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MEN WHO HAVE SEX WITH MEN IN HANOI:
Social Profile and Sexual Health Issues
Khuat Thu Hong, Le Bach Duong, Vu Thanh Long
&
Institute for Social Development Studies
Research Report
On request of
Policy Project
Draft
Hanoi, 2005
1
If the homosexuals don’t break the law, then they are not even one iota less dignified than us.
We have no right to mockingly talk about them... You have to keep in mind that there are
many sexless things in this life. They are morality, talent, and dignity. Therefore, it’s unfair to
associate homosexual people with some certain defects, and sometime doing this can even
become guilty (Film Director Le Hoang) – VietnamNet forum (5/6/2003)
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Table of Contents
Recommendations .......................................................................................................... 9
Involve policy makers .................................................................................................................. 9
Advocacy for reduction of stigma and discrimination against MSM ...................................... 9
Using their frequent venues ........................................................................................................ 9
Using internet as an educational channel ................................................................................. 9
Set up counseling centers and hotline where MSM can seek for information and advice... 9
Make sexual health services MSM friendly to increase their testing and access to
treatment ....................................................................................................................................... 9
Improve quality of condom and diversify methods of distribution ....................................... 10
Raise awareness of lubricant and make it available ............................................................... 10
1
INTRODUCTION ......................................................................................................... 11
1.1
Background ..................................................................................................... 11
1.2
Research on MSM in Viet Nam ....................................................................... 13
1.3
MSM research in Hanoi .................................................................................. 15
1.3.1
1.3.2
1.3.3
2
Research questions ...................................................................................................... 16
Research methodology and methods ......................................................................... 16
Ethic Issues.................................................................................................................... 17
FINDINGS ................................................................................................................... 18
2.1
MSMs in Hanoi – Who are they? .................................................................... 18
2.1.1 Socio-Demographic Profiles ........................................................................................ 18
2.1.2 Sexual identities ............................................................................................................ 20
2.1.2.1
Gays........................................................................................................................ 21
2.1.2.2
Bi-sexuals ............................................................................................................... 23
2.1.2.3
Straights men .......................................................................................................... 25
2.1.3 Social Relations ............................................................................................................. 26
2.1.3.1
Family ..................................................................................................................... 26
2.1.3.2
Marriage .................................................................................................................. 29
2.1.3.3
Friends .................................................................................................................... 30
2.1.3.4
Workplace ............................................................................................................... 32
2.1.3.5
Community and society at large ............................................................................. 33
2.2
2.2.1
2.2.2
2.2.3
The world of MSM ........................................................................................... 34
Between the circle of MSM ........................................................................................... 36
Leisure time and entertainment activities .................................................................. 36
Identifying “them” and “us” ......................................................................................... 38
2.3
Process of gender identity formation and development of sexual
orientation ..................................................................................................................... 40
2.3.1 Childhood and Adolescence –“I want to play with boys” ......................................... 40
2.3.2 “Why am I different?” ................................................................................................... 41
2.3.3 Coming out - “I want to live my life” ........................................................................... 44
2.3.4 First sexual experience ................................................................................................. 45
2.3.4.1
First sex with women – “Do I really like it?” ............................................................ 45
2.3.4.2
First sexual experience with men – Pleasure and anxiety ..................................... 46
2.4
Current Sexual Practice and Sexual Health Issues ...................................... 49
2.4.1 Lively dating................................................................................................................... 49
2.4.2 High frequency of sexual intercourse and multiplicity of sexual partners ............. 50
2.4.2.1
Sex with men .......................................................................................................... 50
2.4.2.2
Sex with women ...................................................................................................... 53
2.4.3 Diverse sexual practice ................................................................................................ 54
2.4.4 Lot of misconceptions and myths about risk and safety .......................................... 56
2.4.5 Use of condom and lubricant ....................................................................................... 59
2.4.6 Limited access to information and poor utilization of SH service ........................... 63
2.4.6.1
Source of information on sexuality and sexual health ............................................ 63
2.4.6.2
Utilization of counseling services ............................................................................ 65
2.4.6.3
Testing .................................................................................................................... 65
2.4.6.4
Health seeking behavior - utilization of STI treatment services ............................. 66
2.5
2.5.1
2.5.2
MSM community in Hanoi: Issues of Migration and Sex Work. ................... 67
Homosexuality and migration ...................................................................................... 67
Male-male sex business in Hanoi and migration ....................................................... 69
3
2.5.2.1
2.5.2.2
2.5.2.3
2.5.2.4
2.5.2.5
2.5.2.6
2.5.2.7
2.6
2.6.1
2.6.2
2.6.3
3
Who provides male-male sex services in Hanoi? ................................................... 69
Who buys male sex service? .................................................................................. 71
How one engaged in to sex work? ......................................................................... 75
Reasons to engage in sex work: Money or Pleasure? ........................................... 76
Earning from sex service ........................................................................................ 77
How and where sex transactions are made? ......................................................... 78
Is the sex work safe? .............................................................................................. 81
Needs of MSM ................................................................................................. 82
Information on sexual healths ..................................................................................... 82
Gay friendly sexual health services ............................................................................ 83
Societal acceptance and legitimacy ............................................................................ 83
CONCLUSIONS AND RECOMMENDATIONS ........................................................... 85
3.1
Conclusions and implication for sexual health interventions ..................... 85
3.2
Recommendations .......................................................................................... 87
3.2.1 Involve policy makers ......................................................... Error! Bookmark not defined.
3.2.2 Advocacy for reduction of stigma and discrimination against MSM . Error! Bookmark
not defined.
3.2.3 Using their venues .............................................................. Error! Bookmark not defined.
3.2.4 Using internet ...................................................................... Error! Bookmark not defined.
3.2.5 Set up counseling centers and hotline where MSM can seek for information and
advice Error! Bookmark not defined.
3.2.6 Make sexual health services MSM friendly to increase their testing and access to
treatment ........................................................................................... Error! Bookmark not defined.
3.2.7 Improve quality of condom and diversify methods of distribution .... Error! Bookmark
not defined.
3.2.8 Raise awareness of lubricant and make it available........ Error! Bookmark not defined.
4
REFERENCE .............................................................................................................. 89
4
LIST OF ACRONYMS
DKT
FHI
IEC Information, education, and communication
IDU Injecting drug user
ISDS
MSM Men who have sex with men
MSW Male sex worker
SIDA
STI Sexually transmitted infection
UNAIDS Joint United Nations Programme on HIV/AIDS
USD
VND
5
GLOSSARY
AC – chi nhung nguoi thich lam phu nu
Bóng kín
Bóng lộ
Bóng lõa
Boy - straight
Hifi
Tám vía
Hai thì
Lại cái
Pêđê
Xăng pha nhớt
Ben, đi ben – anal penetration
“Hàng”
Đồng cô
Con bà - chỉ chung cả bóng kín và bóng lộ
Sàn – Sàn nhẩy
Hàng – trai mại dâm
“Hàng” – penis
Tộp – blow job
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EXECUTIVE SUMMARY
Although the majority of HIV-infected people in Vietnam were found among injecting drug
users (IDUs), the real impact of the epidemic is sexual transmission from high-risk
populations to partners including commercial partners and other sexual partners. Already,
there is evidence that the epidemic has begun to spread to the general population. While the
HIV risk and prevention needs of men who have sex with men (MSM) have been found in
other Asian countries, they are not well understood in Vietnam. Therefore, MSM are not
currently targeted as a high-risk group in HIV prevention efforts. This inattention may likely
be attributed to the almost lack of awareness of homosexuality. All of today’s images and
information regarding sexuality in Vietnam are targeted at and pertinent to heterosexuals.
Homosexuality has been left virtually untouched in popular culture and among HIV/AIDS
campaigns. As a result, there are many myths and misconceptions about MSM among the
public that have been influenced not by personal knowledge of the matter but by assumptions
that have become truths through media and unscientific research.
The situation has been improved with several studies on MSM conducted in the southern part
of Vietnam during the last few years. However, the MSM population in the north remains
almost unknown. As POLICY Project's first step toward development of advocacy strategies
related to MSM issues in Vietnam, this study tried to fill some of the gaps of knowledge
mentioned above and to contribute to better understanding of the MSM community in Hanoi.
The main research questions are related to the sexual identities of MSM, their sexual health
issues and needs, and the implications for intervention efforts. The study was conducted by
the research team from the Institute for Social Development Studies. Thirty six MSM were
invited to take part in this study. Seven key informants, like health providers, family
members, and friends of MSM, were also involved. The in-depth interview was the main
technique of data collection.
Key findings
The MSM community in Hanoi is both socially and sexually diverse. This diversity has
several implications on their sexual health and should thus be taken into account when
designing and implementing sexual health interventions for this group.
Regarding their social profile, MSM in Hanoi come from different backgrounds. The
diversity in socio-demographic background of MSM in Hanoi implies that the sexual health
interventions should not be the same but be differentiated accordingly to each subgroup’s
characteristics.
MSM in Hanoi experience heavy stigma and discrimination from their family and from
society. While most MSM can rely on economic and emotional support from their family,
they rarely expect the latter to accept their same-sex orientation. Instead, they are constantly
under pressure to conform to the social norms about marriage and having children as well as
to fit gender stereotypes regarding masculinity. The negative societal attitudes toward bóng lộ
deepen their fear of being discovered and thus push MSM underground. This creates more
difficulty for interventions to reach this group.
With regard to their lifestyle and the level of disclosure of their same-sex orientation, MSM
in Hanoi can be categorized as bóng kín and bóng lộ. Bóng kín carefully hide their same-sex
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desire and/or male-male sexual behavior. Bóng lộ openly live with their homosexual identity.
Many bóng lộ dress and behave like women. The invisibility of bóng kín may limit access to
them for intervention efforts. Stigma against bóng lộ may appear as a barrier for intervention
efforts to get their trust as well as support from community.
The world of MSM in Hanoi is characterized by lively networking and dating through the
entertainment actitivities of its members. The Internet is an increasingly important means of
communication and networking among young MSM.
In terms of their sexual identities, the MSM community in Hanoi consists of the following
three major subgroups: gay men, bisexual men, and straight (heterosexual) men. Most gay
men have sexual relations exclusively with men. Bisexuals and straight men have sex with
women and men. Both bóng lộ and bóng kín prefer having sex with “genuine” men. Bóng kín
rarely want to associate with bóng lộ. The same holds true for bóng lộ if they know about the
true identity of bóng kín.
Most MSM have their first sexual experience with men during adolescence. The majority of
them have mixed feelings after that. They enjoy having sex with men but feel shame and
guilt. Most of them continue wrestling with doubts about their sexual identities for a long
time. For many of them, conforming to gender norms becomes an obsession. This creates a
psychological drama that may remain for the rest of their lives and thus affect their selfesteem and push them deeper into depression.
Although MSM are aware of the risk of infection of HIV/AIDS and sexually transmitted
infections (STI), they still have misconceptions and myths about male-male sex. Many of
them believe that male-male sex is safer than male-female sex and that women are the source
of STI. There are myths that anal intercourse and oral sex are safe if the penetrator ejaculates
outside. Some people are confident that they can identify healthy or unhealthy men by their
appearance.
The sexual behavior of MSM in Hanoi is characterized by lively dating, high frequency of
sexual intercourse, multiple sexual partners, and diverse sexual practices wherein condoms
are used inconsistently or not at all. The myths of the safety of male-male sex are main
factors explaining this risky practice. Lack of skill in negotiation is another important barrier
to the safer sex behavior of many MSM. Knowledge and use of lubricants for anal intercourse
is poor.
Few MSM are aware of or use voluntary counseling and testing. Many MSM prefer selftreatment when they get infected with STI. This can be a way to avoid stigma associated with
infection of STI. MSM are more likely to use a private clinic to avoid being discovered.
Some health providers may not be aware of the existence of MSM and their sexual health
issues. This may affect the providers’ ability to identify the specific needs of MSM clients
and thus limit their opportunity to provide MSM with more relevant advice and treatment.
This study documented and confirmed a close connection of migration and homosexuality.
Many gay men choose migration as a strategy to escape stigma and discrimination in their
home town or village and to live openly with their true sexual identity.
The male-male sex business in Hanoi is currently very ebullient. Besides local men, migrants
become an important source of supply for this market. Sex workers are diverse in terms of
8
their social profiles. They are students, workers, soldiers, drug users, unemployed, or urchins
who run away from home.
Clients of male-male sex business also come from different social backgrounds. This means
that there is a big community of homosexual men and MSM in Hanoi. They hide their true
identities and lifestyles in order to avoid the shame and discrimination associated with
homosexuality. This vast but invisible population poses great challenge for safe sex
promotion programs.
Recommendations
A golden principle is that all interventions targeting MSM should respect the diversity
of the MSM community and involve all of its members in the entire process.
Involve policy makers
All of the programs targeting MSM, whether they include research or intervention or both,
should involve policy makers throughout the process.
Advocate for reduction of stigma and discrimination against MSM
Interventions for the improvement of sexual health and prevention of HIV and STI for MSM
should be combined with advocacy to reduce stigma and discrimination against this
community. One effective way of doing this is to use the media to disseminate information
and advocate about sexuality and sexual rights in general and homosexuality and the rights of
people with same-sex identities in particular. This involves training for media professionals
and designing and disseminating media programs to change public discourse about
homosexuality and homosexuals. Sexual health education should include a section about
homosexuality and the rights of homosexuals.
Use familiar venues
Interventions can be integrated in some appropriate entertainment activities and venues such
as a quiz on HIV/AIDS and STI and prevention methods. Brochures and leaflets may be more
suitable in public places such as parks or lake areas. Involvement of peers is essential for
access to the target group.
Use the Internet as an educational channel
Educational messages and counseling can be disseminated through the Internet. Specific Web
sites for this purpose should be designed and introduced to the community of MSM.
Set up counseling centers and a hotline where MSM can find information and
advice
The counseling centers and hotline should be run by experts in the field of sexuality and
sexual rights, including the area of homosexuality. Knowledge of legal issues regarding
identity and civil rights is also important for a counselor to know.
Make sexual health services MSM friendly to increase testing and access to
treatment
Train sexual health providers both in public and private sectors to be aware of issues of MSM
and to be able to identify and meet the specific needs of these clients.
9
Improve the quality of condoms and diversify methods of distribution
The inconsistent or lack of use of condoms has partly resulted from the poor quality of some
brands of condoms available in the Hanoi market. Those who used condoms prefer highquality condoms with colors and scents. Thin texture and a shape that is suitable for
containing semen are also favorable features of a condom. The promotion of condom use
should take this into account. Condoms should be made available in the venues where MSM
often meet for sexual encounters. A network of outreach collaborators can also promote and
distribute condoms.
Raise awareness of lubricant and make it available
Incorporate information about lubricant and its use in educational activities and printed
materials. Distribute a lubricant sachet together with a condom.
10
1 INTRODUCTION
1.1 Background
Vietnam is considered to have one of the newest HIV/AIDS epidemics of the region that is
now spreading rapidly. UNAIDS estimates that 40 to 120 people become infected everyday.
The Ministry of Health estimates that there were 160,000 HIV infections cumulatively at the
end of 2002. Associated with intravenous drug use and commercial sex, the epidemic is
currently concentrated among younger people aged 20 to 39 who make up 82.5 percent of
cases (Hien et al, 2004).
Although the majority of people infected with HIV in Vietnam were found among IDUs, the
real impact of the epidemic is sexual transmission from high-risk populations to partners,
including commercial partners and other sexual partners. Already there is evidence that the
epidemic has begun to spread to the general population. HIV prevalence among pregnant
women attending antenatal clinics increased more than ten-fold between 1994 and 2002, from
0.03 percent to 0.39 percent. HIV prevalence among army conscripts also increased from 0
percent in 1994 to 0.7 percent in 2002 (UNAIDS, 2003).
Efforts have been made to control the spread of HIV and STI through sexual transmission;
however, the situation has not yet improved. The rate of HIV infection through sexual
transmission is still growing year by year, and in some groups the rate growth has become
alarming.1 Despite the increase in people’s knowledge about sexuality and the change in
public discourse toward more open discussion about sexuality during recent years, there are
still a lot of misconceptions, myths, stigma, and discrimination surrounding sexuality. There
is also evidence of unsafe sex practice prevalent among different population groups.
Perhaps, partly due to emphasis on population control, family planning, and afterward on
reproductive health, sexuality is addressed only in terms of heterosexual and married couples.
All of today’s images and information regarding sexuality in Vietnam are targeted at and
pertinent to heterosexuals. Homosexuality has been left virtually untouched in popular
culture, not to mention among HIV/AIDS campaigns. As a result, there are many myths and
misconceptions about MSM among the public that are influenced not by personal knowledge
of the matter but by assumptions that have become truths through media and unscientific
research. One common belief is that MSM are not truly homosexual but are temporarily
following a fashion or trend of the West (Colby et al, 2004). Some information material
describes two kinds of homosexual men in Vietnam. The “true” kind is inherently
homosexual and is “very rare,” and the “fake” kind has been influenced by fashion or
experimentation into trying homosexuality temporarily. These ideas are widely accepted as
truth despite the lack of facts and scientific evidence to support them.
Of the current number of HIV/AIDS cases in Vietnam, it is unknown how many are
attributable to homosexual contact. Because the current HIV surveillance system does not
include MSM, the true nature of the epidemic in this population remains unknown. However,
a number of studies on MSM in Vietnam point to the fact that this population is at risk and
should be targeted for interventions and public health programs.
1
For example, the rate of HIV infection found among pregnant women has increased from 0.03 in 1994 to 0.39
in 2002, and recently it has been found that the rate of infection among MSM in Ho Chi Minh City was as high
as eight percent.
11
As has been found in other Asian countries, the HIV risk and prevention needs of MSM in
Vietnam are not well understood. Therefore, MSM are not currently targeted as a high-risk
group in HIV prevention efforts. This inattention may likely be attributed to the strong stigma
and intolerance associated with behaviors that stray from the societal norm of Vietnam, such
as homosexuality. On top of this is the stigma associated with HIV/AIDS found across Asia.
One result of this is a low level of awareness and knowledge about the disease among the
general population.
The process is slow and has not yet resulted in homosexuality being readily accepted or even
acknowledged. As has become apparent in other Asian nations, MSM compose a vulnerable
population in the country that deserves more attention if the battle against HIV/AIDS is to be
won in Vietnam. What needs to be determined is whether this is attributed to men who have
unprotected sex with infected female sex workers or with other MSM and subsequently infect
their wives. Because the possibility exists that MSM might act as a bridge to the general
population, more research and action are warranted. Studies have shown that many MSM in
Vietnam engage in sexual relations with women as well.
In Vietnam, MSM have rarely been targeted by public health programs. There are some key
reasons for this neglect.

Although homosexuality has been mentioned sporadically in professional documents, it
was, until recently, not a familiar concept to the majority of the population.

Along with rapid economic and social changes and increasing attention to sexuality, male
homosexuality has become more visible in the last few years, which has resulted in some
negative social attitudes. Although a small number of press articles show some sympathy,
many consider homosexuality a moral flaw or even label it a “social evil.”

Many people, including professionals, confuse the two terms gay man and MSM, and
believe them to be the same group. Thus, discussions about MSM sometimes focus only
on men who identify as being gay, and other MSM are neglected.

Only one study has ever measured HIV seroprevalence among MSM. The sample size
was small, and the study did not come to any conclusions on the HIV vulnerability of
MSM as a group. Because MSM are not included in the country's sentinel surveillance
program, there are no official statistics on HIV prevalence among this group.
The fact that HIV prevention programs largely do not target MSM creates an illusion that
they are not at risk (SCF UK, 1997). However, international literature and the limited
research already conducted in Vietnam point out that MSM are particularly vulnerable to
HIV/AIDS. Explanations include factors at the individual level (the practice of multiple
partners and lack of or inconsistent condom use in anal intercourse) and those at the
environmental level (poor societal understanding of MSM and their practices, prevalent
stigmatization of and discrimination against them, the health sector's ignorance of this group,
and the serious lack of services targeting them).
Since the late 1990s, the Vietnamese government has acknowledged the importance of men’s
sexual health in its overall efforts to combat HIV/AIDS. Nevertheless, MSM as a group
remains a reluctant area for discussion, not to mention intervention, for the reasons
12
mentioned above. But as long as the silence surrounding MSM is not broken, the group will
continue to be vulnerable to the epidemic, excluded from health education programs, and
invisible to health services, and their vulnerability will continue to pose a threat for HIV
transmission to the larger community. It is important that efforts are made to meet the needs
of MSM for improvement of sexual health and social well being and hence to ensure that
their rights are respected and protected. This requires insights into the psychosocial world of
MSM and their needs in order to raise awareness of researchers, public health professionals,
society and the state and to help design appropriate policies and interventions.
1.2 Research on MSM in Vietnam
So far, few studies on MSM have been conducted in Vietnam. Their main purpose has been
to describe the HIV-related knowledge, attitudes, and practice of MSM (Care, 1993; SCF
UK, 1997; Cao H N et al., 2002; Colby, 2003). Almost all of these studies took place in Ho
Chi Minh City (SCF UK, 1997; Cao H N et al., 2002; Colby, 2003). Only one small study
was conducted in Hanoi focusing on male prostitution (Doussantousse et al., 2002). These
studies show that, in general, the majority of MSM know about HIV/AIDS, but many of them
have a low perception of risk and still practice unsafe sex.
A number of studies on MSM are currently being conducted. These are expected to provide
further understanding about MSM but will also focus on sexual knowledge, attitudes, and
behaviors, and a couple of them will examine the prevalence of HIV/STI among MSM.
This means that many questions will still be left unanswered. These include why MSM
practice unsafe sex, how they use sexual health services, what MSM need for services, and
how services could be made available and accessible to them. There is very little contextual
understanding of the sexual interactions and networks of MSM. No study has explored the
identities of MSM or how these identities and other socio-economic and cultural factors
affect the life and sexual experience of different groups of MSM and their needs for health
and social well being. Such information is crucial for designing appropriate programs
addressing the sexual health of MSM.
Ignorance and denial of MSM and homosexuality is found within the government and
criminal justice systems. There are no laws or regulations specifically relating to same-gender
sexual relationships nor any official interest in subject. In Vietnam, female prostitution is
criminalized and specifically identified as a “social evil” in the government’s mass media
campaign. Male prostitution, on the other hand, is completely ignored by law enforcement,
although it is a well known enterprise (Doussantousse et al., 2002). One study of MSM in Ho
Chi Minh City identified 54 male sex workers (MSWs) out of the total sample of 219 MSM
(Colby et al., 2004). A study conducted in 2002 in Hanoi also examined MSWs, most
between the ages of 18 and 25. Interviewees estimated that about 100 MSWs were working in
Hanoi. Many areas within urban centers are known to be popular places for MSM to meet
each other and cruise for other MSM, such as Lake Hoan Kiem in Hanoi and the beaches of
Nha Trang. Men in these areas soliciting sex are not concerned about police because they are
aware that their behaviors are not monitored.
