HIV/AIDS EPIDEMIC AMONG

INJECTING DRUG USERS IN

VIETNAM
February, 2012

S M Tanvir Ahmed
School of Public Health

CONTENTS
PART A:
Summary Presentation on Research Monograph
PART B:
Summary Presentation on Proposed IDU
Research

Presentation on Research
Monograph

IDU & HIV/AIDS Epidemic

Brief Introduction
Review Methods
Risk Behaviours
Characteristics
Injecting Behaviours
Sexual Behaviours
Discussion & Implication
Research Need
Concluding Remarks

IDU & HIV/AIDS Epidemic in

Vietnam

Still technically categorized as concentrated 1

epidemic stage, mostly affecting:
Injecting Drug User (IDU) 18.4%
Female Sex Workers (FSW) 3.2%, and
Men who have Sex with Men (MSM) 16.7%
According to the national level forecasts the
prevalence is less than 0.5% among adult 1.
Around 70% reported HIV cases under 30 years,
45.5% within age bracket 20-29 years in 2009 1.
Some provinces have rising prevalence well
above 20% among both IDUs and FSWs 1,5.

Brief Introduction
It appears a recant
slowdown and
stabilising in
prevalence among
IDUs in 20091

But high variability

exists (2005-06)
across provinces which
confirms chances of
further transmission5

Review Methods
This research monograph presents broad
framework which aims:
To document systematically the patterns of
HIV risk behaviours among IDUs in Vietnam,
To allow understanding of the current state
of responses, and
To recommend future research needs
among IDUs with regard to stabilise and
slowdown epidemic among IDUs.
Whether risk behaviours across IDU population
or the sub-groups that shape the epidemic?

Review Methods
Griffith University Library Database searched
during Sep-Oct, 2011 (Medline, JSTOR, Science
Direct etc.
Search strategy:
Free words, key words & combinations
Timeframe 1995 onwards
Both Peer reviewed, non-peer reviewed
Total of 75 documents selected for this review
60 peer reviewed articles
15 national, international, reports, plans etc.

Review Methods .
60 peer reviewed articles included:
IDUs: 40 articles presenting risk behaviours
FSWs: 10 selected presenting sexual mixing
Others: 10 selected presenting HR
development
15 non-peer reviewed reports and documents
Surveillance report, strategic plans, project
documents etc. in Vietnam
Peer reviewed articles are best described as:
North Vietnam-24, South Vietnam-8 & both-2
Rest 6 presents national epidemiologic data
Period of publish: 1995-2000: 9 2001-2010: 31

Risk Behaviours
Majority male (sampled 80-90%), unemployed,
Single (60-70%), Young age (20-29 years) 3,6,7,8,14
Very short transition from non-injecting to
injecting (8-14 months)4,5,6,8
Injecting heroine currently9
Injecting in shooting gallery (reducing
nowadays)9 and public places (street, park)2,7,10
Involve in social injecting and resource pool 16
Majority being injected by others (dealer, friend)
Majority sexually active with FSW in 6 month 3

Risk Behaviours
Sharing of needle, syringe and other injecting
equipment is widespread among IDUs:
In early stage more than 80% IDUs shared their items
- Nowadays direct sharing reducing2 but indirect
sharing mechanism widespread3,4,5,7,8
More than 50% IDUs visit FSWs and enjoy unsafe sex
frequently:2,3,8,11-16
51.4% IDU had protected sex last time with FSW 1
77.7% FSW had protected sex with most recent
client1
Multiple sex partners5,7,8,11-16
One-thirds involved in high risk sex also aged less
than 28 years and nearly two-thirds of them single
(63%)16

Discussions & Implications

Firstly, this review prominently stands out
sub-groups of IDU population especially
young injectors less than 30 years
highlighting enhanced coverage through
harm reduction services.
Secondly, the chain of infection
developed through sexual mixing among
IDUs to FSWs and onward transmission
need to prevent before reaching a
threshold level which facilitate growth
among general population.

Discussions & Implications

Thirdly, development of south to north
epidemic gradient with some provinces
crossing 1% among general population 15.
Then, drug using FSWs specially those who are
injecting (15-20%)11,12 are also partnering noninjectors and clients from general population
which is a dangerous combination for developing
wider heterosexual epidemic in future.
Lastly, risk behaviours of IDUs (male & female)
who are already HIV infected need under
extensive coverage and treatment.

Future Research
Target younger, newer IDU subpopulation
and investigate distinct IDU network to
develop evidence-base innovative project.
Investigate short transition period from noninjecting to injecting which will provide
insights for suitable project design approach
for preventing longer drug use career.
Examine extent of sexual network mixing
among IDUs and FSWs which will assist
innovative sexual health project design to
prevent epidemic among wider population.

Concluding Remark
Target young IDUs and their sexual links as
the most important prevention need.
Vietnam has still windows of opportunity to
incorporate lessons learned from epidemics
of other countries (Thailand, Cambodia).
Greater challenge lies in reaching the
identified younger, newer sub-groups of IDUs
with promising efforts as per their service
need.

