Download THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS

THE 6TH
NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS
Male Sex Workers in Vietnam:
Risk Factors &
Preliminary Findings from a
Sexual Health Intervention
(SHEATH)
Scientific Symposium on HIV and HCV Infections in Key
Populations
Hanoi, Vietnam
November 2015
ACKNOWLEDGEMENTS
National Institute on Drug Abuse
Grant Number: DA022170
National Institute on Drug Abuse / PEPFAR
Grant Number: 033673
The 6th National Scientific Conference on HIV/AIDS
RESEARCH COLLABORATION
New York University, College of Nursing
Lloyd Goldsamt, PhD
Hanoi Medical Univ., CREATA
Le Minh Giang, MD, PhD
Center for Applied Research on Men and Community Health (CARMAH)
Donn Colby, MD
Bao Le, MSW
Univ. of Puerto Rico, School of Public Health
Michael Clatts, PhD
The 6th National Scientific Conference on HIV/AIDS
SUMMARY
• YMSWs in Vietnam evidence multiple, complex, and interacting sources of risk and
multiple poor health outcomes.
• YMSW have limited contact with health services (including HIV testing and
treatment)
• Lack of knowledge and stigma are key barriers to engagement and retention in
care.
• It is possible to identify, reach, and engage YMSWs for participation in HIV & health
services interventions.
• Targeting YMSW in these types of interventions may be expected to yield
substantial individual and community level benefits across the full spectrum of HIV
prevention and care.
The 6th National Scientific Conference on HIV/AIDS
HIV IN SE ASIA
• Global Burden of HIV: 35 million (2.1 million new infections in 2013
• Asia/Pacific region has a “concentrated” HIV epidemic
• 350,000 new infections in Asia/Pacific region 2013 (little change in
incidence in last 5 years)
• MSM populations account for a rapidly growing proportion of new STI/HIV
infections throughout the region
• Behavioral risk is especially high among among young male sex workers
(YMSW)
Source: HIV and AIDS in the Pacific: UNAIDS Report 2013.
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INCREASING STI/HIV MSM/MSW IN VIETNAM
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EPIDEMIOLOGICAL STUDY
YMSW IN VIETNAM
• 2010 – 2011
• Community-based ethnographic mapping in Hanoi, Nha
Trang, and Ho Chi Minh City
• Targeted/venue-based sampling (n=654)
• Cross-sectional survey and biological screening
• Eligibility:
Age 16-35 years of age
Sex with a male client partner <90 days
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DEMOGRAPHIC CHARACTERISTICS
• Mean Age: 22 (39% under the age of 21)
• Education: 58% had no completed high school
• 50% of monthly income from sex work
• Unstable housing <30 days: 88%
• Migrant: 53%
• 47% attracted to both men and women, 30%
attracted exclusively to women, only 14% identify as
“Gay”
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HIGH RATES OF DEPRESSION
Source: L Goldsamt, M Clatts, Le MG, G Yu (2014) Prevalence and Behavioral Correlates of Depression and Anxiety Among YMSW in Vietnam, Internat J. Sex. Hlth
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SUBSTANCE USE (<30DAYS)
Tobacco: 80%
Alcohol: 98%
Amphetamines: 38%
MDMA: 37%
Ketamine: 10%
Opium: 8%
Heroin (smoking): 8%
Heroin (injection): 8%
Source: Yu, G., et al. Substance use among male sex workers in Vietnam: Prevalence, onset, and interactions with sexual risk.
International J. of Drug Policy (2014)
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MULTIPLE, CONCURRENT SEX PARTNERS
654 Vietnamese MSWs by sex
partner type
Sex work clients, female
elective partners and
male elective partners
9%
26%
18%
Sex work clients and male
elective partners
Sex work clients and
female elective partners
47%
Sex clients only
Source: Clatts MC, Giang LM, Goldsamt LA, Yu G. 2015. Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health
The 6th National Scientific Conference on HIV/AIDS
HIGH RATES OF UNPROTECTED SEX &
CONCURENT MULTIPLE PARTNERS
Unprotected Anal or VaginaI
Intercourse in the last 30 days
57%
34%
Male elective partners
32%
Female elective partners
Sex clients
Source: Clatts MC, Giang LM, Goldsamt LA, Yu G. 2015. Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health
The 6th National Scientific Conference on HIV/AIDS
HIGH RATES OF STI/HIV
Source: Clatts MC, Giang LM, Goldsamt LA, Yu G. 2015. Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health
http://dx.doi.org/10.1071/SH14101.
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COMPLEX (“SYNDEMIC”) SOURCES OF RISK
SUBSTANCE
USE
DEPRESSION &
ANXIETY
STIGMA & ALIENATION
FROM CARE
BEHAVIORAL
RISKS
LIMITED UNDERSTANDING
OF HIV RISK
POVERTY &
LACK OF
OPPRTUNITY
STI/HIV &
POOR HEALH
OUTCOMES
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SHEATH INTERVENTION
(Sexual Health Education And Targeted Harm reduction)
•
•
•
•
•
SHP interventions originally emerged as a challenge to risk factor
model (placing greater emphasis on situational, contextual, &
structural factors to understand dynamics of risk).
SHP has been widely applied in structural, community, and
individual level interventions, including HIV prevention and care,
sexual decision-making, and health services
SHEATH is a composite intervention in which we bundled content
from multiple intervention sources, including Sexual Health
Promotion (education) and Harm Reduction (risk reduction)
Locally adapted for use in targeted YMSW populations and
environments in Hanoi and HCMC
Delivered by specially trained Health Educators, using
Motivational Interviewing to enhance personalization and with an
emphasis on protective factors and sources of resiliency
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CORE COMPONENTS
1. Sexual Health
2. Sexual Diversity and Sexual Rights
3. Detailed education STI/HIV (including symptoms, sources of
transmission risk, interactions, and treatment options
4. Sexual Harm Reduction (including the full range of strategies to
behavioral risk, including role selection, sero-sorting, partner selection
strategies, condom use, etc.)
5. Substance Use (education about alcohol and drug use, modes of
administration, interactions with sexual decision-making)
6. Stigma, bias, and social barriers to health care (including skills
development in stigma management)
7. Role of health services in protecting sexual health, including
habituation of HIV testing at 4-6 months intervals, HBV vaccination
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STUDY DESIGN
Two cites: Hanoi and Ho Chi Minh City
Delivered by health educators using motivational interviewing
techniques to increase personalization
Community/venue-based outreach education (11,993 community
interventions delivered)
Random selection from the community for the clinic-based intervention
Individual-level intervention using a 2-session format (matching
conventional pre/post HIV testing infrastructure) (>1,000 interventions
delivered)
Community level evaluation: Repeated cross-sectional survey in
diverse YMSW venues
Clinic evaluation: Pre & post test measures
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ACCEPTABILITY:
Helpfulness & Relevance of Intervention Content
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SIGNIFICANT IMPACT ON A BROAD RANGE
OF HEALTH SEEKING INTENTIONS
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MOST YMSWS HAVE NEVER HAD CONTACT
WITH HEALTH SERVICES &
LESS THAN HALF HAVE HAD AN HIV TEST
Community Sample
Community Sample
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SIGNIFICANT IMPACT ON
KNOWLEDGE OF HIV STATUS--(Critical Step in the HIV test & treat cascade)
Community Sample
Clinic Sample
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