While no action has been taken on the part of government health bureaus in terms of
HIV/AIDS among MSM in Vietnam, numerous studies on the population should raise a red
flag to those who monitor and wish to respond to the epidemic. One of the first studies on
MSM in Vietnam, conducted by Wilson and Cawthorne in 1999, profiled the findings of an
13
MSM outreach program conducted in Nha Trang, a popular beach resort in south central
Vietnam. High-risk behaviors such as having multiple sex partners and infrequent use of
condoms were common among most of the MSM interviewed. Knowledge about HIV
transmission was poor; many believed that oral sex was more risky than anal sex, and some
thought that HIV could be passed through intact skin. The authors believed that such
misconceptions could be attributed to unclear and unspecific public health messages, such as
messages stating that HIV is transmitted by body fluids without specifying which fluids are
most risky. Other public health messages simply told people to stay away from AIDS without
giving information about risky behaviors.
One study conducted among MSM in Ho Chi Minh City found similar risky behaviors and
levels of knowledge about HIV/AIDS (Colby, 2003). Having multiple sex partners was
common, with the mean number of 3.3 in the past month, and 81 percent reported having sex
with nonregular male partners. Condom use was not very high; only 32 percent reported
using condoms during their last intercourse. Twenty-two percent of the men also reported
engaging in sex with women in the past year, which is evidence that MSM in Vietnam are not
necessarily characterized by exclusively male-male sexual behavior. This fact supports
assertions of the bridge theory of HIV transmission to the general population. Most
respondents were aware that high-risk sexual behavior and body fluids could transmit HIV,
but only about half knew that someone who appeared healthy could transmit HIV. The
majority of respondents (87 percent) felt that they needed more information in order to
protect themselves from HIV, but at the same time many did not perceive themselves as at
risk for HIV. Many self-rated their risk for HIV very low. Half believed their risk to be none
or low, and 44 percent were not sure of their risk. This low level of knowledge and selfperceived risk is likely attributed to the lack of efforts to inform MSM about the risks they
may be taking and about HIV/AIDS in general. If MSM do not believe that HIV/AIDS
concerns them, it makes sense that they have little knowledge about the matter and little
reason to believe that they need to protect themselves. The author concludes that campaigns
focusing on male-female sex may be why many MSM believe that male-male sex is safer.
A 2002 study conducted by CARE International sought to find out more about homosexual
men in Vietnam and their associated risk and HIV knowledge. In the survey of 107
homosexual men, sexual risk-taking was found to be common. One risk is having multiple
sexual partners; the average number in the previous two weeks was 3.27, and over half (59
percent) had two or more partners in the previous two weeks. Of those who reported having
two or more sexual partners, five was the average. While most men were aware of
HIV/AIDS, specific HIV knowledge was low and wrought with misconceptions. Only 72
percent knew that HIV/AIDS can be transmitted by sex with a man, and only 25 percent
knew that it could be transmitted by sex with a friend. The men believed that it was more
likely to catch AIDS from sex with a woman than with a man (80 percent with a woman and
73 percent with a man). These misconceptions about HIV/AIDS transmission indicate an
underestimation of risk among the respondents. Further evidence of the commonly held belief
that AIDS is a heterosexual disease is that 36 percent did not believe there is a risk of
contracting HIV/AIDS from sex with men. Nearly half of the men also believed that
foreigners can catch the disease more easily than Vietnamese can; these men were certain that
avoiding sex with foreigners protects them from contracting HIV/AIDS. Many of the men (49
percent) also did not feel that avoiding HIV/AIDS was in their control, believing that God or
fate decides. These erroneous beliefs are dangerous for MSM and point to the need to
transmit correct information about HIV/AIDS to these men in Vietnam. Special effort should
14
be made to emphasize that is not only a heterosexual disease but something that concerns
MSM too.
A study conducted by Save the Children in 1997 in Ho Chi Minh City found that at least onethird of the 297 MSM reported having had sex with women, including female child sex
workers. This, coupled with the fact that half of the men reported never using condoms and
that only 29 percent used a condom the last time they had sex, shows that there is a great risk
of passing infection not only between the men but also to female sexual partners. Despite the
fact that public awareness campaigns have solely focused on heterosexual risk of HIV/AIDS
that have lead to the misconception that male-male sex is safer, this study and many others
show that many MSM engage in unprotected heterosexual sex as well. Currently, HIV
infection has been reported mainly among males, who make up 84.6 percent of all reported
cases. (Hien et al., 2004). This pattern will soon shift to a more generalized epidemic,
affecting women and men equally, if HIV/AIDS among MSM is not effectively targeted. The
2002 CARE report found that 26 percent of the men in the study aged 25 and older who
labeled themselves as homosexual were also married.
The studies conducted about MSM in Vietnam have all found very similar results. Each one
is in strong support of the next with regard to the need to increase HIV/AIDS knowledge
among MSM, to inform men about ways to modify high-risk behaviors, and to reduce the
stigma associated with MSM. Also of great concern is the potential HIV/AIDS bridge
between MSM and the general population. The inattention to MSM may be attributed to the
lack of recognition and respect homosexuals receive from the rest of Vietnamese society. As
is true in many Asian nations, homosexuality is regarded as deviant behavior and is often
confronted with denial, shame, stigma, and discrimination in Vietnam.
As far as HIV/AIDS is concerned, local authorities think that if they can control drug use and
female prostitution successfully, HIV will no longer be a problem (Hien et al., 2002). This
misconception will continue to be threatened as more evidence becomes apparent that MSM
need to be recognized as a population that is at risk for HIV/AIDS to prevent the eventual
spread into the general population. If HIV prevention programs and media about HIV
continue to stay silent about homosexuality, the perception among MSM that male-male sex
is not a risk for HIV will remain strongly held. Fighting the stigma associated with
homosexuality may be the first step because the resulting shame presents a barrier to
accessing health care and educational services for MSM.
1.3 MSM research in Hanoi
As POLICY Project's first step toward the development of advocacy strategies related to
MSM issues in Vietnam, this study tried to fill some of the gaps of knowledge mentioned
above.
The key argument underlying this research project is that MSM are not a homogenous group.
Little is known about the indentities of Vietnamese MSM, but international literature
suggests that different MSM may self-identify differently.2 Depending on how one identifies
himself, he may adopt different behaviors and/or roles in sexual relationships, and he may
2
It is common in the West for MSM to identify as gay, bisexual, or even straight, and sometimes as top, bottom,
or versatile. In India, MSM identify as kothi (a feminine and penetrated identity seeking relations with “real
men”) or as gay. In Cambodia, MSM identify as MSM long hair and MSM short hair.
15
have a different perception of risks. This partly defines his needs for sexual health services,
the ways he pursues these needs, and the opportunities or barriers he encounters.
In addition, MSM (of any identity) live in different contexts depending on their age, marital
status, education, occupation, wealth, etc. Their behaviors and needs may be directly affected
by these factors and so may their identities and expression of identities. For example, a young
unmarried man who is grappling with his attraction to men may have different behaviors and
needs from one who is publicly gay, and both of these men may have different behaviors and
needs from a married, socially established, middle-aged man who likes to have sex with men.
1.3.1 Research questions
In an effort to understand the sexual health needs of MSM a heterogeneous group, this
research tried to address the following questions.
1. Who are the MSM in Hanoi? Which subgroups are there (as defined by a combination of
relevant variables, potentially including but not limited to sexual identity, marital status,
age, education, and occupation)?
2. What are the differences (or similarities) among these subgroups in terms of sexual
behavior (partner seeking, dating, relationships, sexual activity, and safe sex)? How are
these affected by the above-mentioned group-defining variables?
3. What are the differences (or similarities) among these subgroups in terms of healthseeking behaviors (recognition and treatment of STI and other problems, use of public
and private services, and opportunities and barriers)? How are they affected by the abovementioned group-defining variables?
4. What are the implications for public health policy and programming in (1) safe sex
promotion and HIV prevention and (2) provision of sexual health care services in order to
meet the needs of MSM?
5. What are the other (felt) needs of MSM of the different groups, for example, for social
support, recognition, and non-discrimination?
1.3.2 Research methodology and methods
Given the nature of the research questions, this study used qualitative research methods to
collect information directly from MSM. Because the topic of MSM is socially and politically
sensitive and because there is a psychological and behavioral complexity in the experiences
of MSM, an anthropological approach was adopted. This approach requires inquiring into the
group’s sub-culture through associations and using different ethnographic methods to define
MSM subgroups, their sexual and health-seeking behaviors, and their needs and implications
for public health intervention.
Forty MSM were identified, approached, and associated with. Thirty six of them agreed to
take part in the research. Snowball sampling was the main method used to reach the target
group, with efforts made to make sure that the sample is relatively heterogeneous, with
dimensions of age, marital status, education, occupation, and self-identified sexual
orientation.
16
During the fieldwork, the research team found specific types of respondents, for example,
unmarried MSM (self-identified gay or bisexual or struggling with their sexuality), married
MSM (self-identified gay, straight, or bisexual), MSWs (self-identifying either gay or
straight), male-to-female transgender people, and MSM who have come out as gay and those
who keep their attraction to and/or involvement with males a secret.
Apart from MSM, key informants who have knowledge of or experience with MSM were
also included in this study. In-depth interviews were conducted with them. Three family
members, including a wife, a sister, and a brother of MSM, two friends who are not MSM,
and three health providers were interviewed.
1.3.3 Ethical Issues
This study, like other studies conducted by ISDS, strictly followed all national laws and
policies that pertain to the protection of human subjects. Specifically, prior to interview, the
researcher briefed each interviewee about the research’s objective and obtained his verbal
informed consent. The researcher also explained that the interviewee has the right to not
answer questions or to withdraw from interview whenever he wants and that his name and
address will not be used in any document. In addition, the information that someone is an
MSM were never disclosed to any third party. All photographs of the participants of the
study, which were taken and then used in the report, have the subject’s written consent.
Interviews and group discussions were taped and transcribed. Identification information on
the transcripts includes only the following:
 Name of interviewer and date of interview
 How the interviewer accessed the respondent (e.g., at a bar or through a friend)
 Type of place where the interview took place (e.g., home, bar, cafe, or without identifying
the exact place)
 Relationship with another respondent (in the case of family members or friends)
Respondents' names and addresses did not appear on the transcripts. Fake names were used if
the respondents mentioned their own or other people's names. Names of respondents used in
this report are not real.
All of the tapes were destroyed by the POLICY Project.
17
2 FINDINGS
2.1 MSM in Hanoi—Who are they?
This study confirmed what has been found internationally, which is that MSM can be found
in all walks of life, at all socioeconomic levels, among different socio-cultural groups within
a society, and in urban as well as rural areas. Contrary to the popular notion that all MSM are
alike, they are, in fact, very heterogeneous both socially and sexually.
2.1.1 Socio-Demographic Profiles
Table 1 summarizes basic information on socio-demographic characteristics of MSM
interviewed in this research.
Among the total of 36 men interviewed, 15 of them are under the age of 25. Thirteen are
between ages 25 and 29. The rest are between the ages of 30 and 52. The youngest among
this group is 19 years old, and the oldest is 52 years old.
A bóng kín, who knows many MSM in Hanoi because he sometimes works as a pimp
confirmed that MSM can be any age.
There is no limit of age. I used to know very young [gay] boys and elderly ones.
Some even became grandpas, and some recently died because of old age (Van, 39
yeas old, bóng kín).
Characteristics
Age
19 and younger
20-24
25-29
30-39
40 and older
Education
Lower secondary
Upper Secondary
Vocational
University
Marital status
Single
Married no children
Married with children
Place of original residence
Hanoi
Northern provinces
Ho Chi Minh City
Urban-rural
Urban
Rural
Number
1
14
13
3
5
8
18
6
4
27
5
4
15
19
2
22
14
18
Regarding educational attainment, nobody in the group had lower than an eighth grade
education. Only four studied in university, but two dropped out after their first or second
year. Among the eighteen people who reported an upper secondary school education, four
dropped out after 10th grade. Six men reported studying at vocational school; however, only
four completed their school curriculum.
Three-fourths of men interviewed were single. Most of them lived with their boyfriends.
Only seven people lived with their parents. Among nine married men, two had one child, two
had two children, and one was about to be divorced.
Almost two-thirds of the sample was migrant. Fitfteen of the 36 participants were born in
Hanoi and have lived there since then. The rest came from different Northern provinces and
cities including Hai Phong (five), Quang Ninh (one), Thanh Hoa (one), and Thai Nguyen
(one). Seven came from provinces surrounding Hanoi like Ha Tay, Hung Yen, Bac Ninh, Bac
Giang, and Ha Nam. Two participants came from Ho Chi Minh City. More than one-third of
participants (14) was from rural areas.
More than one-fourth of interviewed men worked in service or entertainment enterprises in
positions such as bartender, hairdresser, assistant in an Internet shop, bridal make-up shop
clerk, tour guide, hotel receptionist, or sales assistant in a CD/VCD shop. Five people were
doing business such as running a guest house or working in a business company. About 11
earned their living from the sex business; three of them were pimps at the same time.
Talking about MSM in Hanoi, the same bóng kín (cited above) said that they are of various
social backgrounds.
Talking about social backgrounds, I can tell that they are engineers, policemen, court
officers, and from the armed forces. Many come from the army. And there are also the
workers, intellectuals, school boys, and students. There are even the playboys, those
social evils that use drugs. Some of them have to sell sex just because of it [drugs]
(Van, 39 years old, bóng kín).
A straight man involved in the sex business said that many gay men worked in areas that
require certain degree of artistic talent, and others do very typical jobs like everyone else.
Most of them choose to work as barbers or hairdressers, dancers, or religious ritual
servants (len dong, hat chau). Ninety percent of these servants are gay. Then, those
who do bridal make-up jobs are also gay. Generally, they can have any kind of job.
Some gays say that fate is on their side because some of them can do business well
and some can be motorbike drivers, some are car drivers, some are company officers,
some are managers; no job is the exception. Some of them even got married. And they
also work as policemen. I used to have a client who worked for a ministry (Trong
Hieu, 26 years old, straight).
This man believed that some gay men, because of their effeminacy, do not want to do typical
male jobs but prefer to do female work. The straight men who sell sex to men are either
migrants from countryside, are in debt, or just like to play around.
Some gay men have male bodies, but they’ve got female characteristics. They don’t
like to be involved in the tough jobs like military or police force; they love the gentle
work that is supposed to fit the women, like running a business or dancing. About the
19
“boys”, many come from the poor rural provinces. Some of them are basically the
playboys who left home to indulge in debauchery and ended up with a lot of debts,
which lead them to become prostitutes to earn money to cover their debts. In this
society, there are so many things that pull them into this business [male prostitution]
(Dinh Tuan, 23 years old, bisexual).
The findings of this study prove that MSM are not “special”, “ill”, or “spoiled” people like
the images being portrayed in articles in various newspapers in Vietnam. MSM in Hanoi are
not “special” but are people with diverse social backgrounds. They are not “ill” people in
terms of physical health. Like people of other social groups, among MSM there are
hardworking people who do useful work for family and society. There are also some
individuals who engage in drug use or crime or behave in ways that society does not approve
of. Most of them are dutiful sons and brothers in their family, good friends, and responsible
citizens.
2.1.2 Sexual identities
MSM are not homogeneous with regard to sexual orientation, sexual preference, and lifestyle.
Regarding their sexual orientation, MSM can be identified as gay, bisexual, or straight. Based
on their sexual preference, they may be categorized as top, bottom, or versatile. Talking about
the level of disclosure of their same-sex orientation, MSM can be divided in two subgroups.
Members of the first subgroup keep their same-sex orientation (or same-sex relations in the
case of straight men) confidential to all or most people, including family, friends, and
community. They behave and dress like other men, trying to accomplish men’s roles and
stereotypes. The second subgroup, on the other hand, do not disguise their true orientation.
They openly express their sexual attraction to men; many members of this subgroup may
dress and behave like women.
In India, MSM identify as kothi (a feminine or penetrated identity seeking relations with “real
men”) or as gay. Filipinos call the effeminate men bakla. Thailand has katoey. In Cambodia,
MSM identify as MSM long hair and MSM short hair.
In Vietnam, most popular terms addressing MSM refer to their sexual orientation including
more traditional terms such as đồng cô3, đồng tính luyến ái, pê đ ê4, lại cái5, tám vía6, new
terms like bóng lộ7 and bóng kín8, or new slang words such as hifi9 , hai thì10, or xăng pha
nhớt11.
Regarding their sexual orientation, in accordance with their self-identification, participants in
this study can be categorized into the three following subgroups: gay (21), bisexual (10), and
heterosexual (five).
“Đồng cô” in this context refers to effeminate men
“Pêđê” originated from French term “pederast”
5
“Lại cái” means half man and half woman
6
“Tám vía” means incomplete man
7
“Bóng lộ” is “open shadow”—means the gay man who opened about his same-sex orientation
8
“Bóng kín” is “closed shadow”—means the gay man who keeps his same-sex orientation confidential
9
“Hifi” is “changeable character”—means a man with woman’s character and manner
10
“Hai thì” is “two periods”—a person who has dual identity or bisexual
11
“Xăng pha nhớt” is a mixture of gasoline and lubricant—means a bisexual
3
4
20
The boundary between these categories of MSM is fluid, however. A number of participants
who classified themselves as bisexual said that they always prefer men over women. It is also
possible that some participants are not really aware of their own sexual orientation, even
though they declare that they are straight men. Regarding their lifestyle or the level of
disclosure of their sexual orientation, the majority of participants in all three subgroups are
bóng kín. Few members of gay subgroup identified themselves as bóng lộ.
2.1.2.1
Gays
Twenty one participants in this research identify themselves as “pure” homosexuals, or have
sex with men exclusively. Beside the diversity in social background, this subgroup is not
homogenous in terms of sexual preference and lifestyle. They can be simply classified as
bóng lộ and bóng kín.
According to a bóng kín who is Hanoian, the term bóng lộ refers to effeminate men who
behave and dress like women or gay men who are open about their same-sex orientation,
while bóng kín are masculine gay men who try to hide their true sexual orientation.
“Bóng lộ” means the pêđê people who talk in a shrilly feminine way, wear colorful
clothes, earrings, nose rings, or a lot of jewelry. Those who wear very colorful clothes
and dye their hair are called “bóng lộ”; sometimes they even make up their faces.
Bóng kín are gay people with muscular bodies and a very normal appearance; they
also play sports. They look very muscular, but they are gay, secretly gay. They also
play a lot, but secretly (Dao, 27 years old, married).
The young man cited below, however, provides further explanation on how MSM in Hanoi
identify each other and which terms are used to refer to each category.
The bóng kín are always restraining and hiding themselves, trying to create a
masculine appearance to get married. Loa are those who already had a transgender
surgery. And bóng lộ are those who just wear the sexy clothes and trim their nails, but
they are still men (Quang Thao, 24 years old, bisexual).
A young bóng kín said that a person like him is difficult to be recognised. He also said many
bóng kín are men of different social background, some even are on high social status:
Bóng kín like me can never be recognized, but the bóng lộ can easily be. Many of
them [bóng lộ] have gone for surgery to have big breasts like women. Most of the
bóng kín are very normal; many are directors or vice-directors of companies or are
engineers (Hoang Hieu, 22 years old, gay bóng kín).
The term “bong” has two meanings. The first, when used in the term “đồng bong”, means the
intermediary as mentioned above. The other meaning refers to a person’s character; it means
freakish. A freakish person is someone who is inconsistent, who prefers to dress colorfully or
brightly, and who enjoys receiving praise. Thus, bóng not only refers to look or appearance
but also to character or manner and behavior.
Another term, “đồng cô”, is a very popular term for effeminate men in the North.
Traditionally, đồng cô refers to effeminate men who are involved in religious practices when
they play the role of intermediary between living people and people who have passed away.
21
Because of this special ability, their “different” lifestyle was tolerated or even seen as a
means for them to connect with the other world.
In the old days, đồng cô like us carried a load of belief and worship. In the subsidized
time, people looked up to us. Whenever people talked about đồng cô, they talked
about belief and worship. From that perspective, people had certain kind of respect for
us (Hoµng, 52 years old, gay).
Eventually, all effeminate men, whether or not they practiced that religious service, were
referred as đồng cô. For many people, đồng cô is used for all men with same-sex orientation,
regardless of whether they are effeminate or masculine gay men (Khuat Thu Hong, 1998).
A Hanoi-born bóng kín clearly explained the popular terms addressing different subgroups of
MSM in Hanoi.
From the perspective of a Hanoian, men who are attracted to males, either secretly or
openly, are gay, but are gay on different levels. Those who are seriously attracted to
males are đồng cô or pêđê and are very easily recognized when walking down the
street. At the same time, the bóng kín are only known among the gay community.
Between gay’s conversations, they may ask each other “is that person a gay or a boy?”
“Boy” here means a normal guy. When [a gay group] is asked “gay or boy”, they
would reply “gay.” “Gay” is a common noun for this group. In Hanoi, those who
come from a pretty high position, like the intellectuals, or those who want to keep
secret about their identity call each other gay in a polite way. They never call each
other by such bad words (Van, 36 years old, bóng kín).
Many bóng kín and bóng lộ in Hanoi believe that it is their destiny to be bóng. This man, like
other bóng lộ, believed that he had căn cô (destiny to be an effeminate man) and this căn cô
was a sort of compensation for his suffering.
Frankly saying, I do believe in Buddha. The fortune teller said that I had căn cô,
which means I have support from the passed-away people. Anyway, at least heaven is
compassionate to me; I don’t have that, but I have this in return. I have to serve in a
religious worship ritual every year. Last year, I had to go in June. This year I will go
in October (Ngoc, 41 years old, bóng lộ).
Similar to the findings on MSM in Cambodia, Nepal, and other countries, gay men in our
study, both bóng kín or bóng lộ, often prefer masculine men in terms of their preference for a
sexual partner. However, the masculine gay men do not like effeminate gay men.
The bóng lộ who speak in a feminine way are always attracted to real men, but some
of them like to be with someone from the same subgroup. As for me, I don’t like real
men; for example, I don’t like you. I like someone like me, because I think people in
the same group can sympathize with each other better. If I am into a real guy and he
pays no attention to me, all my effort is just down the drain. (Dao Tuan, 27 years old,
married)
In his recent book Syssyphobia: Gay men and Effeminate Behavior, Tim Bergling (2001)
quotes a study published by the American Psychological Association showing that a
substantial number of effeminate-identified men prefer masculine men as sexual partners.
22
There is a suggestion that they are attracted to their opposites. However, it is very often that
the opposites they prefer do not like their opposites. In other words, effeminate men may
prefer their opposites (masculine men), but masculine men do not prefer their opposites
(effeminate men). This proved true in our findings.
We do not tend to like someone like us. That means we are only attracted to real men.
It’s very difficult for us because real men are only into women and would never be
attracted to people like us in general. It’s really miserable (Hoai, 22 years old, gay).
