
| | - Lei Zhang
- Kirby Institute, the University of New South Wales, Sydney, Australia
- * E-mail: (DAT); (LZ)
| | - Christopher Doran
- The University of Newcastle, Hunter Medical Research Institute, New South Wales, Australia
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Translating knowledge into policy: provision and use of evidence in the Tobacco Harm Prevention Law in Vietnam. J Public Health Policy 2012; 33:454-61. [PMID: 22932025 DOI: 10.1057/jphp.2012.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vietnam is currently considering a Tobacco Harm Prevention Law and the Ministry of Health has been asked to provide supporting evidence. This analysis explores factors influencing uptake of evidence in that legislation process. The political environment reflects the government's ambivalence over how to balance health and socioeconomic issues of tobacco control in a state-owned industry. Although the growing presence of transnational tobacco companies is alarming, the role of Framework Convention on Tobacco Control in prompting government compliance with set milestones is encouraging. Evidence of effectiveness of interventions for health needs now to be complemented with socioeconomic evaluation, and strengthening of the ties between advocates and decision makers.
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Vuong T, Ali R, Baldwin S, Mills S. Drug policy in Vietnam: a decade of change? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 23:319-26. [PMID: 22206713 DOI: 10.1016/j.drugpo.2011.11.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/19/2011] [Accepted: 11/21/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Driven by the rapid spread of HIV, Vietnam's response to drug use has undergone significant transformation in the past decade. This paper seeks to identify and analyse factors that prompted these changes and to investigate their impact on the lives of people who use drugs. METHOD This policy analysis is based on a review of Vietnamese Government documents, peer-reviewed publications and the authors' knowledge of and involvement in drug policy in Vietnam. RESULTS The last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions. However, HIV prevalence among drug users at 31.5% remains high due to limited access to effective interventions and impediments caused by the compulsory treatment centre system. CONCLUSIONS The twin epidemics of HIV and illicit drug use have commanded high-level political attention in Vietnam. Significant policy changes have allowed the implementation of HIV prevention and drug dependence treatment services. Nevertheless, inconsistencies between policies and a continued commitment to compulsory treatment centres remain as major impediments to the provision of effective services to drug users. It is critical that Vietnamese government agencies recognise the social and health consequences of policy conflicts and acknowledge the relative ineffectiveness of centre-based compulsory treatment. In order to facilitate practical changes, the roles of the three ministries directly charged with HIV and illicit drug use need to be harmonised to ensure common goals. The participation of civil society in the policymaking process should also be encouraged. Finally, stronger links between local evidence, policy and practice would increase the impact on HIV prevention and drug addiction treatment programming.
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Affiliation(s)
- Thu Vuong
- Family Health International (FHI), 7th floor, Hanoi Tourist Building, 18 Ly Thuong Kiet Street, Hanoi, Viet Nam.
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Pharris A, Hoa NP, Tishelman C, Marrone G, Kim Chuc NT, Brugha R, Thorson A. Community patterns of stigma towards persons living with HIV: a population-based latent class analysis from rural Vietnam. BMC Public Health 2011; 11:705. [PMID: 21923941 PMCID: PMC3184634 DOI: 10.1186/1471-2458-11-705] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 09/18/2011] [Indexed: 11/30/2022] Open
Abstract
Background The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma. Methods To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership. Results We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46). Conclusions Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analyzing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.
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Affiliation(s)
- Anastasia Pharris
- Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Higashi H, Khuong TA, Ngo AD, Hill PS. The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:24. [PMID: 21923945 PMCID: PMC3191345 DOI: 10.1186/1747-597x-6-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 09/18/2011] [Indexed: 11/18/2022]
Abstract
Background Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Methods Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. Findings The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. Conclusion The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.
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Affiliation(s)
- Hideki Higashi
- The University of Queensland, School of Population Health, Herston, QLD 4006, Australia
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