Perceived barriers and facilitators to uptake of HIV testing services among people who inject drugs in Vietnam

ABSTRACT

Background: The concentrated HIV epidemic in Vietnam disproportionately impacts people who inject drugs (PWIDs). This qualitative study aims to understand PWID’s barriers and facilitators to HIV testing and treatment services (HTTSs). Methods: A participatory research methodology was used. PWIDs were included in the recruitment of participants, development, and refinement of study instruments, data collection, and validation of the research findings. In-depth interviews (IDIs) (N = 18) and focus group discussions (FGDs) (N = 10) were conducted in Hanoi, Ho Chi Minh, and Thai Nguyen. Data were analyzed using a thematic approach. Results: PWIDs reported multiple structural and social barriers to HTTS. Structural barriers included the requirement for local residence documentation to access HTTS, fear of incarceration, and limited operating hours. Significant stigma and social discrimination toward drug users further disincentivized HTTS uptake. PWIDs also expressed concerns about provider capacity and commitment to offering confidential, private HTTS. HIV treatment knowledge was limited: HIV diagnosis was perceived as equivalent to a death sentence. PWIDs who were aware of treatment did not believe it was accessible, effective, or affordable. Conclusions: Future strategies must address the structural and social barriers related to accessing HTTS and destigmatize these services for PWIDs. Approaches should consider using alternative channels as a means to increase coverage of HTTS, and be complemented with social and behavior change communication strategies.

KEYWORDS:

• Community-based participatory research
• HIV
• persons who inject drugs
• qualitative
• stigma

Declaration of potential conflicts of interest

Support from the Elton John AIDS Foundation made this research and programming to improve PWID access to safer syringes and HIV services in Vietnam possible. There is no conflict of interest to declare.

Acknowledgments

We would like to thank the Provincial AIDS Committee leadership in all three provinces who ensured that this study was feasible, particularly: Dr Tieu Thu Van (HCMC), Dr La Thi Lan (Hanoi), and Dr Truong Binh and Minh (Thai Nguyen). We would also like to acknowledge the contributions from Mr Mahesh Paudel who provided technical input during design and analysis phases, and Gary Mundy, Kristen Little, and Navendu Shekhar for their comments and review of the manuscript.