I would only love a man who is a real man. I would never get involved with a man
that is anything like a woman, even if I am very attracted to him (Hoang, 52 years old,
bóng lộ).
Some participants in our study reported that they spent a lot of money and emotional
investment on young men hoping that they would get love and attachment in exchange.
To tell the truth, I don’t know why but I absolutely don’t like gay people at all, even
though I am one of them. I even feel uncomfortable when they touch or embrace me.
But it’s different to be with a man who is really a man. I mean, he should be pretty
rough and well educated; it’s more important to me. Because I am a very fragile
person myself, I don’t need any more fragileness. I’m like a woman; I need someone
to lean on. It’s very a simple reason (42 years old, bisexual).
Like the bóng kín cited below, many gay men in this study realized bitterly but clearly that
despite intimate relations they had with straight men, the straight men would never love them.
Some men like me a little bit, but no one would choose to love me. There’s no true
love at all (Anh Tuan, 25 years old, bóng kín).
However, it is not the universal truth for everyone in this subgroup. Some participants said
that they preferred having sexual partner who shared similar characteristics.
As for me, I like to be with someone from the same group as me because they are
more sympathic and their love is true. Those real guys are like the logs; they just lie
down like death, and I don’t like that… The gays are different. They always like to
play with my body and make me enjoy it (Dinh Tuan, 23 years old, bisexual).
2.1.2.2
Bisexuals
Richters (1997) outlines the three main ways of defining or conceptualizing bisexuality. The
first is the experience of sex with both men and women (behavioral bisexuality), the second is
sexual desire for both genders, and the third is self-identification as bisexual. A general
definition that encompasses all of the above is that a bisexual is someone with “the potential
for being sexually and/or romantically involved with member of any gender” (McInnis and
Kong, 1998).
Ten men among the participants of this study identified themselves as bisexual with the
experience of sex with both women and men. Six of them are currently married, three had
one child, and one had two children.
23
Often bisexually is seen as a transition phase between heterosexuality and homosexuality
(Eliason, 1997). Bisexuals are often blamed for confusion about their own identity (Eliason,
1997) or denial of their true sexual orientation because they are afraid to come out or are
unable to choose (Deacon, Reinke, Viers, 1996). Bisexuality is often labeled as experimental
or “going through a phase” in adolescence (Eliason, 1997) and merely circumstantial in
prison environments (McKirnan et al., 1995).
This study, however, tends to confirm that bisexuality is not a transitional phase but is a
category of sexual orientation apart from heterosexuality and homosexuality. The
participants, regardless of some confusion, accepted their situation; not all wanted to change
it. Moreover, their confusion was mainly caused by the pressure of social norms to be either
heterosexual or homosexual rather than by their own problems.
Studies found that people who identified as bisexual are not necessarily equally attracted to
men and women. Some bisexuals are attracted to characteristics other than gender (Elaison,
1996). Others see themselves as having a continuum of sexual preferences (Deacon et al.,
1996), and some perceive a fluidness of sexual identity (Wilson, 1996). Bisexuals in this
study also shared these characteristics. Many of them clearly understood their dual
preference.
I can categorize myself into the type of “7/3.” That means I am attracted to men 70
percent, and the other 30 percent leans to women. I don’t know how you can define it,
but it’s my own way of calling it (Dinh Tuan, 23 years old, bisexual).
I can have sex with both sexes, but nowadays I prefer men. I especially feel the
difference when having sex with men; it’s much more pleasurable and passionate than
having sex with women (Minh Hoang, 25 years old, bisexual).
Some men, however, said they preferred both sexes equally and accepted their dual identity
referring to predestination by God.
I am not totally a man. It’s a little bit shameful to say it out loud, but I will tell you
straightforward. I like boys, and I like girls also. I was born that way and don’t know
why (Anh Tan, 25 years old, bisexual).
For some other participants, the concept of fluidness of sexual identity can be an appropriate
explanation for the changes they experienced in sexual preference. Not all men realized their
dual sexual preference until they had the opportunity of intimacy with other men. This man
only discovered his sexual preference for man when he was massaged by a man, which
happened long after he got married.
After the time I went to the massage service, I knew that I was a “hifi”. Previously, I
was confused, so I went to check if it was right or wrong (Long, 26 years old,
bisexual).
For this 41-year-old married man, complicated relationships with women destroyed his
pleasure in sex with women and pushed him to engage in sex with men and to eventually
enjoy the new pleasure.
24
Now I hate women, not because I hate that thing [sex] but because I hate the troubles
they bring that make my life turn upside-down. That may be the reason why I became
a gay without awareness… To tell the truth, I’ve never had this in my mind before, but
now I think that the guys are very interesting in their own way… I feel that they can
make love to me much better than women do. I’m now totally interested in doing it
with the guys (Minh, 41 years old, bisexual).
Some bisexual men preferred to maintain their dual identity.
I still want to get married and have children like everyone, and sometimes I can go
out secretly; that’s all. It’s interesting to live with a guy at home, but it’s difficult to go
out with him in society. I have that feeling and characteristic, but I am still a man
anyway, so I still want to build up a normal family with wife and children (Anh Tan,
25 years old, bisexual).
All members of this subgroup were bóng kín. They try hard to keep their same-sex preference
and sexual relations with men extremely confidential, especially those who are currently
married. The invisibility of this subgroup makes it difficult to access its members for sexual
health and HIV intervention programs and activities.
2.1.2.3
Straight men
Five men in this group assured us that they are exclusively heterosexual but practiced samesex sexual intercourse because of economic reasons. This provided more reason for them to
be bóng kín. Many participants in this study said that they knew a lot of men who came from
other provinces and who sold sex to male clients in exchange for money or for material
benefits such as housing and food. Male students are most favorable to the male clients.
They clearly explained that they truly preferred women and that they did not like having sex
with men at all. Money was the only motivation for them to engage in sexual relations with
men.
I absolutely have no interest in it [having sex with men], but I can pretend to enjoy it
when I’m with clients. I feel really guilty because I have to show fake enjoyment to
make my clients satisfied even when I have no feeling at all. Actually, I don’t belong
to this group. I’m attracted to women, and this job is only to make a living (Anh Tuan,
23 years old, straight sex worker).
Regardless how much male clients pamper them, these young men, after years working in the
business, still disliked sex with men.
I definitely don’t like it. Even nowadays, when I “go” with clients, I still don’t feel
interested in it. Some men are very skillful at sex, even more skillful than women, but
I myself cannot accept that (Hung, 24 years old, straight sex worker).
Frankly saying, I only like to have sex with women. I have no interest in having sex
with men at all. Many times, to tell the truth, I cannot manage to find any money from
anywhere, so I have to accept it as the only way out (Ngoc Quynh, 21 years old,
straight).
25
It was quite stressful for these men when they had to live a double-faced life. As sex workers
to the male clients, they had to hide the fact that they had multiple sexual partners. As men to
the rest of people around them, they had to hide their sexual relations with men.
I’m always in a stressful mental state because I have to live two lives but keep one
secret. For example, I have to keep a secret from this man about my relationship with
another. I always have to struggle with my thoughts. I always have to behave like a
normal person to show that I am no different from anybody else. I don’t want other
people to know that I also have sex with men (Ngoc Quynh, 21 years old, straight).
In sexual relations with other men, straight men often play the role of “top” or penetrator.
I take the man’s role. The clients take the woman’s one (Anh Tuan, 23 years old,
straight sex worker).
Those straight men, or đàn ông xịn, who sell sex to other men can be called by the popular
term “gái” (girl) like the female sex workers are called.
People like to call me “gái.” (Ask: You mean “girl”?) Yes, just like prostitute girls
(Anh Tuan, 23 years old, straight sex worker).
In the following sessions, these subgroups of MSM will be referred to mainly when
discussion addresses sexual behavior and related sexual health issues.
2.1.3 Social Relations
2.1.3.1
Family
Studies elsewhere have not supported the assumption that same-sex sexual preference could
be caused by a family’s circumstances (Gagnon, 1977). Therefore, this part of our study has
no intention to examine the linkage but tries instead to provide better understanding of the
lives of MSM in Hanoi and, by doing so, to demystify the image that was created by media
recently of gay men as individuals without any attachment to the earth. Almost all
participants in this study have a stable family with both parents still alive and with the
members living together. The families are also diverse in terms of social background. A
number of MSM have parents who or used to work in the government sector. Many families
work in small businesses. The majority of those who migrated from other provinces are from
farmer families. Some are from well-off families, and others are from mid-income families.
Few are from families in difficult economic situations.
In general, most men who participated in this study have a good relationship with their
families. Many, especially the rural-to-urban migrants, work to support their families. They
all tried hard to keep their sexual orientation hidden because they did not want to upset their
families. In a culture where family and children are the most important values and marriage is
universal, a man who does not want to build his own family and have his own children is not
likely to be accepted. Except for the heterosexual men, most MSM in this study, including the
bóng kín who were able to hide their true sexual orientation and those who were married, said
that their families were unhappy with them. In fact, the attitudes of the families varied from
pity and tolerance to anger and disappointment. Whatever the attitudes were, they formed an
26
interminable pressure on the men that eventually became a never-ending guilty feeling for
them. Some families, in order to continue family line, continued to force their son to marry
even after they found out that he was gay.
I am the only son in the family, so my parents really wanted me to get married. Even
when my father knew I was gay, he still forced me to get married. So I did it to please
him (Dao Tuan, 27 years old, bisexual).
Effeminate men were often scolded by their family because of the men’s “different” manner.
Recalling his childhood, a bóng lộ said that his father and brother often bit him because he
behaved like a girl.
I was like this ever since I was very young. But my family lived in a poor rural
province that time, so I didn’t understand much about that. This kind of thing was not
so popular in the old days, so I was very strictly banned by my family. To tell the
truth, I was beaten up so many times for coming home late at night. My parents said
“just beat him to death if he comes home too late” (Thanh, 40 years old, gay bóng lộ).
The family tried hard to “reconstruct” the son to be a “real” man again by forcing him to
dress like men.
My mom said “you are a boy, how come you only like to dress up like a girl?” So,
whenever I go out in women’s clothes, I have to change back into men’s clothes
before reaching our alley. I hide some bras, but one time my parents found them and
threw them all away… They also asked my elder brother to beat me up to prevent me
from wearing them again (Thanh, 40 years old, gay bóng lộ).
This 52-year-old bóng lộ said that for many years his family scolded him because of his
lifestyle and insisted that he get married.
My family said “why don’t you get married? What kind of man are you with the
cosmetics and women hair-do all the time?” They scolded me a lot (Hoang, 52 years
old, gay bóng lộ).
Families of bóng kín may not be annoyed by their manner but are very upset and disappointed
about their son’s future. This creates a guilty complex for these men.
Parents always want their children to be normal, but I’m surely not normal at all this
way. Any parent would suffer from the misery of having this kind of child. Even
though I am the first to suffer from this misery, my parents surely are suffering from
the greater depression (Hoai, 22 years old, gay bóng kín).
It is very common for them to be unable to explain the causes of the bad luck that happened
to them or their family. Vietnamese people tend to believe in karma. Families of MSM
believe that being gay is their destiny and that having a gay son is retribution by the family’s
karma.
This is my sincere confidence. If he is really attracted to men only, we can not do
anything but accept it. Parents can just give birth to children, but God gives them the
characteristics. Unfortunately, he was born with that destiny; he has to accept it that
27
way. We can not do anything. If that was another kind of difficulty, we could really
help him out by sharing the burden. But with this kind of problem, what else can we
do but accept it? He has to live with a vey disadvantaged destiny (Sister of a bóng
kín).
Perhaps, for most Vietnamese people, gay men are seen as unhappy people because in this
culture, happiness means having a family and children.
No one can be happy living alone, do you agree? Since you are a human, you have to
have a family with husband, wife, and children (Sister of a bóng kín).
The deepest disapointment of the family is the risk of having no one to continue the family
line. It is most critical if the gay man is the eldest son of the family and is supposed to be
head of his kin.
The whole family is so sad; he is the first son. As the custom of Vietnamese, all the
grown boys have to set up a new family and give birth to a new generation to
maintain the continuity of the family line (Sister of a gay bóng kín, Hanoi).
After we knew [that he is gay], my mother was so depressed. She cried all day long in
her room; she couldn’t do anything but stay home all day. She was so sad because of
the gossip. Also, my brother is the “real child” [eldest son of the eldest son] of the
family, and he is now at the age of getting married and having children, so it added
more misery to my parents (Quyet, 27 years old, brother).
Sometimes the family is very determined about marriage, using financial measures to push
the son to make “right” decision.
Many times, my mom told him that if he chooses not to get married, the house would
never belong to him. It is obvious that he has the right to own the house, but if he
doesn’t set up a family, that right will not be his anymore (Sister of a gay bóng kín,
Hanoi)
Not all families react negatively. Few families tried to understand their son’s situation. These
were mainly from the urban and highly educated group.
My father is an intellectual. He might understand that I am not totally a man, so I
think he will not prohibit me anymore. My siblings are also knowledgeable, so I think
it’s not so difficult for me. I think my family just feels worried about me, so they take
better care of me (Quang, 24 years old, bisexual).
The family was upset when they first discovered their son’s true sex preference, but
eventually they accepted the fact and stopped pressuring the son.
At first, they [my family] were so sad, but after a while they understood. I guess they
have discussed it together a lot. Now they understand that it’s a natural problem and
they can not do anything to force me to change, unless I don’t like it anymore and
want to get married. So, no one rudely interferes or tries to influence me anymore.
They let me be free to do whatever I want to because they know I am not a
thoughtless son (Van, 36 years old, bóng kín).
28
Some families accepted the situation, although with lot of bitterness and worries, and some
even accepted that fact that the gay man lived together with his partner.
Anyway, I wish someone would come to stay with him, to make him happy, and to
take care of him whether rain or shine, whenever he is healthy or sick and needs
someone to take care of him. But I don’t think a man will move to live here, never. A
woman can give birth to children to keep her man, but what can a man give to keep
another man with him (Sister of a gay bóng kín, Hanoi)?
Afterwards, once they understood his real situation, my family stopped forcing him to
get married and just tells him to find a good person to be friends with, I mean a good
man (Quyet, 27 years old, brother).
Once they accepted the gay family member, the families tried to understand the situation.
They expressed their sympathy to the gay man and no longer blamed him, believing that it
was not his fault.
At first I blamed him a lot, but now I understand his situation, so I can not blame him
anymore. (Ask: How did you blame him?) I blamed him for not being attracted to
women but to men. After a while, when I understood him, I felt sorry for him.
Actually, he has done nothing wrong; he made no mistake at all…I can not find the
words, but there is something that made him turn out this way. So many times he
confided that he felt so much pity for himself. Now I don’t blame him for anything,
neither do my parents. No one in my family is angry about him now (Quyet, 27 years
old, brother).
The straight men or đàn ông xịn in this study had no trouble with their family because they
carefully hide that part of their sexual life with men from their family and friends.
No one in my family knows I’m doing this job. Sometimes they want to know more
about what I am doing, but I don’t let them know where I work. They only know
where I live. Now and then, when someone from the family comes to visit me for one
day or two, I try not to go out overnight to hide my work. I won’t let my family know
what kind of work I do (Anh Tuan, 23 years old, straight sex worker).
2.1.3.2
Marriage
Nine men among the MSM interviewed were married. Four of them had children. One said
he was about to divorce his wife. The interviews revealed that the lives of those MSM who
were married was more complicated. They had to hide their sexual preference for men even
more carefully than unmarried gay men because they did not want to hurt their wife and
children.
Those married men are the most secretive ones; there are even some men who can
have sex [with men] in secret for their whole lives. Some others just want to keep the
secret for as long as they can. Some reveal the secret to their families, but there’s still
an unspoken rule that no one in that family can interfere into his personal life (Van, 39
years old, bóng kín).
29
To keep regular sexual relations with his wife, this man admitted to become a faker in his
bed.
Sex between me and my wife is just normal, but somehow there’s a little bit
reluctance. But still I have to do it; I can not give it up. (Ask: Can your wife recognize
that reluctance?) No, she can’t. I’m very good at pretending (Dinh Tuan, 23 years old,
bisexual).
Despite his effort, Thuy’s husband failed to hide his preference. Thuy discovered the truth,
but she tried to hide her discovery from him.
At first, when I didn’t know it yet, I just thought he was tired. But after I found out, I
think he just tries to finish his duty with me so he can hide the truth that he is a person
like that [gay]. That’s why I feel so uncomfortable, because even if he tries hard, it
can not be as good as expected. I feel that he’s not comfortable, so I don’t dare say
anything. Because if I say it, he will know that I know it, and I really don’t want that
to happen (Almost crying) (Thuy, 23 years old, wife of a bóng kín).
The wife, however, eventually felt more and more upset about being neglected completely by
her husband.
Previously, we used to have sex three or four times a week, but lately he doesn’t even
want to sleep with his wife for a whole week sometimes. He doesn’t even embrace me
while we sleeping together (Thuy, 23 years old, Long’s wife).
Nevertheless, she accepted the situation because she did not want to hurt him. She believed
that it was her fate.
Since I’ve known that [he is gay], I don’t tell him that I know. I keep it secret because
I’m so afraid that I may hurt his pride. Then our life would no longer be comfortable,
so I accept this situation. Now I think it’s my destiny that I have to suffer from this...
Now I know he has no interest in people of the opposite sex, so I don’t dare suggest or
expect anything from him anymore (Thuy, 23 years old, Long’s wife).
According to some bisexuals, they did not have many problems with their wife because they
still enjoyed having sex with women and still valued conventional family life.
Actually, I behave like a man with my wife. I can love and live with her like
everybody does. I want to show that I am a real man and that nothing has changed or
is different (Vu Long, 25 years old, bisexual).
2.1.3.3
Friends
Most participants of our study have friends who are not MSM. Very few people dared to
disclose their true sexual orientation to their non-MSM friends because they were afraid of
being stigmatized by their friends.
30
My friends are all normal people. Most of them don’t know that I am like this, and
I’m really afraid of letting them know the truth, so I keep it a very close secret (Dinh
Tuan, 23 years old, bisexual).
Even with his dearest friend, Long did not dare to share his secret.
I have a close friend, but I will definitely never tell him this secret because he has
been a long-term friend, and we all come from the same hometown. (Ask: What have
you been afraid of?) I’m afraid that if I let him know, people will look at me with
different eyes (Long, 26 years old, bisexual).
Hieu, a 22-year-old bóng kín, never dared to let his friends know his true sexual preference
because he deeply realized that gays did not yet have a place in Vietnamese society.
Actually, I don’t dare reveal it to my friends. Vietnamese society has not accepted this
yet. This can be something normal in other countries, but Vietnam doesn’t accept
people like this; they are offended by people like this. To be honest, Vietnamese think
it’s disgusting (Hoang Hieu, 22 years old, bóng kín).
Some participants said that being known as gay by their friends and other people is the thing
they were most afraid of.
My worst fear is to let friends and society [know]. Family can understand and
sympathize with me, but friends and society may look down on me just like the way
they hate those pêđê (Nguyen Hung, 29 years old, bóng kín).
Those whose sexual orientation is known by their friends had a hard time at school or in the
workplace. Some participants in this study dropped out of school because of stigmatization
from school mates. This man was labeled by his classmates as pêđê because he shared his
emotions with his friend in a class. He was even disciplined by the school principal because
of that “immoral” behavior.
When I was going to school, I was once punished because I desired some classmates.
After that time, my classmates called me Huy pêđê, and gradually I felt so bored
(Quang, 20 years old, bóng kín).
However, similar to the case of families, many participants were supported by their nonMSM friends once they disclosed their secret to their friends. This emotional support was
very important for these men to gain their confidence and no longer stigmatize themselves.
At first, when I told the truth, he said he was so surprised that I was like that. Then he
encouraged me to try living well. He said that there were so many people like that
around, like singers or artists, so I have to try to live... When I have more friends who
understand me, I feel better. I don’t have to close myself down anymore. I don’t feel
the complexities anymore; life is coming back to me (Quang, 24 years old, bisexual).
Some participants said most friends treat them normally and even showed them sympathy
and respect.
31
Some friends are chilly, but they are few. The others still behave normally; they are
still very polite and respect to me, and some are sympathetic. Some good people said
that “being like that is his disadvantage. He is still a proper person even living with
that misery” (Van, 36 years old, bóng kín).
Bao, a non-MSM friend of Du, said he fully understood difficult situation of men like Du in
Vietnamese society. Bao highly valued the courage of these people who tried hard to work
and to survive with dignity.
Their misery is that they don’t have to right to do whatever they want (Bao, 32 years
old, Du’s friend).
Actually, in their love life, it’s not as good as normal people; they have to struggle in
their mind for their love. They have to make sure that even people who know them
like that still sympathize with him. It’s very hard for those people to survive and have
sympathy in a society like this (Bao, 32 years old, Du’s friend).
Tuan, a straight man, has been a close friend of Du for many years. Tuan knew Du’s situation
and respected Du’s feelings. Tuan wished that the stigma toward gay people no longer
existed.
I know it, but that’s okay for me; I sympathize with that. I only tell my friend that if
it’s his desire, I don’t want to interfere too much. I feel sorry for him because I can
see that he is emotionally deprived. I want my friend to stay healthy and live equally
with everybody. I know some people still discriminate against people like my friend,
but I am very much sympathetic toward them. What I want to say is that I hope people
can understand and sympathize with them and look at them as normal people in the
society (Tuan, 34 years old, Du’s friend).
2.1.3.4
Workplace
The bóng kín in this study, because they were able to keep their preference secret, reported no
stigma relating to their sexual orientation at the workplace. However, bóng lộ could have a
more difficult situation. Hung, as cited below, had to quit his job because he was discovered
by co-workers who later circulated rumors about his effeminate behavior.
Back when I was working in Saigon, there were two guys who made friends with me.
They dressed like women, so I followed them by wearing women clothes too. But my
co-workers happened to see me in those clothes, so they knew my secret and told each
other that I was “đồng cô” like this and like that. I felt so ashamed, so I didn’t dare go
to the construction site anymore (Hung, 25 years old, bóng lộ).
Some participants said that highly educated people in the workplace, like offices, have less
stigmatizing attitudes toward gay men.
For the office workers… at my workplace, all of the people are intellectuals, so they
consider that thing normal. They don’t think it’s too bad (Quang, 24 years old,
bisexual).
32
The majority of participants in this study did not have a stable job but often moved from one
job to another. This could be linked to the very nature of the work of rural-to-urban migrants.
However, this could be a strategy of gay men to keep their identity hidden from co-workers
to avoid stigmatization.
2.1.3.5
Community and society at large
Different pieces of Hoang’s life story cited below reflect the evolution of people’s
understanding about homosexuality. As discussed above, in the past, there was a mythical
cloud surrounding đồng cô people. People’s attitudes toward đồng cô were often mixed with
pity, curiosity, and disdain. Those đồng cô who able to serve in religious rituals were
respected. In general, people did not know much about đồng cô and homosexuality.
