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Abstract
The HIV epidemic in Vietnam is concentrated primarily among injecting drug users (IDUs). To prevent HIV-1 superinfection and to develop effective HIV prevention programs, data are needed to understand the characteristics of high-risk HIV-positive IDUs. In Citation, we conducted a community-based cross-sectional study among predominately male, out-of-treatment IDUs, aged 18–45, in the Bac Ninh Province, Vietnam. Among 299 male participants, 42.8% were HIV-positive, and among those, 96.9% did not know their status prior to the study. Furthermore, 32% were HIV-positive and had high HIV behavioral risk (having unprotected sex or having shared injecting equipment in the past 6 months). Injecting for ≥3 years, younger age, and pooling money to buy drugs were independently associated with being at high risk for transmitting HIV. IDUs who purchased more than one syringe at a time were less likely to have high HIV behavioral risk. Structural interventions that increase syringe accessibility may be effective in reducing HIV risk behavior among HIV-positive IDUs. Study limitations are noted in the article.
RÉSUMÉ
L’épidémie de VIH au Vietnam est principalement concentrée chez les utilisateurs de drogues par injection (UDIs). La prévention d’une surinfection de VIH-1 ainsi que le développement de programmes de prévention anti VIH nécessite des données supplémentaires pour comprendre les caractéristiques des IDUs séropositifs a haut risque. En Citation, nous avons mené une étude communautaire bidimensionnelle parmi des UDIs a dominante masculine, sortis de traitements, âgés de 18 a 45 ans, dans la province de Bac Ninh au Vietnam. Parmi les 299 hommes participants, 42,8% se sont avérés séropositifs, parmi lesquels 96,9% ignoraient leur séropositivité avant l’enquête en question. 32% se sont avérés séropositifs, avec un comportement VIH a haut risque (relations sexuelles non protégées ou échange de seringues lors des 6 derniers mois). L’utilisation de drogues par injections pour une durée >3 ans, un âge jeune, et la collecte d’argent furent associés indépendamment avec un risque de transmission VIH. Les UDIs ayant acquis plus d’une seringue a la fois se sont avérés moins susceptibles d’avoir un comportement VIH. Des interventions structurelles permettant d’augmenter l’accès des IDUs a des seringues peut s’avérer efficace afin de diminuer les comportement a risque VIH parmi les IDUs séropositifs. Les limites de l’étude en question sont expliquées dans le texte.
Mots Clés: Séropositivité, séropositifs, utilisateurs de drogues par injection, Vietnam
RESUMEN
La epidemia del VIH en Vietnam se concentra principalmente en usuarios de drogas injectables (UDI). Para prevenir la super infeccion del VIH-1 y desarrollar programas de prevencion de VIH efectivos se requiere datos para entender las caracteristicas de los UDI VIH-positivos y de alto riesgo. En el Citation, realizamos una encuesta comunitaria transversal entre UDIs fuera de tratamiento, mayormente masculino, de 18 y 45 anos de edad en la Provincia Bac Ninh de Vietman. Entre 299 participantes masculinos, el 42.8% fueron infectados con el VIH y entre ellos, el 96.9% no sabian de su infeccion antes del estudio. El treinta y dos porciento fueron VIH-positivos y tuvieron un comportamiento de alto riesgo para el VIH (teniendo relaciones sexuales sin proteccion o compartiendo equipmiento para injectar en los ultimos 6 meses). Haber injectado por ≥ 3 anos, ser mas joven, y juntando dinero entre otros para comprar drogas estuvieron asociados de forma independiente con ser de alto riesgo para transmitir el VIH. Intervenciones estructurales que aumentan la acessibilidad de las jeringuillas pueden ser efectivos en reducir el comportamiento de riesgo para el VIH entre UDIs infectados con VIH. Se identifica limitaciones en el texto.
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THE AUTHORS
Dr. Vivian Go is an Associate Professor in the Infectious Diseases Program of the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Her research has primarily focused on understanding and responding to the social context of HIV prevention in South and Southeast Asia. Her research integrates qualitative and quantitative methods to examine barriers to HIV prevention among marginalized populations. Over the last decade, she has worked in collaboration with the Vietnamese government to develop and evaluate HIV prevention interventions for IDUs.
Dr. Constantine Frangakis is a professor in the Department of Biostatistics at the Johns Hopkins Bloomberg School of Public Health. He develops designs and methods of analyses to evaluate treatments in medicine, public health, and policy. The increased quality and number of available treatments and increasing ethical and practical constraints are transforming the field of intervention research: The factors of research interest are no longer the same as factors that we can intervene on humans. To address this, he has been developing new designs and methods for partially controlled studies, that is, studies that explore the factors that can be controlled, in order to investigate the effects of the factors of research interest.