Part B: Summary Presentation on

Proposed IDU Research
Title: HIV Infection and Behavioural Risk Factors
among Young Drug Users in Hanoi, Vietnam.
Location: Hanoi, Vietnam
Participants: Young Adult Injecting Drug Users
Age Group: 30 years of age or less
Duration: 3-5 years (primary selection)
Participants:
Community and treatment centres

Study Components:
Epidemiological Survey and HIV Testing (Rapid
Testing)
Brief Network Survey

Research Objectives
To estimate the prevalence of HIV infection among
young IDUs in selected sites in Hanoi, Vietnam,
To examine the behavioural risk factors among
young IDUs that influence the HIV transmission in
selected sites in Hanoi, Vietnam,
To characterise the social and drug related
contacts of young injecting drug users within their
networks highlighting network composition and
patterns of mixing, and
To recommend future programmatic directions for
developing innovative program (expansion of
harm reduction) among young IDUs in Hanoi,
Vietnam.

Schematic Design

Sampling and Data Collection

Around 350 IDUs will be recruited
proportionately from treatment centres and
community settings (detect 20% difference
among high risk and low risk of IDUs with
sufficient power)
Respondent Driven Sampling will be used to
recruit participants from community setting
(selection start with 10 seeds each recruiting 4
from own IDU networks)
A total of four waves of RDS data collection will
help to reach required sample IDUs
Research ethical and strict Inclusion, Exclusion
criteria will be maintained

Analytical Procedure
Epidemiological survey
Descriptive statistics for describing epidemiologic
characteristics
Inferential measure (chi-square, ANOVA, Regression)
at required level will be done to analyse association
ELISA, Western Blot testing for detection HIV
antibody

Network survey data

Network characteristics (contact nos, types etc. ) to
differentiate different types of IDU networks (age
group, type of drug, ethnicity etc.)

Collaboration and Support

Vietnam Authority of HIV/AIDS Control

NIHE
Griffith University
Other international and national organizations
(AusAID???, AEI???, FHI???, UANIDS???,
PACT???)
Other academic Institutions (Hanoi school of
public health???)
Support areas include: protocol development,
ethical approval, data collection instrument
finalisation, data collection, work opportunity
for proper knowledge and familiarity in contexts

Limitation

Seed identification
Collecting network data
Recall duration
Willingness to participate in HIV testing

Reference used

1.
UNGASS, THE FOURTH COUNTRY REPORT ON FOLLOWING UP THE
IMPLEMENTATION
TO THE DECLARATION OF COMMITMENT ON HIV AND
AIDS, VAAC.Hanoi. 2010.
2.
Hien, N., et al., Risk factors of HIV infection and needle sharing among
injecting drug users in Ho Chi Minh City, Vietnam. J Subst Abuse,
2001. 13(12): p. 45 - 58.
3.
Nguyen, T.A., et al., Risk factors for HIV-1 seropositivity in drug users under
30 years
old in Haiphong, Vietnam. Addiction, 2001. 96(3): p. 405-413.
4.
Vinh, D.T.N., et al., LETTER TO THE EDITOR: Knowledge, attitudes, belief
and practice related to HIV/AIDS among young people in Ho Chi
Minh City,
Vietnam. European
Journal of Epidemiology, 2003. 18(8): p. 835-836.
5.
Ministry of Health, Results from the HIV/STI Integrated Biological and
Behavioral
Surveillance (IBBS) in Vietnam 2005-2006. 2006: Vietnam.
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Quan, V.M., et al., HIV in Vietnam: The Evolving Epidemic and the
Prevention
Response, 1996 Through 1999. JAIDS Journal of Acquired
Immune Deficiency
Syndromes, 2000. 25(4): p. 360-369.
7.
Thao, L., et al., Changes in High-Risk Behaviors Over Time Among Young
Drug Users in South Vietnam: A Three-Province Study. AIDS and
Behavior,
2006. 10(0): p. 4756.
8.
Hien, N.T., et al., The social context of HIV risk behaviour by drug injectors
in Ho Chi
Minh City, Vietnam. AIDS Care, 2000. 12(4): p. 483- 495.
9.
Strathdee, S.A., et al., HIV and risk environment for injecting drug users:
the past,
present, and future. Lancet, 2010. 376(9737): p. 268-268-284.

Reference used

10. Tran, T.N., et al., Drug use, sexual behaviours and practices among male
drug users in Hanoi, Vietnama qualitative study. International
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Drug Policy, 2004.
15(3): p. 182-188.
11. Tran, T.N., et al., Drug use among female sex workers in Hanoi, Vietnam.
2005,
BLACKWELL PUBLISHING LTD.
12. Tuan, N.A., et al., Intravenous Drug Use Among Street-Based Sex Workers:
A High-Risk
Behavior for HIV Transmission. Sexually Transmitted Diseases,
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13. Tran, T.N., et al., Drug use, sexual behaviours and practices among female
sex workers in Hanoi, Viet Nam--a qualitative study.
International Journal
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infection among
male injection drug users under 30: a cross- sectional
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16. Schumacher, C.M., et al., Social injecting and other correlates of high-risk
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International Journal of Drug Policy, 2009. 20(4): p. 352-356.