Nowadays, more people know what homosexuality is and can link this to the phenomenon of
đồng cô.
To tell the truth, in the past, most people, even in Hanoi, did not know anything about
đồng cô. They didn’t understand the secret inside, the sex, the instinct, the desire for
sex of đồng cô. They didn’t understand anything but the religious aspect (Hoµng, 52
years old, gay).
According to Hoang, people’s better understanding about homosexuality and đồng cô lead to
stigmatization of this group.
In the old times, society did not discriminate against us as much as they do now; they
were more respectful to us. But at that time, they didn’t understand much about a gay
person’s instinct like they do now. Nowadays, a normal person can also thoroughly
understand a gay person’s instinct. It’s because of the society (Hoµng, 52 years old,
gay).
Other participants also deeply realized the negative attitudes of people around them.
In the public opinion, we have not been accepted yet; people still don’t have the right
perspective toward this issue. They don’t know that we in fact are not happy at all
being this way; it’s just like an unexpected accident. None of us want to be born this
way. Yet this does not belong to any moral framework, right? It’s okay for the
knowledgeable people, but most people still have prejudice against people like us.
(Van, 36 years old, bóng kín).
They did notice the change in the way people treated them. However, the “new” treatment
implied pity for gay men as incomplete persons rather than respect as an equal.
People understand and sympathize a lot. I can see that people don’t look at us with
strange eyes anymore. At first, they pryingly spied on me. But now, from their
behavior, even without saying a word, I know they sympathize with me more because
they see that I’m not perfect like a normal person (Van, 36 years old, bóng kín).
Besides unhappiness in intimate relations with her husband, Thuy was constantly afraid that
people around would know her husband secret because she knew that homosexuals were not
easily accepted in society.
33
I am so afraid people will know that my husband is not a normal person. These kinds
of people are now being spied upon by the whole society with very unfriendly eyes
(Thuy, 23 years old, Long’s wife).
According to the participant who came from the South, in Sai Gon there were fewer stigmas
towards gay men than in the North. People seemed more open to different lifestyles and were
less concerned about an individual’s private life.
This group receives more sympathy in Saigon because people there are more open
minded; they don’t stigmatize too much. But here in the North, few people accept it.
They only accept it after staying close to us a while and getting the chance to
understand us more. It’s different in Saigon where we can do whatever we want to.
Generally people there just mind their own business; they don’t care about another
person’s private life (Le, 30 years old, bóng lộ).
In the countryside, living as a gay person was impossible.
A few years ago, when people first knew [that he was gay], it created a very bad
reputation for our family. It wasn’t like here in Hanoi. When he left the traditional
theatre and went back home, people gossiped about it a lot. It’s different here in
Hanoi. People just mind their own business. In my hometown, people even whispered
and commented about my family, like “See, that family has such a bad son, how come
their son became like that?” And among the young people, when one guy knew the
story, the rest would know it later on (Quyet, 27 years old, brother).
However, even in the big city, the lives of gay men were not always easy. Unusual behavior
and actions were under the close attention of people around the gay men.
Generally, even if I play, I play very secretly. Because Vietnam is an Asian country,
our traditional habits and customs are different from other countries. It might be okay
for two men to get married to each other in some countries, but here in Vietnam, it’s
not. Here, if two men embrace on the street or if a man bring another man to his place
to sleep overnight, people will sure gossip about it a lot (Dao, 27 years old bóng kín).
Nevertheless, homosexuality is still unknown for many people in Vietnam. The comment
cited below is a straight man’s opinion that female sex workers are easily identified but male
sex workers are not. This comment indicates that, in general, people are not aware of sex
between men.
In Vietnam, if people see two men going into a hotel, they think it’s normal because
they may think that those men are just going in to take drugs or just to take a normal
rest. No one would think that those men are going to have sex with each other, but
they might guess that a [female] prostitute will be called up later (Trong Hieu, 26
years old, straight).
2.2 The world of MSM
34
This section of findings, while helping to get an insight into the world of MSM in Hanoi,
reveals the networks and relations among the subgroups. Thus, it can suggest ideas for
follow-up interventions.
35
2.2.1 Inside the circle of MSM
Among themselves, members of some subgroups feel relaxed and allow themselves to speak
or behave according to their true identities. For instance, many bóng lộ and bóng kín enjoyed
addressing each other as women. They called each other “girls” and preferred to be called
“elder sister” or “younger sister.”
Generally, we call men who dress like women “sister.” There are even some people
who wear men’s clothes but still like to be called “sister.” Those who want to keep
their secret, like me for instance, call each other “elder brother” or “younger brother”
(Hung, 25 years old, gay bóng kín).
Normally, we call each other “this girl,” “that girl,” “aunties.” Otherwise, we call each
other “sister” (Dinh Tuan, 23 years old, bisexual).
A hierarchy or order could be established among one group with members of different ages.
Older members were usually addressed as seniors with respect. Young members of the same
age called each other as sisters in a friendly manner.
With the older ones, about 10 years older, we call them “che” to show our respect. But
in everyday life, normally we call each other “elder sister” or “younger sister” (Vu
Long, 25 years old, bisexual).
The way of addressing each other among those who engaged in the male sex business is very
similar to the world of female sex business.
In our partnership, when Thanh and I meet, we usually say “hi mum” because it’s a
part of our business [pimp]. But with younger girls, normally I say “hi girl, where are
you going, girl?”(Lan, 42 years old, bisexual, pimp).
2.2.2 Leisure time and entertainment activities
In their leisure time, many middle-aged transgender people in Hanoi are very keen on
traditional music and dance. Young people like modern dance and spend most of their spare
time at different discotheques. Other people enjoy hanging out with their friends in cafes or
simply chatting for hours.
There are some who are like old women; they love traditional music and dance. In the
daytime, they go to the market or go to buy lottery. But in the evening, they go to
theatre to watch traditional music performances. Some others are more active; they
love to go to discotheques. Some only like spending time at cafes or joining in the
crowded places just to chat, even when they don’t need anything from that crowd.
They just like spending time there. For example, at the Hoan Kiem or Thien Quang
lakesides (Lan, 42 years old, bisexual).
Different subgroups of MSM in Hanoi have different venues where they get together. Those
who are Hanoian or more educated often gather in bars or discotheques such as Apocalypse
or New Century.
36
When the A bar was still open, we always gathered in groups of four or five to go
there dancing. After then, we went rambling around the lakeside, teasing each other
and teasing people (Vu Long, 25 years old, bisexual).
Young people from well-off families like to go to pubs or high standard venues where they
drink expensive brandy and show their superiority.
People from rich families always have a way to show us up, like if we do something,
they always do something better than that. (Ask: Like what?) Like if they go to the
same discotheque as us, they always order expensive western alcohol. If they have the
money, they always tease us (Quyet, 19 years old, bóng kín).
Karaoke shops are also frequented by many young MSM, including rural-to-urban migrants.
There are some karaoke shops at the beginning of P street. I can only go out on
Saturday nights, so I go there to gather with some friends and then go rambling
around (Van Hung, 25 years old, bóng kín).
Networking is often made during gatherings and through trustworthy friends.
At first I only knew one guy, the one two years older than me. Then, through him I got
to know more people. Normally, on the Saturday nights when we’re out singing
together, people bring friends along. So now I know more people; that’s how I know
D. (Van Hung, 25 years old, bóng kín).
Many MSM, especially rural-to-urban migrants, spend their leisure time wandering with their
friends in some famous public places such as Hoan Kiem or Hale lakes. They go there not
only to kill time but also to look for sexual partners.
In my spare time, I just go play around the lakesides. Normally, people there ask me
to go out with them but they still pay me money. Maybe they don’t know that I was
there because I am gay also. Normally, I go to Hale and Hoan Kiem lakesides; those
are the two most central ones. (Ask: Are there many gay people at Hoan Kiem
lakeside?) Usually more than ten. They are not just gathering there but at Hale
lakeside also. In other spare time, they go play somewhere else, too (Tran, 23 years
old, bóng kín).
Other guys love to go to the universities or colleges, which have big concentrations of male
students to try their luck at finding a partner.
We accompany them whenever they meet up to go out, for example, to go to some
university to make friends with the male students. Like for example, we go to
University of Construction at Giai Phong Street. (Ask: Are there many gay students in
that university?) There are some. Generally, all the universities have gay students;
there is no exception. For example, I made friends with one student, just like the
normal way two guys make friends with each other. After a while, when we knew
each other more, I could ask him out. I got him drunk on beer or alcohol and then
brought him to the guesthouse and asked him to stay there overnight. After I did it to
him, he knew it, but he was still normal. When I made love to him, he might have felt
37
good, but after that he might have been afraid because his true preference is girls
(Hoang Hieu, 22 years old, bóng kín).
This suggests that information, education, and communication (IEC) activities addressing
MSM should also take place in the venues with a great concentration of young men.
Many young MSM like to spend their time chatting in Internet shops where they look for new
partners or watch gay Web sites. In the paragraph below, Quyet shared an experience he used
to make friends with a guy he liked.
When I go to the Internet shop for chatting, I use a Webcam and a female nickname,
Hoang Ngoc for example. If I want to woo a guy, I have to point that Webcam to a girl
sitting next to me, just for few seconds, then turn the Webcam off. (Ask: What
happens then?) Then I talk about dating. (Ask: Have you ever successfully “trapped”
a guy that way?) Yes I have. Once, that guy saw that the girl in the Webcam was
really beautiful and became interested in her. So he asked me to go out for some
drinks, and he chose the meeting place. I went there before the appointment time, so I
knew his face first. After a while, I came over to his table and asked if he was bored
waiting for the Webcam girl for so long, then I switched the conversation to ask him
out for something to eat (Quyet, 19 years old, bóng kín).
Closer relations were often formed among a small group of three or four people. Members of
the group may do the same job or share a common hobby. They care and help each other like
sisters.
There are about four or five people I can consider as close friends. This friendship can
be called “sister’s friendship.” One is now 30 years old, another is 40, and the oldest
one is now 50 years old. Their jobs are just worshipping (Tran, 23 years old, bóng
kín).
Like MSM elsewhere, the entertainment activities that many members of the communities of
MSM in Hanoi like most are beauty contests or fashion shows.
They held the fashion competitions and the beauty contests where they can perform in
just their underwear or very tight pants to show off their bodies (Dao Anh Tuan, 27
years old, bóng kín, sex worker).
This section of findings suggests that interventions can take place at entertainment
institutions and public venues including bars, clubs, discotheques, karaoke shops, and
Internet shops. IEC programs can be included in entertainment activities. Web sites with
educational content should also be designed and disseminated.
2.2.3 Identifying “them” and “us”
Almost all participants were confident that they could identify different types of MSM. Many
said that they could recognize even most carefully closed bóng kín.
Those who can be recognized easiest are those who want to be transgender, very
mincing. Those who try hard to act normal but can not are gay. Those who give the
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green light are easier to recognize. They give the signals for others to catch (Van, 36
years old, bóng kín).
Bóng kín are not as easy to recognize as bóng lộ, but I can uncover it all just by
looking at the way they move and looking at their eyes. For example, I sit here and
over there sits a handsome man; I like him. If he just glances at me once then I will
know he is exactly like me. Or I can recognize them by the way they drink and
smoke. The way they talk also lets us know. People like us always talk in a more
gentle, softer way than normal people. And the way they move is also different. No
matter how secret they are, their steps are still very soft; their thighs always stick
together while walking. Also, even if we walk very normally, our hips still move a bit
(Hoai, 22 years old, gay bóng kín).
According to these participants, even the most masculine gay man can be identified by their
special manner or overt attraction to men.
There’s always something very feminine in their voice and behavior. Their walk is
also very soft, and they talk very gentle. Many look very manly with a beard, big and
tall ... But anyhow, I can recognize they are gay just by looking at them. They never
glance at girls; they just look at the men (Trong Hieu, 26 years old, straight).
Despite some common characteristics, many members of different subgroups of MSM tend to
emphasize the boundary between the subgroups and highlight their own group’s superiority
over the other one.
Certainly, bóng kín would not refer to themselves as đồng cô or anything, but they are
very knowledgeable and talk very politely about the related issues. Those bóng lộ or
bóng lõa are usually cruder, so usually the intellectual bóng kín don’t like to hang out
with them (Quang, 24 years old, bisexual).
Even I’m gay, but I do hate those bóng lộ. They are much too showy; they even make
up their faces (Dao, 27 years old, married bóng kín).
If bóng lộ often prefer to broaden their contacts to other subgroups, then most bóng kín try to
limit their circle of social relations within subgroup of bóng kín as they do not want other
people to discover their true sexual identity.
My job is a pimp, so I know it all. Some people call me up to find a partner just to
have sex, make friends, or even to have a deeper relationship with someone of the
same sex.12 They refuse to meet the straight guys. But there are also some people who
are afraid of going with people of the same sex (Lan, 42 years old, bisexual).
Most of the bóng kín always hang out with other bóng kín only. Sometimes they have
relationships with people from other groups, but normally they restrain themselves
from doing so because they are afraid of getting a bad reputation or something like
that (Quang, 24 years old, bisexual).
12
The word “sex” here means belonging to a same subgroup, like bóng kín or bóng lộ
39
This section of findings suggests that a peer education program with MSM should not assume
that this community is homogeneous. Instead, a delicate approach should be used to carry out
the education program. Members from different subgroups should be recruited for training to
be peer educators for their own subgroup.
2.3 Process of gender identity formation and development of sexual
orientation
This session focuses exclusively on the two first subgroups of MSM in this study because the
subgroup of straight men did not share the same characteristics that will be discussed below.
2.3.1 Childhood and Adolescence—“I want to play with boys”
For many participants of our study, the desire for the same sex emerged early, around
puberty, although it was not necessarily clear to them at that time. However, it can come
earlier or later and in different forms. In their study with young people in Chicago, Herdt and
Boxer have noted that desire for the same sex can emerge before puberty (Herdt and Boxer,
1993). This also happened with some participants in our study. As cited below, Duy’s desire
for attachment to other boys appeared at quite a young age.
At about the age of seven, I liked to play with the boys. (Ask: What do you mean?) It
means I liked boys. Every time I saw a handsome boy, I tried to get closer to him. But
I thought of myself as being a girl, so I used to hang out with the girls only (Pham
Duy, 22 years old, gay bóng kín).
With Thanh and with Quyet’s brother, the homoerotic desire for the same sex first appeared
in their dreams to be girls.
When I was very young, I used to take the incense cover from our family’s altar to
paint my lips and my nails red. Also, I liked all the women’s stuff, like clothes or
whatever… (Thanh, 40 years old, bóng lộ).
He liked to play the girls’ games like nhay day [skipping rope] or o an quan; he didn’t
like those rough and naughty games of the boys. He loves flowers, all the time. I
remember when we were young, we had to wear whatever our parents bought us, but
he only chose the colorful stuff like clothes in green, blue, red, yellow, or purple.
When he performed at the theatre, he made his hair in so many colors, it was too
colorful… And the way he walks is so strange; he walks like women doing the catwalking (Quyet, 27 years old, brother of a bóng lộ).
Many participants recalled their first concerns about their own gender and sexual preference
from around 13 to 17 years old.
When I was in the 10th grade, I started to feel attracted to the males. At first, it was
just a light feeling, but I even had that feeling from the time I was in the fifth grade
(Tran, 23 years old, bóng lộ).
I started to feel the complexities when I was in the ninth grade. I felt so sad because I
was into boys only. I suffered from that bad feeling wherever I went (Hoang, 22 years
old, gay bóng kín).
40
Many participants, like this young bisexual man, recalled their confusion and anxiety when
they first realized their same-sex desire.
At that time, I felt attracted to both boys and girls, but usually that feeling turned more
to the boys. I was so sad then because I couldn’t find anyone to talk to and share my
feeling with (Dinh Tuan, 23 years old, bisexual).
Participants who grew up in rural areas reported more confusion and anxiety due to their own
ignorance about homosexuality and also because of strict social control in these settings.
I was totally grown up at 16 years old and started becoming attracted to boys at 17
years old, but I had no opportunity to experience it in my hometown. I couldn’t
confide my feeling to someone I loved there… A very long time later, after I finished
military duty and moved to Hanoi, I learned about sex between people of the same sex
(Hoai, 22 years old, bóng kín).
2.3.2 “Why am I different?”
Having grown up in a society where heterosexuality is the norm and where family and
children are central values, the young men in our study with same-sex preference underwent
a rough and sometimes painful process of gender identity development. Lacking help from
the supposed supporting agencies such as family or school, many felt lost and bitter.
Many participants reported spending lot of time looking for answers to questions they asked
themselves about their own sexual identity.
At the time, I asked myself many questions and tried to find the answers. I looked for
books, magazines, or stories about that issue. I also watched Thai gay porno videos
(Quang, 24 years old).
This 25-year-old bóng kín spent a long time searching for his “true identity” and then realized
that he could never reach it.
There are so many things for me to think about. It’s obvious that everyone wants to be
born and grow up normal and live in a comfortable way. I was born a boy, so I have to
grow up to be a man. But there are some factors, even internal or external, or it might
be because of my weak mind that I could make a big mistake. Even now, I still wish I
were mistaken, but it’s hopeless (Van Hung, 25 years old, bóng kín).
When they realized that their wish would never come true, many of our participants accepted
their situation as their destiny.
I also wish I were the same as everyone in this society. I really don’t want to belong to
the other sex group, but God has made me this way, so I have to accept it anyway
(Hoai, 22 years old, gay bóng kín).
In Vietnamese culture, homosexual practice, although has never been heavily damned like it
used to be in other cultures, always been seen as abnormal. The notion of being “normal” and
41
wish of being “normal” was therefore the greatest torment for this bóng kín and his peers in
this study.
I do suffer from my sexual life because up to now I have only had sex with men, but I
really want to be normal so that I can have sex with women. But I can not [have sex
with women], and that is the worst torment of mine (Van, 36 years old, bóng kín).
He even went further to discuss the notion of being healthy and unhealthy when talking about
a heterosexual relation versus a homosexual one.
“Healthy” is normal sex between men and women. “Unhealthy” is abnormal;
homosexual is abnormal. Even if we talk about the mental issue, people who live
abnormal sexual lives like us do not have good health and longevity (Van, 36 years
old, bóng kín).
The prevailing gender stereotypes and the notion of masculinity and femininity regarding
sexuality—that sexual relations could happen exclusively between men and women—were
seen as eternal verities. The process of internalization of these values and stereotypes indeed
deepened the self-stigmatization of those men who have same-sex preference.
I am a boy, so I am supposed to be attracted to girls, but I don’t like girls at all. I like
boys; that’s abnormal. Also, I live in Vietnam. Here in Vietnam, naturally, men have
to be attracted to women and vice versa. So that’s why I’m abnormal (Dinh Tuan, 23
years old, bisexual).
For many participants, the pain and confusion of their gender and sexual identity seemed
never ending.
I’m still heartbroken now because I’m not in the right sex; my sexuality does not fit
my body (Hoai, 22 years old, gay bóng kín).
I suffer from many sleepless nights. I’m so sad, and I keep on thinking in circles. I
want to cry, but I could not. I wonder why people like us are so disadvantaged. If I
were a girl, even an ugly girl, I would still get married and give birth to children. And
the man, whatever he might be like, can still live a normal life with wife and children.
But we can not do that. Many times I crave for those normal things, but I can never
achieve them (Ngoc, 31 years old, bóng lộ).
By citing these episodes we have no intention to dramatize the situation of gay men in Hanoi.
Instead, we would like to change the prevailing perception about this group and eventually
change the current public discourse about homosexuality. We would like to prove that
homosexuality is not a lifestyle that some “bad guys” prefer. The pain, confusion, and anxiety
that gay men have to bear throughout their lives show that being gay is not their choice
because it is not their power to decide their own sex. Their pain and confusion come from the
pressure to conform to prevailing social norms and values.
Dao (cited below) engaged in same-sex relations when he was 18 with his cousin. They were
once caught by Dao’s father who later forced Dao to marry. Shortly after marriage, Dao
shared his true preference with his wife and proposed divorce. After that, he began intensive
sexual activities with different male partners. He also sold sex to foreigners. Below is an
42
extract from Dao’s interview when he talked about how he underwent depression and
anxiety.
At first, I could neither eat nor sleep. I wanted to adjust myself; I wanted to change
back to the way I used to be, but I really didn’t have any feelings for women. I can
feel the strange eyes of people looking at me. I feel hurt by that; I feel heartbroken for
myself because I was born this way. But nowadays, I already feel a little bit at ease
because there are now so many [gay people] around. I don’t know about the other
provinces, but here in Hanoi, to tell the truth, I think at least 35 percent of the men are
gay (Dao, 27 years old, bóng kín).
The most difficult issue for many young men is marriage and how to handle a married life
and to love a woman.
I don’t know how to love a woman, and it’s difficult for me to face that truth. If I get
married to a woman, it’s just to please my parents, my friends, and society. Actually, I
have no feeling for women (Huy, 25 years old, bóng kín).
In order to “find” themselves, some people tried hard to “switch” their sexual orientation and
to conform to the prevailing norms. However, they finally realized that this was beyond their
control.
So many times I decided not to go out with guys and just go with girls to lead myself
back to normal. I used to be able to have sex with women, but now I can not… I’ve
tried to balance this situation. I remind myself again and again that I have to go out
more with women to forget [the thought of having sex with men]. So I’ve tried to have
more contact with women to build up my emotion for women again, but it only works
20 to 25 percent of the time, and sometime it doesn’t work at all. Too often I have sex
with men, and that’s why I can not find emotion with women again (Quang, 24 years
old, bisexual).
I have many girls as my close friends. I want to love them and even think about
getting married. But I’m so afraid that I can not do it; I’m afraid that we can’t be
happy. I’ve tried to do it once with a [female] prostitute, but I could not do anything
(Van, 36 years old, bóng kín).
For some young men, keeping their true preference hidden from people around them was a
daily struggle. This 20-year-old bóng kín even had to quit his studies to avoid disclosure to
his school mates.
I also had a girlfriend from Hai Duong; she liked me a lot. I didn’t like her, but I had
to politely pretend to like her to camouflage [the truth] from other people. I thought
that if I hated her too much, my friends would know it and laugh at me or my family
might know it too. So I had to keep going on, but after a while she understood me.
There were some other influences that made me drop out of school (Quang, 20 years
old, bóng kín).
Many participants considered their lives to be failures because they were gay.
43
In my spiritual life, I have so many miserable feelings. And in my real life, all of my
sisters have successes in their lives; they all have children. As for me… (Hoang, 52
years old, gay bóng lộ).
It was very common for most homosexual men in this study to question themselves about
their “nature.” In the context of Vietnam, finding a reliable source of information about
homosexuality was almost impossible. Therefore, the answer they found was usually
unsatisfying and sometimes lead to more anxiety and depression.
I also asked myself the question “why am I this way” and tried to find out the answer.