Dr. Le Van Nam, vice director of Bac Ninh Department of Health and standing member of the Provincial Committee for AIDS, Drug and Prostitution Prevention and Control, has made a great contribution to HIV prevention programs in the Bac Ninh Province, including support to peer education programs and setting up VCT services throughout the province. He was the site director of the network-oriented HIV/STD prevention intervention among IDUs in northern Vietnam in collaboration with Johns Hopkins University.
Ms. Teerada Sripaipan has an M.P.H. from the Emory University Rollins School of Public Health. She has been working as a data analyst in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Her research interests include social and behavioral aspects of HIV infection and prevention among underserved, disadvantaged populations.
Dr. Anna Bergenstrom holds a PhD from University College London and has worked in the field of HIV and AIDS since 1994. During 1994 to 1999 she worked on different HIV research studies in the Department of Primary Care and Population Sciences in the Royal Free and University College Medical School in London, United Kingdom. In Citation2003–2004 she was the Project Director in the Department of Epidemiology, off-site in Vietnam overseeing the implementation of a Johns Hopkins University Bloomberg School of Public Health HIV/STI prevention research trial among injecting drug users. She has also worked in UNAIDS Inter Country Team in South Asia, New Delhi (2000–2002), UNICEF Indonesia Country Office and UNICEF East Asia and Pacific Regional Office (2005–2007). She is currently working as Coordinator (Expert/Advisor, HIV/AIDS Prevention and Care) in the UNODC Regional Centre for East Asia and the Pacific, based in Bangkok, Thailand.
Dr. Fan Li received her B.Sc. from the Department of Mathematics, Peking University, and a Ph.D. from the Department of Biostatistics, Johns Hopkins School of Public Health, in Citation2006. After finishing a 2-year postdoc in the Department of Health Care Policy at the Harvard Medical School, she is currently an assistant professor in the Department of Statistical Science, Duke University. Her research interest is in causal inference, Bayesian inference, and their applications in epidemiology and health policy.
Dr. Carl Latkin is a professor in the Department of Health, Behavior, and Society. His work focuses on HIV prevention and care among disadvantaged populations, domestic and international approaches to behavior change, social and personal network analysis, neighborhood factors and health behaviors, IDUs, sexually transmitted infections, alcohol, harm reduction, mental health, social support, social context and risk behavior, and integrating qualitative and quantitative methods.
Dr. David D. Celentano is professor in and interim chair of the Department of Epidemiology at the Bloomberg School of Public Health. He has been working in the field of HIV/AIDS since 1983 on the behavioral aspects of HIV infection among gay and bisexual men and IDUs and, for the past 15 years, on HIV epidemiology and prevention in northern Thailand. His research integrates behavioral science theory and research with epidemiology in the study of behavioral and social epidemiology. Currently, he is the Principal Investigator of four studies supported by the National Institutes of Health (NIH) in Thailand, focusing on interventions to influence the association between opiate use, methamphetamine use, and use of other drugs on HIV. The focus of these interventions is to harness indigenous peer networks for risk reduction.
Dr. Vu Minh Quan is an assistant professor of the Department of Epidemiology at the Bloomberg School of Public Health. He received his medical degree from Hanoi Medical School and was a medical officer at the National AIDS Standing Bureau of Vietnam for 6 years and an Epidemic Intelligence Service (EIS) officer at the US Centers for Disease Control and Prevention (CDC) before joining the Bloomberg School of Public Health in Citation2003. He has numerous publications on the epidemiology of HIV/AIDS in Vietnam and HIV prevention efforts among IDUs in Vietnam. He is an investigator and the field director for two randomized controlled trials for HIV/STD prevention interventions among drug users in northern Thailand.
Notes
1 In Citation2004, the Prime Minister approved the National Strategy for AIDS Prevention and Control, which included the following: scaling up harm reduction programs; expanding HIV counseling, care, and treatment; and reducing stigma and discrimination against people with HIV and AIDS (National Committee for AIDS, Drug and Prostitution Prevention and Control, Citation2004). In Citation2006, the National Assembly passed the Law on HIV/AIDS Prevention and Control, which legalizes harm reduction measures, including condom promotion, access to sterile injection equipment and substitution treatment for opiate dependence (The XIth National Assembly of the Socialist Republic of Vietnam, Citation2006).