Back in the year of 1999, there were so few stories about it, and the newspapers also
rarely mentioned this. I had to explore it myself gradually. You know, the Internet was
so expensive (Van Hung, 25 years old, bóng kín).
2.3.3 Coming out—“I want to live my life”
The question of whether or not to come out (or to disclose one’s own sexual preference)
tortures most homosexuals. The factors determining this process include the values that a
person wants to maintain or achieve in his life and the fear, guilt, shame, and other possible
consequences of being known as homosexual. The level of coming out or disclosure, as
Gagnon (1977) pointed out, depends on how much the person wants to maintain what he has
and how able he is to overcome the fear, guilt, and shame. Because of the heavy stigma
toward homosexuals in Vietnamese society, coming out then became the most difficult
choice for most homosexual participants in our study. In doing so, one may risk losing
everything, including family, friends, career, social position, and reputation. Therefore, many
homosexual men in this study chose to stay in the “closet” or to be bóng kín (keeping their
true sexual preference concealed) to maintain what they had or what they achieved. Some
men emerge from the closet only momentarily, only in their group, or only for having sex in
impersonal circumstances. Other homosexuals came out to their parents, close friends, or
some gay friends but not to the rest of the world. Coming out could take place as the result of
being accidentally caught or known by others.
Below is a young man’s story about his brother who was no longer able to keep his
homosexual preference when he was caught of having sex with other men. Then he begged
his family to accept him.
He told the truth, that he didn’t want to be that way, but his real preference and
emotions are just like that. So he begged our parents and siblings to sympathize with
him for being that way. Our parents couldn’t do anything but cry at the time, but they
love him anyway. My eldest sister cried; the younger sister and my mother also cried
a lot (Quyet, 27 years old, brother).
In Dao’s case, he came out to only some members of his family. In fact, Dao’s same-sex
preference was known to his father only when he caught Dao having sex with Dao’s cousin.
His father kept this secret for himself only and did not share it with other members of family.
However, in exchange for this, Dao had to marry a daughter of his father’s friend.
Only two years ago, [my father] found out. I kept the secret very well, but one time
we accidentally forgot to lock the door. He caught us doing it when he suddenly came
44
over… I am the only son in the family, so my parents really wanted me to get married.
He knows I am gay, but he forced me to get married, so I did it to please him (Dao, 27
years old, bóng kín).
Many young men remained bóng kín in their hometown or village but came out as bóng lộ
when they were in other settings where people did not know them. Thus, coming out did not
affect their families.
I guess you already know about the gay’s lives. There are few [gay people] back in
Hai Phong, so I didn’t dare reveal my condition there. Only when I am here, I am bold
enough to let it be revealed (Pham Duy, 22 years old, bóng lộ).
Minh Khoi shared his secret with his boyfriend and with a few other gay men who were in
the same group he usually associated with.
Normally, I don’t do much talking on that issue. I only talk with my boyfriend about it
because it’s so difficult to talk with other people about that. Only with some friends in
this group is it okay (Minh Khoi, 21 years old, bóng kín).
Perhaps for most people, coming out to themselves was a difficult process that usually began
with confusion, anxiety, questions, and hard struggle. Many people, after years of struggle,
accepted their situation, convincing themselves that it is the destiny that was arranged by
God.
I have to accept myself as being this way without any reason. My parents gave birth
to me as a boy, but God gave me these kinds of characteristics. So all I can do is
accept it and not worry too much about it (Hoai, 22, bóng kín).
Perhaps most homosexual and bisexual men in this study, except those who did not want or
were unable to hide their effeminate tendency, tried hard to keep their same-sex preference
hidden from the people around them, including their family (unless they were caught in
action or were pushed to get married). Coming out would have cost them a lot. This situation
forced them to put up a lot of barriers.
2.3.4 First sexual experience
2.3.4.1
First sex with women—“Do I really like it?”
Many participants in this study had their first sexual experience with a woman when they
were younger than 20 years old. For some people, this even happened earlier, around ages 16
and 17, with a sex worker.
The first time I had sex with a woman happened when I was in the 10th grade. We
called it “go for prostitutes.” (Ask: You went alone or with your friends?) With my
friends. We collected the money then caught a girl to play together... Because all my
friends already knew what to do, I followed them, but actually I didn’t feel very
excited for that (Vu Long, 25 years old, bisexual).
45
The first time I had sex with a woman was in the year 2000 when I came back to
school from my hometown after the traditional New Year holiday. My friends invited
me to go with them to meet a girl at the brothel (Hung, 24 years old, straight sex
worker).
Some participants said they had their first sexual intercourse with their girlfriend.
My first sexual experience was with a girl. She was my girlfriend. It was when I was
10; when I was in the 12th grade. She was two years younger than me (Le Hoang, 25
years old, bisexual).
That was when I was 16 years old and had just dropped out of school. At that time, I
was still attracted to girls a lot, and I still didn’t know that I also had a preference for
boys. [That feeling of mine] was so great (Dinh Tuan, 23 years old, bisexual).
2.3.4.2
First sexual experience with men—pleasure and anxiety
For many participants, their first sexual experience was one with a man. To a number of
them, first sexual encounter with a male partner happened at age around 17-20 years old.
Their first male partner could be a superior:
Only after I entered the army at the age of 18 did I know that I was attracted to men.
That night, I slept in the same room with the platoon leader. He touched me all over. I
felt a little pleasure but pushed him off to run away. A few days later, I came back to
his room, and then after few times I got used to it. I let him have sex with me. Then,
in those two years, we continued our relationship as lovers until I finished military
duty (Hoai, 22 years old, bóng kín).
Their first male partner could also be an acquaintance, like in Quynh’s story.
At the time when I left home, there was a rather old man who had his own private
house and was living there without his parents. He let me sleep in his place. At night,
when I was very tired and slept soundly, he came over to me, took off my clothes, and
had sex with me. At that moment, I knew what he had done, but I accepted it without
any resistance because, anyway, he gave me a place to sleep. That time was so long
ago (Quynh, 21 years old, straight).
Their first male partner could also be a casual acquaintance, like what happened to Quang.
It was with a boy who polished shoes. That day, I went to Thu Le park near my house
and made friends with that boy. He said he came here from Thanh Hoa to earn money
by polishing shoes, and he had to share a rented flat with some friends. I asked him
about his family, he said his family was very difficult. After some talking, I told him
that I wanted to help him. Then I said straightforward that I liked him and if he came
over to do that to me, I would give him 100,000 dong. He agreed, then I lead him to
my place (Quang, 23 years old, bóng kín).
For most participants, the first experience of having sex with men left very strong
impressions on them. They recalled it with great excitement.
46
I’ve liked men since I was 17 years old, but only a year after I had my first sex
experience with a man, and I do like it. I like to have sex with men more than with
women, and sometimes I still have sex with men (Dinh Tuan, 23 years old, bisexual).
The very first time, I felt so pleasurable and surprised. I was so surprised that two men
could satisfy each other that good (Du, 36 years old, bóng kín).
Some participants considered this event the turning point in their life.
I felt that I had found the other half of my life; I had found my new source of joy
(Pham Duy, 22 years old, gay sex worker).
Huy could never forget the strong feeling of his first time being penetrated.
When that man pressed me down, I felt so wonderful. I could sense that the feeling
was so strong, that his strength could burst me. I felt so happy that I exploded even
though it hurt when his penis was inside me (Huy, 25 years old, bóng kín).
For Quang, his first sexual encounter with a man was a great relief from the anxiety and selfstigma that he bore for years.
After that first time, my fear and anxiety was all swept away. Previously, I thought I
was hopeless. Then, after I met more people like me, I feel that it’s easier to live, and I
feel less complex (Quang, 24 years old, bisexual).
A man’s first sexual experience with another man could be a rite of passage for becoming a
gay man.
After that time, I felt myself totally become gay; at the time I did not even know how
to name it correctly (Quyet, 19 years old, gay bóng kín).
However, many participants recalled how they felt worried and anxious about what had
happened.
My first feeling was uncomfortable. I felt the complexities, and I was a little bit
afraid. I asked myself if I belonged to this group. I watched movies sometimes; I saw
those pêđê come to the theatre to act, and I didn’t like those types of people. But all of
a sudden, I was like them… (Van Hung, 25 years old, gay bóng kín).
Discovery of his own true identity was a great sadness for Huy after his first sexual encounter
with a man.
After that first time, I discovered a lot about myself, that I am definitely attracted to
men and that I don’t like women at all. But right when I found it out, it gave me a
very sad feeling. Because, at the same time, I can feel that I am so unusual. I’m not a
normal person; people like us are abnormal (Huy, 25 years old, bóng kín).
For some people, the strongest feeling was fear due to their perception about the universality
of heterosexuality and unnaturalness of homosexuality.
47
After that first time, I was overcome with fear. (Ask: How come?) Because I
wondered why I showed it to a stranger. I felt something very contradictory because I
am a man; why did I do this? (Ask: Can you explain more?) I mean, from any
perspective, a man has to love and have sex with a woman, not with another man (Vu
Long, 25 years old, bisexual).
The good feeling could be mixed with worries and anxiety.
I felt that it was physically unnatural, but I didn’t feel guilty because no one forced
me, and I did not forced anyone either; we both felt comfortable. Generally, I didn’t
feel guilty. I didn’t think I was bad, but I still felt a little bit strange; there was still
something wrong. After that time, whenever we see each other, we feel ashamed (Du,
36 years old, bóng kín).
Straight men might feel uneasy or strange after the first sexual encounter with a male partner,
but it seemed that these men did not torture themselves much about the event but considered
it as a business and kept going on.
At that time, I did not dare speak with anyone; I just told the pimp how fearful I was.
But actually, I did not dare to speak with others because I didn’t want anyone to know
I was going out with a guy. But just the next day, I had sex with two or three more
men (Anh Tuan, 23 years old, straight).
Like this young man, some straight men were seduced into a sexual encounter with a man
and eventually accepted selling sex to male clients.
When I was drunk, I knew exactly what he had done to me, but I couldn’t resist it
because the alcohol made me so weak. Then, the next morning, he gave me 500.000
dongs, and I took it. From that moment on, I already knew about homosexuality. At
first, I was so angry with him. I wondered why I got to know these bad kinds of
people. I wanted to tear all the money, but then I thought “it’s no use.” Then I went to
find out more about this thing (Hung, 24 years old, straight sex worker).
Hieu was aware of the trap that one rich man put him in, but he voluntarily fell into it and
after that became a called boy.
When I was in financial difficulties, suddenly I thought about him. So I made a phone
call. That man used to lend me money several times before and never asked me to
return it. He asked me out sometimes. Once he asked me to stay overnight at a
guesthouse, then he did it to me, and that’s all. Generally, I felt fear more than
excitement (Trong Hieu, 26 years old, straight).
Anxiety, relief, guilt complex, being disappointed, happiness, and jealousy were the feelings
that characterized the first male-to-male sexual experience of most MSM in this study. The
findings of this study showed that internalization of the prevailing norms, values, and
stereotypes with regard to gender and sexuality in Vietnamese society has, in fact, sharpened
the pain that most participants with homosexual orientation experienced. This can deepen
their self-stigmatization and thus make these communities more invisible to the efforts of
HIV/STIs educational interventions and health service provision.
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2.4 Current Sexual Practice and Sexual Health Issues
This section presents the findings on the current sexual practice of the participants and sexual
health issues of MSM taking part in this study. The findings showed that this group has very
complicated sexual lives. The most common characteristics of all subgroups include intensive
sexual activity and having multiple sexual partners. As presented above, many MSM had sex
with women when they started their sexual life, and a number of them continued maintaining
sex with women while having sexual relations with men. Many engaged in selling and buying
male-to-male sex exclusively, while others also bought female sex service.
Most MSM in this study have a very active sexual life that is characterized by a lively dating
pattern, a high frequency of sexual encounters, multiplicity of sexual partners, and diversity
of sexual practice. Their misconceptions and myths surrounding male-to-male sex as well as
risky practices require urgent measures and interventions to take place.
2.4.1 Lively dating
The lively dating activities of MSM in Hanoi can be observed in a number of public venues
in the city. Depending on their socio-economic status or lifestyle, different subgroups of
MSM have different meeting venues that they frequent. Migrants from other provinces often
gather in parks, massage parlors, and karaoke shops. Gays with better incomes and high-class
male sex workers choose cafes, bars or pubs, or dancing clubs. There is no strict distinction,
of course. Some well-established men sometimes go to parks looking for young men who
have just arrived from the countryside.
There are several parks and public places where the gay community of different generations
used to date each other.
From a very long time ago, for 40 or 50 years already, the nine-stumps tree at BH has
been a gathering spot for the homosexuals, the old gays who were born in the French
domination time. Another place is at LN park near the gate at NDC Street (Hoang, 52
years old, gay bóng lộ).
Many MSM, including migrants and local men, usually looked for their partners in these
public places.
I myself can go to the lakeside to find someone. For example, if I start a conversation
with a guy, if he sympathizes, I will ask him to come over my place to sleep with me.
If he understands me, he will come to stay with me for a longer time. But the longest
time can only be two or three years; later they have to get married (Tran, 23 years old,
bóng kín).
Some places were called “love markets” among MSM because those are places where they
used to gather for chatting and where sex transactions were made.
There are some “sex markets” where people can meet and chat. When someone can
not find a client, he can sit back there gossiping (Hoang, 52 years old, gay bóng lộ).
49
Hanoians and those with higher income usually gathered in discotheque or clubs where they
looked for partners. Those who engaged in the sex business also looked for their clients in
these places.
Generally, I am gay, so I do love going out and gathering in crowded place like
discotheques. But even when go out playing, I can make money (Dao, 27, bisexual).
In the last few years, Internet shops became common places for young MSM to gather or to
look for a new partner.
In my free time, I go to the Internet shop for chatting. I use a female nickname like
Hoang Ngoc, for example (Hoang Hieu, 22 years old, gay bóng kín and sex worker).
I am also looking for partners on the Internet. My nickname is “handsome guy” or
“cute guy.” I look and click on them, and they consider me as a boyfriend to
boyfriends (Dat, 22 years old, bóng kín).
MSM in Hanoi have already found the Internet to be a very convenient place for dating.
Many of them even knew different gay Web sites, including a Vietnamese one.
Out at the lakeside, I heard my friends say “there is a Web site just for people like us
on the net. We can check it out to make friends with many boys.” My friends said that
they met many boys from that Web site, but I still don’t know it. I want to try it once
to see what it’s like (Huy, 25 years old, bóng kín).
2.4.2 High frequency of sexual intercourse and multiplicity of sexual partners
2.4.2.1
Sex with men
The findings of this study showed that young MSM have quite a high frequency of sexual
intercourse and multiple sexual partners.
In these recent few months, I still have four boyfriends. But in the last three months, I
only have two guys. Generally, those westerners are still my boyfriends. They just
come back home for a short time, then they will be here again. They will be back here
in one week or two (Hanh, 25 years old, bisexual).
Bisexuals usually have a tight schedule from keeping sexual relations with both female and
male partners.
I have sex with my girlfriend twice a week, but three or four times a week I have sex
with men (Anh Tan, 25 years old, bisexual).
This young bóng kín very clearly explained the nature of sexual relationships between men.
Our sexual relationships are different from relationships between men and women
because, anyway, our sexual need is higher than normal men. Also, our sex life is very
unstable; we have only irregular sex. Sometimes sex is very intensive, but some other
times there is no action at all (Quang, 20 years old, bóng kín).
50
Some middle-aged MSM have unstable sexual lives because it was difficult for them to have
a regular partner as they got older. To satisfy their desire, they had to buy sex services from
sex workers.
Nowadays, my need for sex is lower; it’s fine whether I have it or don’t. That means if
I go to the market, if the good is cheap, then I will buy. But there was a time when I
went for it very often—for the whole month, one or twice a week. Even when I had
money, I went for it everyday (Hoang, 52 years old, gay bóng lộ).
This was also a case for Ngoc, a 31-year-old bóng lộ and the owner of a guest house in the
Gia Lam district.
Some weeks I have no one at all. Some weeks I have two or three partners. Some
weeks I even have four partners (Ngoc, 31 years old, bóng lộ).
Ngoc said that in the last sexual encounter, because it had been a few days without anybody,
he had such a strong urge that when he had a partner, he did not want to use a condom. After
having sex, he found out that the man was HIV positive. Ngoc has been very worried since
then.
MSM who engage in the sex business, especially straight men, had a very busy sexual life
with multiple partners.
On average, I “go” with clients four times a week. I go whenever I like to. (Ask: How
long is one go?) From 2 p.m. to 8 p.m. (Pham Duy, 22 years old, bóng kín).
At least twice a week, normally four times a week, sometimes it’s up to five times
(Anh Tuan, 23 years old, straight sex worker).
Most MSM in this study have multiple sexual partners. Some have many partners
consecutively. Others have several partners at the same time.
After a year of living with that guy in Nghia Tan Street, I had another relationship
with another guy. (Ask: What happened then?) That time I had so many relationships.
(Ask: How many guys can you count?) About 20 guys. At this moment, I have about
four or five guys that fit me well. Whenever I feel sad, I will call this one. If he is
busy, I will call another instead (Quang, 24 years old, bisexual).
[I have] dozens of lovers; half of them moved to stay with me here. But only the first
boy stayed with me for two years. Another one spent a year and half with me; the rest
just stayed for a few months. Half of them come here to stay; the rest stay at their own
place and come see me here whenever they like to (Van, 36 years old, bóng kín).
At the study time, many participants had a large cumulative number of sexual partners.
Several of them had both Vietnamese and foreign partners.
Until this moment, counting both Vietnamese and foreigners, I have more than 100
partners (Vu Long, 25 years old, bisexual).
51
I can’t remember how many partner I’ve had. I’ve been here since I was 19 years old
and have sex with so many people that I can’t remember them all (Tran, 23 years old,
bóng lộ).
Love among MSM usually did not last long. The same happened with the relationships
between MSM and their non-MSM partners. Many participants had male students or migrants
who agreed to live with them as sexual partners. In exchange, they paid for the partner’s
study and living. However, these relationships were often short.
That longest love I had only lasted three months. Usually, with the students I couple
with, the longest time was just about two and a half months (Dat, 22 years old, bóng
kín).
Actually, it’s very hard to find a same-sex partner that wants to stay with me for long.
If I love a guy who is not gay, he will leave me right after I run out of money. Only
with the money can I raise him (Dat, 22 years old, bóng kín).
Most participants reported having casual sex and irregular partners.
For the last three months, I’ve had sex with irregular partners six or seven times
(Tran, 23 years old, bóng lộ).
I don’t like things that last so long. I like to change. I like to have more partners. Up
to now, I’ve had so many lovers; they were all schoolboys (Quang, 20 years old, bóng
kín).
Besides their boyfriend or regular partners, many participants had casual sexual contacts.
They distinguished between their lover and those whom they had to pay for sex and tried to
keep these encounters confidential from their lover:
No, I can’t remember. Sometimes I have sex with several guys in a month. Each time
I go out with another new one, I have to keep it all in secret from my boyfriend. (Ask:
Do you think your boyfriend also goes out like that?) Certainly he would because it’s
true that everyone will get bored after being with the same old person for such a long
time (Nguyen Hung, 29 years old, bóng kín).
I have three irregular partners. One is Tung. The other is the guy who came back from
overseas, and the other is Ngoc (Hung, 25 years old, bóng lộ).
Casual contacts are usually made through the introduction of friends in the same circle.
With those who just go for exchanging, I was introduced through my friend. Then we
go rent a room at a guesthouse to have sex. (Ask: Which age group are those people
in?) Some are very young, only 19 or 20 years old. They always introduce me to the
young and handsome guys (Nguyen Hung, 29 years old, bóng kín).
If I go out and meet a new guy, I will introduce him to my friends later. Then we all
know each other. It’s like introducing new “hang” to each other (Vu Long, 25 years
old, bisexual).
52
It is noteworthy that the higher the turnover of sexual partners of MSM, the more they face
the risk of HIV/STI infection. Besides, even if they were aware of the risks, having many
sexual partners means that with different partners they need different strategies and skills in
negotiation of condom use. This leads to an assumption that it is not easy to maintain a
consistent safe-sex practice even among those who have good knowledge about STI and
HIV/AIDS and awareness of the risks of infection.
2.4.2.2
Sex with women
The findings of this study confirmed that a portion of MSM had sexual relations not only
with men but also with women. The motivation of having sex with women varied from
reconfirmation of one’s sexual identity to hiding same-sex orientation or keeping balance in
their sexual life.
Although they did enjoy sex with men, many gay men still wondered about their “true”
sexual identity. Time after time, they did try having sex with women in the hope that this
could help them “switch” their orientation. Some did so with their girlfriends.
Once, I decided to give it a try; I decided to make love to a girlfriend at the Tourism
School. I planned how to make love to her, came to her school to take her home, and
brought her around. But actually, I couldn’t love a woman. Even when I embraced
her, I felt normal; I didn’t feel any sexual arousal. It’s different when I’m sitting next
to a man, embracing him; my penis is hardened. But when I hold a girlfriend, or even
if I touch her breasts, I don’t feel anything, even if I touch her breast (Huy, 25 years
old, bóng kín).
Others tested themselves with female sex workers.
Once, about four months ago, I tried to have sex with a female prostitute, but I
couldn’t have an erection (Tran, 23 years old, bóng kín).
For some people, and for the bisexuals in particular, having sex with women could be a way
to hide their sexual preference for men. They often felt uncomfortable when having sex with
female partners, especially their wives.
The guys in my office like to invite each other to go to karaoke or to a discotheque.
Honestly speaking, we go to those places to “buy sex” (Minh, 41 years old, bisexual).
I don’t feel comfortable having sex with my wife because it’s not like I expected, and
I don’t like to have sex with women. I have to imagine my [male] partners to make
me ejaculate (Long, 26 years old, bisexual).
Generally, I only sleep with her once or twice a month, and normally I don’t ejaculate
because I don’t feel very excited (Dao, 27 years old, bóng kín).
Straight men reported having intensive casual sex, including sex with female sex workers, as
a way to keep “balance” in their sexual lives.
53
Those girls I go with are the playgirls, or they don’t have a stable job. For me, having
sex with girls is very easy, and I do not do it for the money (Anh Tuan, 23 years old,
straight sex worker).
I have sex with both female partners and prostitutes (Hung, 24 years old, straight sex
worker).
Talk about female partners, I have about 10. (Ask: Are any of them sex workers?) Yes,
they are (Trong Hieu, 26 years old, straight).
2.4.3 Diverse sexual practice
Similar to the findings of recent studies on MSM in the southern part of Vietnam (Colby,
2003; FHI, 2005), this study also showed a diverse sexual practice of MSM in Hanoi. This
starts from diverse sexual preference to different sexual acts.
A middle-age bisexual and pimp said sexual preference of gay men was similar to that of men
or women. Different persons have different taste regarding sexual partners.
It’s very diverse, exactly like men or exactly like women. Some people are just
attracted to very young boys. Some prefer older ones. Some are attracted to
whomever. Some are only into the bóng lộ. Some of my foreign friends even ask for
cross-dressed people, but some ask for a guy without any trace of woman (Lan, 42
years old, bisexual).
Almost all participants, except for the straight men, prefer “real” men; however, some people
said they enjoy having sex with gays more than those who are not because it was easier to
have mutual understanding and therefore more pleasure with gays.
As for me, I only like to be with someone in my same group because only those guys
can understand us and have true feelings with us. The straight guys just lie down in
bed like logs or like death (Dinh Tuan, 23 years old, bisexual).
Sexual acts varied in a wide range, from touching, caressing, and hand jobs to oral sex
(sucking, licking, and rimming) and anal intercourse. The most common sexual acts reported
were blow jobs, oral sex, and anal intercourse.
Before insertion, two people are blowing each other. When both guys reach the high
feeling, one inserts into another, and then they switch the roles until both guys
ejaculate. As for me, I like rimming the most and then anal intercourse because these
two actions bring me the most pleasure (Hoai, 22 years old, bóng kín).
Some people enjoyed swallowing semen.
I love to swallow men’s semen. No matter what happens, I will explode into his
mouth and he has to ejaculate into my mouth. I don’t like him to ejaculate anywhere
else (Quang, 20 years old, bóng kín).
54
Hung had spent more than year in the South. He said that MSM in the South seemed more
skillful and more careless about safety than the MSM in the North.
In Saigon, people are more skillful. They know more styles for making love than
people here. For example, they can turn around to blow each other, then play anal sex,
and then blow again. Or they can lick all over the body, the feet, and the hands.
Sometimes I don’t understand the way Saigonese make love. They don’t want to use
condoms, and they explode into each other’s mouths (Hung, 25 years old, bóng lộ).
Some people distinguished between the acts they performed to their lovers and to their
clients. With the latter group, the acts were limited to hand jobs and anal penetration with
them being the one who penetrates.
The movement with those I go out with just for exchange is different. With them, I
only use my hand and anal sex, but never oral sex. Mostly they take the role of
receiver (Nguyen Hung, 29 years old, bóng kín).
They said oral sex was exclusively performed between lovers.
Normally, if two people are in love, they use oral. Otherwise, they use hands. With the
lovers, they blow and then insert into each other (Nguyen Hung, 29 years old, bóng
kín).
Some gay men preferred to take the role of receiver, or bottom, because they prefer to play
the woman’s role.
Between giving and receiving, I prefer to receive because I think of myself as a girl
(Quang Hieu, 20 years old, bóng lộ).
I let them consider me as a girl, so I let them go into me first. Because they are not
gay, they may be ashamed [to receive] (Dat, 22 years old, bóng kín).
Vu Long, on the contrary, enjoyed the role of husband who dominated or brought pleasure to
his partner.
I love to be a husband. I like other people to call me “big brother,” and when they
caress me, I would turn over to ask “do you like it” or “was that good” (Vu Long, 25
years old, bisexual).
Straight men usually preferred to be the one who penetrates, or top, but not to be penetrated,
or bottom, because they were afraid of getting an infection and hemorrhoids.
I’ve tried to be bottom once, but it was so painful that I don’t want to try it again
anymore. Generally, people say there’s more risk of getting infecting diseases playing
that way. Moreover, there’s a disease called piles hemorrhoids, so I don’t want to play
the bottom (Anh Tuan, 23 years old, straight sex worker).
Therefore, they often negotiated in advance.
55
If I know he would penetrate me, I would not go with him. If he let me penetrate, I
would go (Anh Tuan, 23 years old, straight sex worker).
2.4.4 Misconceptions and myths about risk and safety
Similar to the results of recent studies (Care, 1993; SCF UK, 1997; Cao H N et al., 2002;
Colby, 2003), almost all participants in this study had heard about HIV/AIDS. They knew
what HIV was and how it is transmitted. Many participants could list popular STIs such as
syphilis and gonorrhea. The majority of them were aware of the risks of infection. Oral sex
could be unsafe if there were sores or bleeding in the mouth. Anal sex was known as the most
risky. Some people had a quite sophisticated understanding about the anatomy of the sexual
organs of men and women and knew that anal intercourse was more risky than vaginal
intercourse. Most of them knew that using condoms when having intercourse could avoid
infection of HIV and STI. Some participants were aware that MSM were vulnerable to
infection of STI because they had many sexual partners and had a lot of casual sex.
However, it was striking to find out in this study that there were lot of misconceptions and
myths about male-to-male sex and about what was perceived as risks and safety in sexual
acts.
Many participants believed that STIs were exclusively transmitted through male-female
intercourse but not thought male-to-male sex.
I think those STIs can just be transmitted through the sex between men and women.
As for us, men who have sex with men can not be dangerous (Hoai, 22 years old, gay
bóng kín).
Syphilis can be hardly transmitted through sex between men, unlike the risk of sex
between men and women that we were taught at school. There’s no chance for
syphilis to infect people if they are two men having sex (Van Hung, 25 years old,
bóng kín).
Some people told me that sex between men and women can bring diseases, but sex
between men, meaning anal sex, is safe (Hung, 25 years old, bóng lộ).
Having the wrong information can lead to the wrong belief that male-female sex has greater
risk than male-male sex and that the latter was almost safe or carried very little risk.
Sex between men and women is more risky with diseases than sex between men
because only one percent of anal sex can cause disease (Quang Hieu, 20 years old,
bóng lộ).
The STIs can only be transmitted through sex between men and women. (Ask: How
about sex between men?) I know only one case of a man who had sex with a man who
got AIDS because those men used drugs. But if men just have sex with each other,
they would never get HIV (Pham Duy, 22 years old, bóng kín).
56
Sex between men and women is riskier because when the penis contacts the vagina
without condom, the vagina can suck semen from the penis faster, which means the
diseases can be transmitted faster, too (Vu Long, 25 years old, bisexual).
Educational activities about reproductive health and HIV/AIDS in many places often targeted
women only. This may lead to the wrong understanding of some participants that only
women could get STIs but not men.
There are many posters about diseases displayed on our ward’s notice board, about so
many diseases, but they are only the diseases of sex between men and women (Hoang
Hieu, 22 years old, gay bóng kín and sex worker).
I know about gonorrhea and syphilis. They are women’s diseases, not men’s diseases
(Thanh, 40 years old, bóng lộ).
They said on TV that those diseases can be transmitted through sex between men and
women. They didn’t say anything about sex between men, so I think people like us are
safe (Hoai, 22 years old, gay).
Many participants believed that women were more vulnerable than men because the
participants did not know that intestine tissue is thinner and more easily torn than vaginal
tissues. Thus, unprotected anal intercourse could be more risky than vaginal intercourse.
Certainly, it’s more risky between a man and a woman because between two men, the
contact point is the very last part of the body, the place for the waste, where the
diseases can be transmitted. But in sex between a man and a woman, if there’s a
scratch, diseases can be transmitted (Dinh Tuan, 23 years old, bisexual).
Other said that anal intercourse was less risky if one managed to ejaculate outside.
In my opinion, homosexuals are at less risk from HIV/AIDS infection. There may be
a risk, but it’s just with those who inject drugs. (Ask: Why?) Because anal sex is safer.
(Ask: Why anal sex safer?) Because, like us, if we have anal sex, we ejaculate outside
the anus. We don’t let the semen go inside, so it’s less risky (Hoai, 22 years old, gay
bóng kín).
HIV can be transmitted through sex between men and women and injecting drugs. But
by having sex the way we do, when we always ejaculate outside, we can never be
infected (Anh Tuan, 23 years old, straight sex worker).
Van was aware of the risk of being infected with HIV through oral sex, but he also believed
that withdrawal could guarantee safety.
I am really afraid because when I brush my teeth hard, my gums can be scratched.
You can’t tell, maybe there’s a lot of HIV in the semen, and if there’s a wound in my
gums also, I would be infected for sure. So I will try to limit it as much as I can. It’s
best to let him explode outside (Van, 36 years old, bóng kín).
57
Some MSM, including straight men, believed that they would be safe if they only have oral
sex with men.
I consider sex with men safer because oral sex is safer than vagina and anal sex (Anh
Tuan, 23 years old, straight sex worker).
Hoang, as cited below, was very confident about his ability to sense the risk. He believed that
he was safe because he had relations with business men only.
(Ask: You always give blowjob to other guys. Do you think you can be infected with
diseases just because of that?) No, I’ve never think about it because I have a very
good sense of premonition. I know if someone has diseases just by looking at his
thing, especially those drug users. Also, I don’t get involved with those poor guys who
are always playing around. I only play with the businessmen who have a good
appearance (Hoang, 52 years old, gay bóng lộ).
Many participants emphasized the risk of infection through male-female sex but were less
aware about the risk of male-male sex.
In my opinion, anal sex with women has the highest risk. HIV is mostly transmitted
from women to men. There are many female prostitutes here, and mostly women get
infected first and then transmit it to men (Tran, 23 years old, bóng lộ).
In some cases, [gays] have anal sex, but they normally have long-term relationships.
They know and believe in each other, so they can do it. So it’s hard for them to get an
infection. Moreover, I don’t see any other way for diseases to be transmitted through
sex between men. But for heterosexual sex, you know, the vaginal fluid has so many
diseases inside. All the diseases are in that fluid (Dinh Tuan, 23 years old, bisexual).
For some people, STIs including HIV/AIDS were something far away.
I don’t think about this thing [STIs] much. I don’t think I will get infected with this.
Even in our group of sex workers like this, few people are infected (Anh Tuan, 23
years old, straight sex worker).
There is a popular belief that semen contains a lot of nutrition and energy. Frequent
ejaculation could therefore seriously affect a man’s health. Some straight men in this study
were concerned mostly with health issues due to frequent ejaculation.
It’s very hard for my sexual life because if I don’t ejaculate for few days, I feel so
healthy. But in the period of frequent ejaculation, I feel so tired every morning. That’s
the high risk (Anh Tuan, 23 years old, straight sex worker).
Still some people believed that HIV was not transmitted through oral sex but though
mosquito bites.
If a mosquito bites an HIV-infected person and then bites me, I would get infection,
but it can be transmitted through oral sex (Anh Tan, 25 years old, bisexual).
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2.4.5 Use of condom and lubricant
As mentioned above, many participants in this study knew that using condom could prevent
HIV infection and STIs. In fact, they reported using condom when having sex with their
partners. However, similar to the findings of other studies (SCF UK, 1997; Colby, 2003; FHI,
2005), this study also discovered that many MSM in Hanoi did not use condoms or did not
use them consistently.
This young man was HIV positive, but he never used a condom with his girlfriend.
My girlfriend knows that I am infected, but she doesn’t like using condoms; she
doesn’t want to use condoms. She said that if she gets infected, “then both of us are
infected” (Quynh, 21 years old, straight).
Hoang dislikes condoms because they lessen pleasure. He never used condoms because he
was very experienced in identifying healthy people.
I don’t use condoms because when I go out playing, I already have the knowledge and
ability to select. I can identify people just by looking at them on the street. For
example, by looking at you I know you are an office worker. Or looking at a country
guy coming to the city to work, I know he is not a playboy. I never use condoms, ever
since my younger days up to now, because condoms take all my inspiration away
(Hoang, 52 years old, bóng lộ).
Young, inexperienced gay men were more vulnerable in relations with older partners,
especially if they were paid by the latter.
That guy goes out playing a lot and doesn’t use condoms. I worry each time I insert
into him without a condom. With other people, it’s okay because I explode outside.
But with him, he always asks me to explode deep inside him, the deeper the better. I
feel a little bit afraid. For example, I feel a little pain. I stayed with him for two
months (Hung, 25 years old, bóng lộ).
Hanh had sex with both men and women but never used condoms. He believed that HIV and
SIDA are two different diseases. He had little knowledge about STI and HIV/AIDS and
didn’t pay attention to this information. He could name syphilis but did not know its
symptoms. He did not know how to identify an HIV-infected person. He did not know how to
use a condom. He has had sex with multiple partners including Vietnamese and foreigners,
but he never used condoms.
I’ve never used a condom with that Aussie man. He talked about using condoms
sometimes, but in the relationship, he loves me so he doesn’t think about it. He said
that “we love each other, we have sex together, so we need not care about that.” For
me, I don’t care about that either because we love each other, and so we give our all to
each other (Hanh, 25 years old, bisexual).
Van also did not use condoms. He said that he only practiced oral sex and would not have sex
if he knew his partner was unsafe.
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I don’t use condoms. When I feel there’s an oral problem with the partner, like their
gums are bleeding or ulcerating, I will stop [having sex] right away (Van, 36 years
old, bóng kín).
When Ngoc was in prison, he made friends with a man who shared the same cell with him
and had sex with him. Later, when both were out of prison, they kept having sex with each
other from time to time, but they never used condoms. Ngoc believed that the man was
healthy because his wife was jealous and because he had no money to play around.
I know him well, so I don’t use condoms. (Ask: Why don’t you use them?) I think its
okay because his wife takes very good care of him. He can not play around.
Moreover, he doesn’t have money, so how could he go out playing (Ngoc, 31 years
old, bóng lộ).
Many participants did not use condoms consistently. With their lover or regular partner, they
used a condom for the first time or stopped using condoms after a while.
I used a condom with Thang for the first time, but later on, I stopped using condoms
with him because we were already in love with each other, so we didn’t need condoms
anymore (Hoang Hieu, 22 years old, gay bóng kín and sex worker).
With the regular partners, we already spent enough time together, so I trust them. But
with the irregular ones, they can go out with so many clients, so I can not trust them.
Then I use condoms (Tran, 23 years old, bóng lộ).
Le had sexual relations with two boyfriends. He believed that he was faithful to both of them
and that these men were also faithful to him.
At the beginning when we first knew each other, we used condoms. But after a while,
we didn’t need condoms anymore because I am not the playing type of guy. With
those two guys, I only used condoms in the beginning, but I didn’t later on. The only
thing we need is lubricant (Le, 30 years old, bóng lộ).
Tuan thought that after a long time (from six months to a year), he could trust his two male
clients. Moreover, he was always doing the penetrating, so he did not care about using
condoms.
With those two guys, I’ve stayed with them for six months or a year already. That’s
long enough, so I don’t use condoms when penetrating them (Anh Tuan, 23 years old,
straight).
According to Hung, there should be mutual respect and trust between lovers or spouses.
Using condoms meant distrusting each other.
He is my lover and not just a partner. Being with a partner means that after sex,
there’s nothing left, just like when a man has sex with a prostitute. He has to be safe,
so he uses a condom. But with his wife, why should he use condom? If I use condoms
with my lover, it’s like we don’t respect each other (Van Hung, 25 years old, bóng
kín).
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Among lovers or regular partners, condoms might be used to reduce pain and not for
protection from cross infection.
For us, we use condoms six out of 10 times we have sex. Those four times having sex
without condoms are when I don’t feel painful. If I feel painful, I will use a condom to
reduce the pain. When I first knew about having sex with men, I usually felt painful,
so I used condoms (Hoai, 22 years old, gay).
Ngoc, a pimp and owner of a guest house, said he was very careful about his safety. He
always used condoms with casual partners, but he never used condoms with his staff. Ngoc
believed that he would be safe because the boys just came from countryside, so they were
healthy and still virgins. Ngoc, however, did not think that he could infect these boys.
I’m very careful. I don’t use condoms with my staff here, but whenever I go out, I
always use condoms. I can manage the staff here. Moreover, they’re still very young
and just came here from the countryside. They don’t play at all and have never had
sex before, so I don’t need condoms. They are like virgins (Ngoc, 31 years old, bóng
lộ).
Minh was aware of AIDS, but he never used condoms with his wife or his lovers.
Normally, with my wife and my true lovers that I have spent several months with, I
would never use condoms. But if I go out, I would surely use them because it’s my
responsibility, so I have to be careful with that epidemic (Minh, 41 years old,
bisexual).
Similar to the findings about non-commercial sexual relations, unprotected sex was quite
frequent within commercial sexual relations. Not using condoms or inconsistent use of
condoms was not rare, especially with regular clients.
I only have anal sex with two guys who I have known for a long time, normally six
months or a year. With these two guys, I don’t use condoms (Anh Tuan, 23 years old,
straight sex worker).
Tan said he did not use condoms consistently. He did not use condoms when he felt the
partner was healthy or when condoms were not available.
With those whom I feel are safe, I will not use condoms with them. Otherwise, I still
use condoms. Sometimes, when we’re in a hurry for sex, we don’t use condoms. (Ask:
What type of people do you trust and don’t use condoms with?) Those who I know a
lot about. For example, I would trust a guy if nothing happens one day after having
sex with him (Anh Tan, 25 years old, bisexual).
With his girlfriend, Tan only used condoms when she was menstruating.
I trust my girlfriend, so I don’t use condoms with her. I read books, so I know that I
have to use a condom when she’s menstruating. And if I go with prostitutes, I surely
have to use them (Anh Tan, 25 years old, bisexual).
According to some participants, many foreign clients did not use condoms.
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Generally, with foreign clients, they rarely use condoms. It is rare for a foreign guy to
pull a condom from his pocket. Normally, they never bring condoms along (Anh
Tuan, 23 years old, straight).
Negotiation of condom use in a female-male sexual relationship was mainly seen as a gender
power issue. In the case of male-male commercial sex, power belongs to client; sex workers
have no voice.
[I don’t use condoms] because I don’t have the right to choose. If I could choose, I
would ask everybody to use condoms with me. But as I said at the very beginning, it’s
just because of the money that I have to do this, so I have to depend on their
decisions. I have to do whatever they want to. (Ask: Have you ever asked someone to
use a condom on you?) They can ask me to use condoms, but I have no right to ask
them to do so (Anh Tuan, 23 years old, straight sex worker).
Condoms were rarely used in sucking and rimming.
Normally, when performing hand jobs, rimming, or blowjobs, we don’t use condoms.
It is rare for someone to ask to use a condom with me when I give him a blowjob or a
hand job. Only one percent [of times] is with a condom; the other 99 percent is
without (Anh Tuan, 23 years old, straight sex worker).
Some participants heard about lubricant, but very few of them reported using it in anal
intercourse.
My friends at Nguyen Gia Thieu Street told me about the cream named “White” that
is sold on Ba Trieu Street. That cream is made for lubricating, to make inserting
easier, and to reduce the painful feeling (Vu Long, 25 years old, bisexual).
I used to use the lubricant that is stored in a tube like toothpaste. Nowadays, I use the
lubricant pack distributed by the DKT’s marketing staffs. It’s like a bag. One bag can
be used for three times, but usually it’s torn after the first time, so we throw it right
away (Quyet, 19 years old, bóng kín).
Like Quyet cited above, Le also used lubricant and liked it, but they both said the packaging
was inconvenient.
That type of lubricant pack is both convenient and inconvenient. It is convenient
because we can keep it in our wallet. However, if we can not finish the whole pack at
one time, we throw the rest away because and waste it because that pack can be used
for two or three times. So people say that the most convenient way for both is to buy a
tube and then use it little by little (Le, 30 years old, bóng lộ).
Some people said they used shampoo or shower cream when having anal intercourse.
If we don’t have condoms, we use shower cream instead. Shower cream can also
make it easier to go in. I always use the Doublerich shower gel (Hoai, 22 years old,
gay).
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They have never seen lubricant for sexual purposes, but they thought it should be made
available in Vietnam.
I think this (lubricant) should also be popularized in Vietnam because this thing is
now not so common in Vietnam. As for me, I’ve never heard about this thing, and I’ve
certainly never used it before. So I think people should know about it (Hoai, 22 years
old, gay bóng kín).
2.4.6 Limited access to information and poor utilization of sexual health
services
2.4.6.1
Sources of information on sexuality and sexual health
Similar to MSM in Ho Chi Minh City (FHI, 2005), many MSM in Hanoi reported that they
looked for information about sexuality or homosexuality in particular and sexual health on
the Internet. In fact, most of them learned about these issues through gay Web sites.
Tuan, for example, learned that people could be different with regard to sexual orientation.
He learned from the Web site that there are people like him. He said it was a venue for him to
share his thoughts and feelings and to find mutual sympathy.
Only after chatting online did I know that there are so many types of gay people.
Some don’t like women at all, and some like both men and women. Getting online, I
can say whatever is on my mind, which I would never dare to say at home because no
one there can understand me (Dinh Tuan, 23 years old, bisexual).
Some people said that they learned about diseases or skills of sexual relations from these
Web sites.
I go online and know a lot about chatting on the Internet. People don’t try to hide
anything when they’re online. Actually, I learned everything from Internet, even about
the experience if having sex [with men] (Dinh Tuan, 23 years old, bisexual).
I go to a Web site about diseases or about sex instruction for couples, for example, or
Web sites that create excitement. I can open the whole page or print it out to bring
home to read. It’s something like a sex education teacher to me (Minh Khoi, 22 years
old, bóng kín).
Khoi believed that the Web sites provided the information he wanted to know.
I’ve looked through the Web sites a lot. I’ve explored and listened a lot. For example,
I go to the Internet café see those Web sites, but people may think that I am a bad
person to view that kind of Web site. But I actually check them out just because I
want to have more knowledge about it (Minh Khoi, 22 years old, bóng kín).
Other participants, however, did not feel comfortable with some Web sites because the sites
were rather obscene.
At first, I checked them out for a while (the Web sites for homosexuals). That guy told
me about those Web sites, but actually I didn’t know anything about it or how to seek
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it online. I checked some gay Web sites for a while, but I was so afraid of them. (Ask:
Why were you afraid?) Because of the way they use the words. (Ask: Vietnamese?)
Yes. In Vietnamese, to say it straightforward, they talk in a very crude way, like “is
yours big or small?” After that, I don’t check back at that Web site anymore (Quang,
24).
I’ve seen some foreign Web sites. They’re so horrible with the sexy porno and the
pictures of people having sex, who are both foreign and Vietnamese (Nguyen Hung,
29 years old, bóng kín).
Besides the Internet, many participants used pornographic material as a source of knowledge
and of learning skills regarding sex and intimate relations.
Some people used these materials as manual at quite a young age.
I started watching porno movie in the 9th grade (Ask: Who did you watch porno with
at that time?) At first, I watched alone and then with classmates. With my boyfriends,
we watched the heterosexual porno first, and then at home we watched men-with-men
porno. (Ask: Have you ever watched porno and then practiced the same thing
afterwards?) Yes, I have. After I watched it, I knew about it already. Then if I want to
have sex with someone in particular, I would call him up. I would do it to him first,
then asked him to insert into me (Quang Hieu, 20 years old, bóng lộ).
When I was 16, back in Phu Ly, I went out with one of my friends who is also gay and
is a year younger than me. We liked each other at that time. He asked his friend to buy
some porno tapes from Hanoi for us. We watched the film tapes and then did it to each
other exactly how they did it on the tapes (Hung, 25 years old, bóng lộ).
According to some participants, their first same-sex intercourse happened during or after
watching pornographic films. Older and/or more experienced partners used these films to
stimulate younger and/or new partners.
One time, I knew a gay man who played a gay porn movie for me to watch. I learned
from it and felt interested in it; I didn’t feel ashamed at all. Afterwards, we always
watched porno together (Hanh, 25 years old, bisexual).
I only learned about sex between men through porno movies; one of my friends
showed them to me. (Ask: Where do you get the porno?) I bought it (Ask: Where can
you buy it?) Many places. It’s very cheap also, 15.000 dongs per piece (Hoang Hieu,
22 years old, gay bóng kín and sex worker)
Some participants said they learned about the risk of HIV infection among gay men from
mass media.
In these recent years, the mass media mentions it a lot, so I’m very knowledgeable
(Hoang, 52 years old, gay bóng lộ).
Peer communication about sexual health issues was mentioned during interviews; however, it
seemed quite limited.
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We tell each other to be careful while going with clients because otherwise we can be
in trouble with SIDA or hepatitis. (Ask: Do you talk about how to prevent it?) Yes, we
tell each other that we can only kiss certain kinds of people ( Hoang Hieu, 22 years
old, gay bóng kín and sex worker).
In the recent FHI study in Ho Chi Minh City, many MSM reported receiving information
about sexuality and sexual health from IEC materials like brochures and leaflets (FHI, 2005).
However, this was not the case in Hanoi. MSM in our study did not mention such a channel
of information. Very few participants reported taking part in the DKT peer club.
I am a propagandist. I can talk with my peers about how diseases are transmitted and
what we should or should not do (Dat, 22 years old, bóng kín).
2.4.6.2
Utilization of counseling services
Counseling on sexuality and sexual health has been set up in Hanoi very recently and is
limited mainly to two hot lines. Many people do not know about the existence of this service.
Few participants in this study reported using the hotline. Hung, for example, said he called to
share his anxiety about his same sex desire.
Once I confided with them about my confusion (that I didn’t know if I was attracted
to boys or girls). I just told them that I should have fallen for a girl, but I in fact hadn’t
(Van Hung, 25 years old, bóng kín)
The answer from the counselors, however, was sometimes general or too broad and was
misleading.
There was a time when I was very stressed, so I dialed up the Center for Health
counseling. At first, I told them that I had feelings toward men. Then I asked if that
was a disease that I had and, if it was a disease, if there was any kind of medicine.
They told me that it wasn’t a disease. It was something…I couldn’t hear it clearly.
They said that if I want to restrain the feelings, I had to stay closer with women in
order to forget the feelings about men (Quang, 24 years old).
One of issues that MSM most frequently asked the counseling center about was legislation
dealing with same-sex marriage.
I asked them if it’s legally right for two men come together in Vietnam. They said the
gorvernment has not promulgated any law on it (Quang, 24 years old, bisexual).
2.4.6.3
Testing
Few participants, mainly those who worked in the sex business, reported having regular
testing for HIV and STI.
I’m a careful person. I go for testing every six months. The test is normally very fast
at #30 Chau Long Street. I go for HIV, hepatitis test … (Dao, 27 years old, married,
straight sex worker).
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Anh Tuan did not have testing regularly but was aware of the risks of infection. However, he
felt hesitant to visit health facilities in Hanoi because he did not want to be recognized by
other people. Whenever he had chance to go to Ho Chi Minh City, he did the test.
I’ve never been infected with this, but being involved in this business is very scary, so
I go for testing once in a while. (Ask: So when was the last testing time?) The last time
was on the 20th of November at Pasteur Hospital in Ho Chi Minh City (Anh Tuan, 23
years old, straight sex worker).
Tran often had unprotected sex with casual sex partners, but he went for a test only when he
was sick.
Last year, I had a non-stop fever for few days. So I went for testing in town, but there
was no problem at all. (Ask: Why did you decide get tested that time?) I was afraid of
getting an infection because, in fact, I went out playing too often (Tran, 23 years old,
bóng lộ).
Most participants, including those who often had unprotected sex with multiple sexual
partners, said they did not do testing because they believed that they were not at risk of
infection.
2.4.6.4
Health-seeking behavior—utilization of STI treatment services
Findings of this study showed the very common practice in Vietnam of buying medicine for
self-treatment when getting sick. Most people do so when they have a cold, the flu, or
diarrhea. Moreover, due to condemnation related to STIs because they are often associated
with promiscuity, those who get infected with these diseases have more reason to prefer selftreatment with antibiotics bought from the pharmacy.
They said that [if they got sick], they go to drug stores asking for medicine. They
don’t dare go in the store with female counters. If there’s a male counter, they will go
in to tell him the situation, and then he will sell them medicine. After five days of
taking pills, they get well. I don’t know the name of that pill, but after taking that pill,
your urine becomes green (Dinh Tuan, 23 years old, bisexual).
Being afraid of stigmatization because of having STI, many MSM were reluctant to see a
doctor. Instead, they looked for advice from the Internet.
If you don’t use condoms, you may have trouble with urinary infections. Ninety
percent of this disease is caused by not using condoms. People know that, so the men
don’t dare to go to doctor because they are ashamed. Later, I read on the Internet that
there are online doctors on the net also. So I asked questions online. They answered
that urinary infection is like gonorrhea and that people with this infection need to have
treatment as soon as possible or else otherwise it would cause complication. But it’s
not as dangerous as syphilis (Dinh Tuan, 23 yeas old, bisexual).
Similar to the findings of the FHI study in Ho Chi Minh City (FHI, 2005), MSM in Hanoi are
more likely to seek treatment in private clinics.
66
Some cases have to go to those general hospitals (the private ones). Few go to state
hospitals (Dinh Tuan, 23 years old, bisexual).
Only one participant reported infection of STI. He believed that he got genital warts because
he did not keep sufficient hygiene. First, he tried to treat himself and went to see a doctor
only when this did not help.
I was infected once. I was infected with genital warts. (Ask: How was it?) I went to
the hospital to have it burned. (Ask: Which hospital?) Bach Mai Hospital on Giai
Phong Street. It was because I didn’t keep hygienic enough; I didn’t go clean myself
right after having sex. At first, I didn’t know what those spots were. I cut them out
myself. It didn’t hurt, but it came back after a few days, so I had to go to the doctor
(Quang, 24 years old, bisexual).
In her interview, a doctor in an STI clinic in Hanoi said she observed an increase of patients
with anal warts who saw her during the last two years.
The number of anal wart cases has recently been increasing. Fewer people were
infected with this disease previously. I wonder if this because of the rising number of
homosexuals now (Female doctor, STI clinic).
The doctor said when providing treatment for these patients, she found that they knew how to
avoid the infection, but they did get it.
With the genital wart patients, for example, we also have to give advice about STI,
which is that if they practice safe sex, they would never get an infection. The patients
always said that they already knew it, but they just laugh it off. They knew it but they
still get an infection (STI clinic female doctor).
2.5 MSM community in Hanoi: Issues of Migration and Sex Work
This section continues the discussion of sexual behavior and sexual health issues of MSM in
the connection with migration and the male-male sex business. Our data confirmed a strong
connection between homosexuality and migration and also a close link between migration
and the ebullient male-male sex business in Hanoi during recent years. For many men,
migration was their strategy to live openly with their true sexual identity. Others, because of
being migrated, engaged in male-male sex as a strategy for survival. This section discusses
why and how such men become incorporated into the MSM community in Hanoi for either or
both purposes and what implications this process may have for their sexual health. Another
part of this section provides an insight into the male-male sex market in Hanoi where
migrants tend to play more and more important roles.
2.5.1 Homosexuality and migration
The connection between homosexuality and migration has been recorded in several studies on
gender and migration in Asia (ILGA, 2002; Janssen, 2003). Among the rapid flow of
migrants, there are many people with same-sex sexual preferences and transgender people.
Motivation or causes of migration of many people may be closely related to the fact that they
do not fit gender norms in their home communities and want to escape discrimination and the
67
pressure to conform. Our findings in Hanoi showed that, for many gay men, migration was a
strategy to avoid stigmatization in their hometown or village and to live with their true sexual
identity or at least to have an opportunity to have sexual partners.
For many migrants, except for the straight men, being far away from their home and
community was the only opportunity for them to come out or, in other words, to live with
their true identity.
There are few [MSM] in Hai Phong, so I didn’t dare to reveal myself there. I can only
be myself here in Hanoi (Pham Duy, 22 years old, bóng kín).
In the countryside, few people know what homosexuality is. However, being sexually out of
norms would be strongly stigmatized. Hoai said that in his home village, he did not dare
express his feelings. It was difficult to find a partner because, being afraid of stigmatization,
those who have same-sex sexual orientation had to keep it extremely confidential. Thus,
moving to city was an opportunity for him to have sexual partners.
You know, it’s hard to show your affection with someone in my hometown. I could
only keep it in my mind; this thing is very secret in the countryside. It’s different here.
That’s one reason why I came here to work (Hoai, 22 years old, bóng lộ).
Being discovered as a gay man by his close friend, Hung left his home village to go to Hanoi.
He missed his family but did not dare come home.
I’m also in trouble now because my best friend has found out about me. I don’t dare
go back to my village. I’m so ashamed; there’s no one like me in that village (Hung,
25 years old, bóng lộ).
Not only domestic migration but also international migration was recorded. If the gay men
from other cities or provinces migrated to Hanoi to look for a partner, then some Hanoian
gays thought of migrating to other countries for same-sex marriage. Ngoc, a Hanoian, for
example, believed that Germany allows same sex marriage. He paid lot of money to enter to
the Czech Republic and from there illegally entered Germany. However, his dream never
became reality.
In 2002, I decided to go to Germany to get married, but I couldn’t. I went through the
Czech forest, but when I reached Germany, they forced me to go back. Many people
felt pity for me because if I said that I am gay, they would let me in right away. I was
almost in Germany. They took my picture and my fingerprints, but they still expelled
me out. I already aimed at one old German to get married to, but it was a dead loss.
I’ve spent more than 300 million but received nothing (Ngoc, 31 years old, bóng lộ).
Ngoc is not alone; many other gay men also wanted to leave Vietnam for a country where
same-sex marriage is allowed.
They want to leave Vietnam for other countries; they don’t want to live here anymore
because they can only get married by going to another country (Dao, 27 years old,
bóng kín).
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2.5.2 Male-male sex business in Hanoi and migration
Sex work was found to be an important part of sexual activity of many MSM in Hanoi. At
least eight participants in this study reported selling sex service to men as their exclusive
income-generating activity. Other men engaged in sex work when they were in need of
money but did not rely on sex work as the only source of income. Motivations of engaging in
sex work were different. For straight men, money was probably the only purpose of being a
sex worker. For many gay men and bisexual men, pleasure could be a primary or important
reason pulling them to sex services. Another important feature of the male-male sex business
in Hanoi is its close connection with male migrants from other cities and provinces. The
findings of this study indicated that migrants have contributed to the ebullition of the malemale sex business in Hanoi.
2.5.2.1
Who provides male-male sex services in Hanoi?
A significant part of male-male sex workers were migrants, including short-term manual
laborers and long-term migrants like students or workers. Difficulty in finding a job and/or
financial limitations pushed these migrants in to sex work. Migrants, therefore, could be an
inexhaustible supply for the male-male sex market given the rapid socio-economic
development process of Vietnam during recent years. Many migrants chose sex work as their
main way of earning a living.
Many guys from other provinces come to Hanoi looking for jobs. They then become
unemployed. There are no subsidies for migrants like them, and now even the people
who graduated from universities can hardly find jobs, so how can they easily find
one? Then, they decide to become involved in the sex business, but with the one
condition that they would only have to serve in one direction. That means they only
have to lie down on bed; then the clients can do whatever they want on them and pay
them money (Lan, 42 years old, bisexual).
Anh Tuan is a typical
example of how a migrant
becomes involved in sex
work. When he was first
approached by a client, he
accepted the offer because
he thought he was asked to
provide a hand job. In fact,
he was asked to provide
more than that. Gradually,
he considered sex work as a
way of earning a living and
became a professional sex
worker.
At that time, I had just come from the countryside. I didn’t
know about that way of going out. But, that first time, I did
it voluntarily; no one coaxed me to do so. I already
understood a little bit about it but didn’t think it was like
that. I thought going out only meant that he might touch my
hands or my feet; I didn’t think he would take off my clothes
and do that to me like that. At that time, I didn’t know what
to do, so he did it to me first then asked me to do the same
thing back later. After that, I don’t know what else I could do
if I didn’t move on this way because I’d be here alone
without any job. Even when there are so many thing I dislike
about this business, I still have to keep on being this way for
the money (Anh Tuan, 23 years old, straight).
Students who come from the countryside to Hanoi for study became a source of supply of
male-male sex workers. Many students agree to be paid for sex (trai bao) in order to make
ends meet or to be able to pay tuition fees.
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I’m looking for the young guys like the students from the provinces. They always
have financial problems… Moreover, they have to study also, so selling sex is not a
regular business for them. It’s just that their lives pull them into this way. These kinds
of guys can be easily approached at the parks (Hoang, 52 years old, gay bóng lộ).
I ask them out for foods or drinks. Then, if I want to have sex, I have to pay 300.000
dongs (Ask: What kind of people are they?) Some are gay also, but the students are
not. They just do it because of their need for money. They are students from the faraway provinces like Medicine University, Technology University, Thang Long
University, or Industrial College (Dat, 22 years old, bóng kín).
According to the participants, the majority of the students and migrants who agree to sell sex
to male clients are straight men.
Normally, they are students. Some from other provinces come here to work, but their
salary is too low, so they have to make extra money. They do it just for the money;
they don’t like men (Tran, 23 years old, bóng lộ).
That guy is a straight man. I heard he came from Thanh Hoa. Now he needs money to
cover his job-training fee. I don’t know how my friend got to know that guy, but now
my friend gives him money to cover his every cost, and he has to come over to sleep
with my friend every night in return (Hung, 25 years old, bóng lộ).
According to our participants, sex work could be a good alternative for migrants, unemployed
people, street boys, and drug users.
Some are unemployed, some have just come here from the countryside, some are
experiencing misfortune, some are street boys, and even some are drug users (Dinh
Tuan, 23 years old, bisexual).
Besides migrants, local gay men also engage in sex work. Some of them often sell sex to
foreigners or rich local clients for a high price.
I used to go out with some foreigners. The highest rate that a foreign client paid me is
about 2.000.000 VND (Vu Long, 25 years old, bisexual).
It seemed that bóng kín were more likely to sell sex than bóng lộ and that the latter were more
likely to be clients who buy the service.
Some local drug users agreed to provide sex service at a low price because they need money
for drugs. Ngoc said, with bitterness, that it was very often that gay men, especially bóng lộ,
had no other choice but to buy sex from drug users.
People like me can only go with those drug users because only the drug users are
always in need of money. In my whole life, I’ve dreamed of a handsome talented man,
but it’s hopeless for people like me. Only the drug users will have sex with me; they
even agree to do it for just 20.000 or 30.000 dongs. They always need money (Ngoc,
31 years old, bóng lộ).
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I’m addicted to drugs, so I need money. It’s a vicious circle. If I were not addicted, I
would not need money. But I’m addicted, so I need money. And because I need
money, I agree to do that (Quynh, 21 years old, straight).
Street boys and urchins were easily involved in male-male sex work due to their needs of
having shelter and food.
Many times I left home to wander around with no money and nowhere to sleep, so I
accepted it. It’s like he “offer” me. He said “if you have no food and no place to live,
just come over here. I will give you money also” (Quynh, 21 years old, straight).
Policemen and military men were considered by gay men as “genuine” men. Some well-off
gay men often looked for sexual partners in Police College or military camp. Being far away
from home and staying for a long time in a men-concentrated place could be factors that push
some policemen and soldiers to engage in sex work from time to time. Le talked about his
experience in Saigon.
There are so many gays in Saigon, but there is only one place where me and one of
my friends love to go to. The straight men are actually there. It’s the police college, or
the military camp. I know their thoughts. On one hand, they have their need for sexual
release. And on the other hand, they have financial difficulties, too. So, we give them
some money sometimes. We just have to know one guy there and ask him out for
drinks, alcohol for instance. He will bring his friends along, and then later in that
evening, if anyone of them agrees to go with me, we can have a one-night stand (Le,
30 years old, bóng lộ).
Moving between cities for sex work was also recorded in this study. Some professional sex
workers reported frequent trips between Hanoi and Hai Phong for sex business.
I still go to Hai Phong, but just for two or three days and then come back here. There
are some clients in Hai Phong. They take care of me to get from A to Z; I only have to
go to the place. (Ask: I heard L talk about someone moved from Saigon to Hanoi after
working there for a pretty long time.) Yes, there are some people like that. But just the
people in Saigon come here to work; few people come to Saigon from here because
Saigon is very complicated. In fact it’s easier to make a living here than in Saigon
(Trong Hieu, 26 years old, straight).
2.5.2.2
Who buys male sex service?
At first look, one may say that the answer is rather simple. Of course, men who have samesex orientation buy male sex service. But this part of the report attempts to go beyond a
simple description of the profile of those clients to show that the sex business in Hanoi has a
large market and to raise the question of how HIV/AIDS interventions reach this vast
population.
According to some newspaper articles, only a very small group of men who have unhealthy
lifestyles (“ăn chơi”, “đua đòi” or “bệnh hoạn”) use male sex service. In fact, the findings of
this study showed that sex business in Hanoi has a large potential market with male clients of
different social groups. Many were young homosexuals, while others were well-established
men who carefully hide their true sexual orientation from people around them.
71
According to our participants, clients are from different social groups, ranging from
businessmen, intellectuals, artists, or government employees.
Some are worship goers, some are businessmen, some are professors, some are
managers, some are engineers, some work for this company, and some work for
others. Generally, they are everyone; there is no exception. Many of them are already
married (Hoang Hieu, 22 years old, gay bóng kín).
They are doctors and journalists. I even knew a man who works for the government
and an enterprise owner (Pham Khoi, 21 years old, bóng kín).
The community of
MSM in Hanoi is
diverse and seems to
be quite large, but a
major part of it is
invisible. This will be
a big challenge for
intervention activity.
They are gay, but they work for the state organizations, so they
have to keep it a very close secret; they don’t let it be revealed.
As for us, we live independently. The simple truth is revealed
widely, and we don’t care about whatever people might think of
us. But they are in that kind of environment so they have to keep
the secret. Sometimes, the pimp asks for their phone number and
then offers them sex services. For example, if they go with a guy,
they will have to pay 100,000 dongs to the pimp (Hoang, 52
years old, gay bóng lộ).
The diversity of social profiles of clients of male-male sex service implies that it will be very
challenging for intervention efforts to reach these people.
[They are] very normal men. There’s nothing womanly in their behavior; they look
like every man on the street. I even have clients who are policemen and journalists
(Anh Tuan, 23 years old, straight sex worker).
This bóng kín was very proud when talking about his clients who, according to him, have
high social status or are from rich families.
Generally, I don’t go with commonplace clients. My clients are usually hotel owners
or those in high social status. Some of them are businessmen, and some are dudes
from rich families. Some of them are from high society or from the dignitary families.
They can be artists or playboys (Dao, 27 years old, bóng kín).
Married and middle-aged men often look for male sex workers in the public toilet at H. lake.
Most of them are married men; many are middle aged already. Now if you go to the
lakeside toilet, you can see many of them. If you go inside the toilet, they will follow
to look at your dick. For example, if you stand here pissing, they will stand next to
you. They would never piss, but just stare at your thing. Knowing they are clients, I
would have to pretend to show off for them to make them see me big and tall so they
would guess that my thing would be big also. Then I will have a client (Hoang Hieu,
22 years old, bóng kín and sex worker).
Wealthy and high social status men could pay big money for male-male sex service.
72
That day, when I was wandering around Hale lakeside, a car stopped right in front of
me, then one man asked me if I brought my ID card along. I didn’t know who this
man was. Then he asked me to go with him to Ngoc Thanh Guesthouse in Gia Lam. I
agreed. He asked me to play doggie style and then played me until the morning came.
Then he asked me some trivia about family or something. I just told him that I came
here looking for a job. He gave me 3 million, and we never met again (Hoang Hieu,
22 years old, gay bóng kín).
Foreigners were an important source of clients for male-male sex business in Hanoi and
recently became a part of the male-male sex market in this city.
Hoang, a 52-year-old bóng lộ, recalled his past days when his first selling sex to a Russian
man. This was during the late 1970s and early 1980s when renovation policy and market
economy have not yet been launched in Vietnam.
That Russian man liked me so he asked me out. But in those days, going out
with a foreigner was very dangerous. I was selling sedge stuffs that time. He
came over to my shop to buy stuffs. He asked to barter, saying that he would
bring clothes to exchange for sedge stuffs. He stared at me, then held my hands
and scratched my palms. So I knew he had intentions with me. He asked me out
the next day. He drove a Moscovich car to pick me up. I was so afraid of the
police. He took me to the suburban. I didn’t like it and just insisted that he go
back to Hoan Kiem lakeside (Hoang, 52 years old, gay bóng lộ).
It seemed that foreigners increasingly contributed to the male-male sex market in Hanoi, or at
least these clients have been more diversified in terms of nationality during the last few years.
Anh Tuan (box #), currently a professional sex worker, said during recent years that he
mainly has sex with foreign clients who come from different countries.
For about the past two or three years, I have had sex with many foreigners. Generally,
most of them are Australian and American. Normally, they can be any nationality,
even black or white or Asian or European. But most of my clients are German and
American (Anh Tuan, 23 years old, straight).
I’ve already had sex with Italian, English, Hongkongese, and Chinese men (Vu Long,
25 years old, bisexual).
Foreigners who stay in Vietnam for a long time occupied a larger part of foreign clients. Dao,
a bóng kín and professional sex worker, said among his regular partners, some were
foreigners who lived in Hanoi for several years.
Foreign clients normally also work in Vietnam or come here to study or to do
business. Some came here to open their own business enterprises. There are also some
foreign tourists, but usually they come here to live and to work (Dao, 27 years old,
bóng kín).
73
Foreign clients used to be straightforward in negotiation and usually paid a higher price
compared to local men.
Previously, there were many foreigners at A. bar that wanted to play. They said
straightforwardly “how much do you want to go out with me?” So I replied “you can
decide how much to pay,” So I have been with some foreigners already. The best
money I once received was from a foreigner; it was about 2.000.000 VND (Vu Long,
25 years old, bisexual).
As discussed in a previous section, participants of this study not only provided sex service but
were also clients of this business. Below is part of Hieu’s story about his first experience of
paying for sex service when he was 18 years old.
I was attracted to so many boys, but I didn’t dare to tell anyone because I was still
going to school. Just when I collected enough money, I went looking for it... My first
sex experience was at the age of 18. I had to get enough courage to decide to go for it.
That time, I went to the lakeside and sat there. Then a man came to cajole me to go
with me. He knew that I need it, I didn’t know how but he could recognize me very
sharply. I asked him where to go, and he said “head to Gia Lam,” and we went there.
Then he did everything to me. I felt so pleasurable for the very first time. It was the
first time I paid 200.000 dongs with no regret at all (Hoang Hieu, 22 years old, gay
bóng kín).
According to some participants, clients buying male-male sex services are not always
homosexual men. They could be middle-aged men who had a high social status but were
unhappy in intimate life because of different reasons. By buying male-male sex, they could
avoid stigmatization from people around them and might not risk breaking up their family.
This finding is interesting but, of course, needs further investigation.
In Vietnam, few
people suspect that a
married man would
commit adultery with
another man.
Therefore, it could be
possible that malemale sexual relations
became an alternative
for some married men,
especially those who
need to protect their
reputation for their
social or economical
career.
Some high-class clients told me that they are not gay. Just
yesterday, I went out with the owner of one of the biggest hotels
in Hanoi. He is still young, maybe just about 40 years old. He
said “I’m not gay, but in my status, I can not bring a prostitute
girl home or go to the brothels. And, at this age, my wife can not
bring me any pleasure. So I changed myself to have sex with
men.” They are not gay, but still they like me. Men can
understand men better. To say it straightforwardly, going out
with men makes them feel safer than going out with women.
Their wives can not please them when they want to be pleased.
But in their status, they can not go out playing with girls, or
bring girls home, or go to brothels. So they look for sex from
men (Dao, 27 years old, bóng kín).
Besides reputation, the men in high social status had other reasons to look for male sex
service. According to Dao, these men enjoyed sex with men because the sex workers could
provide the things that women could never agree to do.
74
Many times, I go with clients who are not gay at all. They are 100 percent men, but
they like to have sex with boys because the boys have the same bodies as them, so
they know exactly where the sensitive parts of those bodies are. Even when those men
know about their sensitive spots, they can not force their wives to do everything with
those parts. For example, they can never ask their wives to perform anal sex, or lick
from their heels to their neck. Their wives could never do that, or they would never
know about those spots of their husband’s bodies. (Ask: But those men also go for
beautiful young girls.) Yes they do, but they said “women just know how to enjoy.”
They can call some beautiful girls over, but those girls just strip down and lie there
waiting. They don’t know how to do those things above. Normally they can do it but
not as well as men do because only men know where the sensitive spots are (Dao, 27
years old, bóng kín).
2.5.2.3
How does one become involved in sex work?
This section describes the ways that one enters the world of sex work. The findings showed
that there were different paths leading young men to this business. With migrants, especially
those who were straight men, the process was often begun with help and tutoring from pimps.
Many gay men discovered the sex work and became involved by themselves, either
accidentally or intentionally.
For rural-to-urban migrants, a very typical path to sex work was through pimps who often
offered help in their first days to the city or when they were in a difficult situation.
Those guys come from the countryside to look for jobs and have no relatives in
Hanoi, so they have to sleep on the bench at the lakeside. If D or L, the two pimps,
find them tall, big, strong, and handsome, they would offer them food, clothes, and a
place to live and even give them money. Those guys can’t help but accept it (Hoang,
52 years old, gay bóng lộ).
Some people were simply seduced by clients. At first they did not considered having sex with
men as a job, but eventually they depended more and more on it as the main way of earning a
living.
When I went out late at night, a man came over to make friends with me. At first, I
didn’t know he was like that. He said that he could give me a ride to my home. I
didn’t have money, so I took that offer. Later, I didn’t think much about him. But
when I was out of money, I recalled him, and I looked for him. That was my way into
this business (Trong Hieu, 26 years old, straight).
The “newcomers" should go through a short “training” about sex services before actually
entering the business.
I have a friend in HB Street; he is a pimp. He always looks for the young guys in
difficult situations or in need of money, entices them to his place, teaches them how to
make love, and then lets them go with clients (Ngoc, 31 years old, bóng lộ).
It does not take long for the men to acquire sufficient skills to be a professional sex worker.
75
From the first time I had sex with men, I had to spend about two months to be skillful
at sex with men (Trong Hieu, 26 years old, straight).
Gay men could be involved in the business accidentally. Some were surprised when they
were paid for sex. However, this did not shock them enough to make them stop this activity.
At first, I didn’t know about it. I just accepted a homosexual man’s invitation. Then he
played anal sex on me, with a condom on, and he paid me money. At first, I was
surprised. I thought “why should he give money when he asked me out?” (Pham Duy,
22 years old, bóng kín).
Many men, both gay
and straight men,
engaged in sex work
through the network of
their friends and
acquaintances. Dao’s
experience was very
typical for well-off
MSM.
2.5.2.4
I often go to discotheques. Some gay friends taught me that.
They said “Do you like to go with the potatoes?” Potato
means the foreigner, and sweet potato means the Vietnamese.
I wanted to find out and try some new feelings with the
foreigners, so I went. After going out with those foreigners,
we headed to the guesthouse. At first I didn’t know how to
offer prices to them, but after my friend showed me how, I
knew how to deal with it. I think, “why should I not do that?”
So I keep on with this business. Now I go with the sweet
potatoes, the Vietnamese, also (Dao, 27 years old, married,
bóng kín).
Reasons to engage in sex work: Money or Pleasure?
As discussed in a previous section, male-male sex workers in Hanoi consist of both men who
have same-sex orientation and straight men. Some found sex work both financially profitable
and enjoyable. Others accepted doing this work only because of is financial aspect.
For a number of young men, having pleasure was their first motivation to engage in sex work.
Money was the second reason.
First of all, I need sexual satisfaction. I feel this work is so suitable because if I don’t
get satisfaction at least twice a week, I can not bear it. That’s why I chose this
business. Some people who are not gay have to be involved in this business because
of their condition, but it’s different with me. I do it for my pleasure, then for the
money (Dao, 27 years old, married, bóng kín).
One time I felt the urge inside my body, so I went looking for what I felt excited for.
Certainly, I found exactly the people who just wanted to exchange, so I both satisfied
my sexual urge and earned some money. So it’s normal (Vu Long, 25 years old,
bisexual).
For many male sex workers, especially for those who are straight men, money is the most or
only purpose for doing sex work.
I feel a little bit disgusting, but after a while I think it’s okay. How can I find another
easier way to earn this much money? (Hung, 24 years old, straight).
76
Sometimes, needs for a shelter and food were stronger than feelings and self-esteem. The
migrants who were unable to find a job might consider sex work an alternative.
After the first time and after being here in Hanoi alone with no job, no place to sleep,
and no money, I decided to follow this way, even when there are so many things I
dislike about this business. I have to keep on being this way for the money… Within
those two years, I had to be with that man only. If I wanted to go with others, I had to
keep it a secret. Generally, going about with them was just for exchanging. I am a
man, they got the money. I slept with them, they gave me money. But frankly saying,
enduring that period of time, I had to tell a lot of lies and keep a lot of secrets so that I
could save some money just in case he got bored and kicked me out (Anh Tuan, 23
years old, straight).
Craving for drugs, as discussed in the previous section, was strong motivation for drug users
to sell sex.
If today I can find enough money for drugs for the whole day, I will not meet him. But
if after the whole day, I can not manage to find any money anywhere, I will go meet
him (Quynh, 21 years old, straight).
It is worthwhile to note that the cross-over between MSM community and drug users should
be kept in mind when designing and implementing interventions for both groups.
2.5.2.5
Earnings from sex service
According to our participants, earnings from male-male sex service are not bad at all
compared to other jobs. The amount of money paid for male sex service varied depending on
the class of the sex worker, client, and sometimes the venue of transaction.
Fees for a “fast go” range from 50.000 VND to 100.000 VND, not including transportation
and venue. If the client is satisfied with the services, the amount could be higher.
It depends on which person. Some pay 500,000, some pay one million, but some only
pay 100,000 or 150,000 (Trong Hieu, 26 years old, straight).
For example, near H lakeside, at NQ Street, there are many cheap guesthouses that
can be rented by the hour. If we take a room for just half an hour or one hour, we just
have to pay 50,000. (Ask: How much is the most you have ever paid?) It was 300,000
once when I was excited (Hoang, 52 years old, gay bóng lộ)
Normally, besides the fee for service, clients also cover hotel room and transportation. An
overnight encounter could cost a few hundred thousand. Some generous clients could provide
a meal or drink.
If just go for sex then go back, I have to pay 100 thousand and another 50 thousand
for the room. It depends on me if I want to go longer, which could be two or three
hundred for going overnight (Tran, 23 years old, bóng lộ).
77
A “fast go” could cost at least 70,000. It includes 20,000 for transportation. And,
about the highest rates, I also have friends who paid one or two hundred USD for one
go. But some other friends just pay 70,000 and not even one thousand more for a go
(Lan, 42 years old, bisexual).
The fee of VND 100,000 to VND 150,000 was an average amount of money paid for the
providers who knew their work.
Generally, each time like that I have to pay from 100 to 150 thousand. I don’t need to
say anymore; he knows exactly what should he do. I don’t need to give any
suggestions or instructions (Giao, 38 years old, bisexual).
The sex workers who were good looking and especially those who could speak English often
earn quite a lot of money for a sex encounter with foreigners or local well-off men.
The sweet potatoes here in Hanoi normally pay 300,000 on average. The most openhanded one can pay about one million. They can be men of high status or the bosses...
Some Westerners are very generous. Some Westerners gave me about 200 USD. But
there are some Westerners who have been here for a very long time and who are very
experienced and can even speak Vietnamese fluently. They may pay just about 20 or
30 USD, but normally they would pay 50 USD (Dao, 27 years old, bóng kín).
Sometimes it was a very large amount of money.
Once, I spent only two and a half days with that Italian man. It was his last day before
returning to Italy. He paid me 16 or 17 million for that (Vu Long, 25 years old,
bisexual).
Some young men were offered to be trai bao (a kept boy) with good pocket money and good
living conditions.
Currently, I have an offer from a man. He would pay me two million. I would have to
do nothing but wait for his call and serve him only two or three times a week. Just
making him explode would be okay, and he would take care of me from A to Z (Trong
Hieu, 26 years old, straight).
Compared to the earnings of female sex workers, the male’s earnings seemed to be better.
This may make the business more attractive to male migrants and thus increase the dynamics
of the male-male sex market in Hanoi. Intervention efforts for the improvement of sexual
health services for this group should therefore take this factor into account.
2.5.2.6
How and where are sex transactions made?
Nowadays, sex transactions are often made by telephone. The wide availability of mobile
phones makes the arrangement and negotiation more convenient.
If we want to meet up, we just make a phone call and then head to the guesthouses in
Gia Lam (Hung, 25 years old, bóng lộ).
78
A network of friends and a mobile phone were the most important conditions for making
good transactions.
Generally, in a week, I only go if I got phone calls from clients. I only go if he is a
regular client. I don’t go with strange clients. I would never answer a call from a
strange number. I only go with proper clients who really want to play. I don’t go out
with those drug users. I have to ask carefully before going out with someone, like how
is he, is he polite, and is he hard to please. I have to ask first because my friends
introduce clients to me. If my friends have clients, they will call me. And I will call
them if I have clients also (Dao, 27 years old, bóng kín).
I call up my friends or someone like me to ask if they have any hang to introduce to
me (Ask: Do you have to pay for asking?) Some don’t take money, but some do. Each
time like that I have to pay them 50,000 (Quang Hieu, 20 years old, bóng lộ).
Many transactions took place in bars, cafes, or karaoke shops, which were conventional
venues for such activities.
We always go to a café; there are many cafes here in Hanoi. Then we start talking.
After all the agreements are made, we head to the guesthouse (Dao, 27 years old, gay
bóng kín, married).
Generally, in the karaoke shops there are always some pimps to make arrangements
through phone calls, and some sex workers introduce clients to each other also. For
example, I met this man today. He asked me to notify him if I knew any tall, big,
handsome guys, and then he would give me reward money (Anh Tuan, 23 years old,
straight sex worker).
Discotheques or dancing clubs were good places for stylish and well-off young men to look
for clients. Those who speak English can make contact with foreigners.
Previously, I usually went to discotheques. Then my friends asked me if I wanted to
go with the potatoes, after dancing at around three or four in the morning. We walked
up to the potatoes to start conversation. After talking for a while, a Westerner started
touching me, and then he asked me if I wanted to come over to sleep with him. I said
yes, then we set the price and I went with him (Dao, 27 years old, bóng kín).
The MSM community in Hanoi often gathers for networking and sex transactions in public
venues such as parks and around lake areas.
Generally, they always go to find sex at the parks. For instance, at HK lakeside, those
bars like A., or C&C bar in HH alley. I know they gather at TL Park and LN Park
also. Another place is TQ lakeside; many people tell me to go there. For me, I already
come to three places (HK lakeside, discotheque, and A. bar) (Anh Tuan, 23 years old,
straight).
Every evening, at HL and HK lakesides, many clients go there looking for hang, and
many sex workers also go there looking for clients (Trong Hieu, 26 years old,
straight).
79
Sex workers usually did not stick to one place but moved around different sites within the
city after few months.
It’s very easy to find sex at G lakeside. Many are there, but they don’t stay there for a
long time. They will move away after one or two months. Others will come take the
place, but they will not work there for long (Tran, 23 years old, bóng lộ).
Pimps played an important role in arranging male-male sex transactions. According to some
participants, there are four prominent pimps in Hanoi.
There are only four pimps here in Hanoi (Tran, 23 years old, bóng lộ).
Lan takes care of the gays, and I take care of the boys. When gay clients need a boy to
go out with, he will contact Lan. Then Lan will ask me to find a rich boy to go with.
(Ask: What does that mean?) That means both of us are the pimps; one takes care of
the boys side, and the other takes care of the gay side (Ph¹m TuÊn, 27 years old,
bisexual, pimp).
A pimp usually manages a number of sex workers who more or less depend on him for
getting access to clients. When he has an order, the pimp looked within his network to find a
sex worker who met the client’s requirements and sent him to the place arranged by the client
or by the pimp.
Through the telephone number, I will come to find. Or I go to the discotheques like
New or Apo, to the cafe in Bao Khanh lane, to Hale lakeside, or to the places where
they live. For example, if a gay man wants a guy to go out with, Lan calls and orders
me to find a handsome guy, big and tall. I will find one and bring him there (Ph¹m
TuÊn, 27 years old, bisexual, pimp).
With some careful clients, the pimp had to accompany the sex worker to the place of
appointment.
I called D that day. He asked me to come over, we made an appointment, and then he
brought me to that man at PDP Street. They paid me 150.000 (Thien, 24 years old,
bóng kín).
When they first engaged in the sex business, many men worked through a pimp who took
part of money as a fee for introduction.
At first, I had to work through Cuong. (Ask: Is Cuong a pimp?) Yes, he is a pimp. I
gave him back 20,000 from each 100,000 I received (Hoang Hieu, 22 years old, gay
bóng kín and sex worker).
They bring me to the clients, so I have to pay for the transportation fee. D doesn’t take
the money, but there was a time when Lan took 100.000, 20.000, or 10.000 and then
took me to the place (Hung, 24 years old, straight).
There were different ways to start a transaction. Experienced gay men know how to deal with
different people by different approaches.
80
I go out once or twice a week. I go to the flower garden first, or to the lakesides, or to
the parks. Otherwise, I have to go back to the massage services. If I meet students at
the park, I would ask “where do you come from?” That’s my way of wooing boys. I
have to know their attitude first. If they look back at me, or talk through some
conversation, I see “ah, this guy should be sympathetic toward gays.” Or, with some
guys who don’t know anything like those who just come here from the countryside
and have no experience at all, I have to seduce them more by asking more questions,
like “where do you live” to keep the conversation going on (Hoang, 52 years old, gay
bóng lộ).
One street in Hanoi had many massage shops with names such as “Traditional Massage.” All
the masseurs were young men from the countryside. According to our participants, sex
transactions or even sex services took place in many of these shops. Hoang described details
about this venue and the way it operated.
At the massage service places, there are many young guys from the poor countryside
who work as masseurs. Generally, they just give services to the men. Normally, they
get 10,000 from the fee, and the owner gets 10,000. For massages for normal men,
they have to warranty the quality. That means that they have to massage the clients for
a whole hour. But with the gay clients, the clients’ hands would travel all over the
masseurs when being massage. If the masseur keeps silent, it means he agrees. Then
the client can freely do whatever he wants with that masseur because there are only
two people in that room. After then the client has to pay for the massage service and
some extra tips for the masseur, for example, 50.000. One massage service shop
always hires about ten young men from the countryside to work as masseurs. Then
they divide the house into many small lots with dim lights on (Hoang, 52 years old,
gay bóng lộ).
2.5.2.7
Is sex work safe?
The immediate answer is no; the male-male sex work is not safe. This study found not only
unprotected sex but also drug use among male-male sex workers in Hanoi.
Issues of unsafe sex practice were already discussed in section 2.4.5 with the evidence that
many sex workers did not use condoms or used them inconsistently. Sex workers have very
little power in negotiation for safe sex practice because they were “bought” by their clients.
This section focuses on other risky practices of the male-male sex workers in Hanoi. It was
found that in order to attract clients, many sex workers used drugs to restrain ejaculation.
To overcome premature ejaculation, most of them took drugs. I mean heroin; using
heroin makes them last longer. If they have money, they take drugs before they go
with the client. They both inhale and inject drugs (Trong Hieu, 26 years old, straight).
On the other side, those men who engaged in sex work to earn money for their drug addiction
could provide sex services at any price. They also tend to have many clients.
I’m not addicted, so I don’t have the urgent need for money. It doesn’t matter if I can
earn one hundred, two hundred, or nothing at all for a day. Those drug users have to
81
earn money and have to make the clients explode as fast as they can. As for me, even
without drugs, I still can earn money (Trong Hieu, 26 years old, straight).
2.6 Needs of MSM
2.6.1 Information on sexual health
All participants expressed their willingness to have more information about sexual health
issues.
I want to be more knowledgeable. The more discussions like this that I have, the
wider my point of view is. On one hand, I know more about myself to avoid bad
things. On the other hand, I can tell this to the young people (Hoang, 52 years old, gay
bóng lộ).
They realized that good knowledge about STIs could help them to avoid these diseases. They
are aware of the risks brought by their practice and believe that being knowledgeable allows
them to be more confident.
Generally, I need to know more about the diseases to prevent them. Even this way of
having sex is my favorite, but everyone afraid of the diseases. So I do want to have
more information on it so I can prevent it confidently (Nguyen Hung, 29 years old,
bóng kín).
Some people wanted to have more information about HIV/STI and prevention methods to be
disseminated in mass media so more people could learn about these issues.
I think it should also be disseminated in the mass media to let more people know more
easily. Some people just don’t know anything and don’t know where to ask (Quang,
24 years old, bisexual).
Other participants, however, suggested a specific program for MSM community. The
information disseminated in mass media so far was too broad. They would like to have the
programs where they could be directly involved and learn more knowledge and skills.
I want a program that is made specifically for people like us. Talking more about this
will give us more knowledge to have better prevention. The information from
newspapers and TV is still so vague, so even though I’ve watched a lot of programs
about HIV prevention, I still don’t have the ability to practice methods directly. I want
to know more details (Nguyen Hung, 29 years old, bóng kín).
Many participants also expressed their wish for good counseling centers where they could go
for information on sexual health issues, getting tested, or for advice about different issues of
homosexuality.
I want to go for their advice, to listen about diseases, about the risk of getting
infected, and about the life. I really want to go to somewhere like that, but I am too
shy to go. I will go if there is an organization or a program where I can go for testing
or doing something related to SIDA prevention. If they give instructions or talk about
this issue, then I can understand more about it (Nguyen Hung, 29 years old, bóng kín).
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Some participants stressed the need for more counseling programs about condoms and
condom use.
I also want this program to counsel about using condoms to make people aware of
how to prevent an infection when having sex. (Long, 26 years old, bisexual).
I also want to have extra instruction, for example, to listen to some program about
having sex and using condoms, so I can understand more about it. (Nguyen Hung, 29
years old, bóng kín).
2.6.2 Gay-friendly sexual health services
Participants suggested that gay-friendly sexual health services should be made available to
encourage MSM to look for treatment.
We need a [sexual health center] just for gay people, a center that can supply
healthcare service, examine people separately, so people can go there for better
examination and treatment (Quang, 24 years old, bisexual).
I hope they will open a center for people like us to go for medical treatment and for
health counseling. For example, if a guy is unfortunately infected with throat
gonorrhea, he may feel ashamed to go to the normal clinics for treatment, but that
center may be okay for him (Van, 36 years old, bóng kín).
2.6.3 Societal acceptance and legitimacy
Many participants expressed their need for being accepted by their families and society. They
wish to openly live with their true identity.
If the society accepts, we would surely come out to do whatever we want to do.
Everyone has their own hobbies. I do love to be a woman, love to walk around and
talk freely. I want to become a woman and have a real husband, and that’s all (Quang,
20 years old, bóng kín).
They wished to be
treated with respect and
be treated equally by
other people. They
wished to live their lives
with dignity because
they know that they have
the right to happiness.
Marriage to people of
the same sex was their
most important wish.
It’s my own hope, and maybe even someone like me hopes
this also, that people consider us as normal people and don’t
look at us with stranger eyes. With people who understand,
it’s okay, but people who don’t understand us always look at
us with very unnatural eyes. We hope in the future we will
have the right to live, the freedom, and the joy and happiness
because we are still Vietnam’s residents; we have all the same
rights as all other Vietnamese people. One more thing I want
is the right to get married. We want to be able to get married
to someone like us with the acceptance of society (Dinh
Tuan, 23 years old, bisexual).
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Hoang and Long believed that it was time to have an association of gay men that works to
empower its members and to advocate for changing society’s attitudes toward these groups.
I do want society to have a new perspective on gay people because gay people are just
as normal as all other residents. They are only different in their instincts or the body
but not in their lives, jobs, or personalities. There are good and bad gay people just
like all good and bad people in the whole society. So we should improve the point of
view. I think Vietnam should have an association to promote homosexual people, to
guide them following the law, to teach them how to conserve their health, and to gain
a friendlier look from the society so as not to make any bad impressions on society
anymore (Hoang, 52 years old, gay bóng lộ).
I want to have (gay associations) so people will not look at us with strangers’ eyes.
Now they now don’t have any chance to talk with gays and to understand the heart of
gay people (Long, 26 years old, bisexual).
The participants wished that the media would not use stigmatizing words to address gay
people and would not use these words in the headings of newspapers and magazines. They
believed that these words reinforced stigmas against gay community.
For example, when writing about a criminal who is gay, the newspaper should not use
words like duc rua or pêđê in the headlines. It’s okay to use these words in the article,
but once they are used in the headlines, it’s possible that people would have a
reinforced negative impression about all other gay people (Hoang, 52 years old, gay
bóng lộ.)
Some newspapers addressed issue of homosexuality with good intentions but instead more
widely disseminated misconceptions and myths surrounding homosexuality. This did not help
to reduce stigma and discrimination against gay people but might have deepened negative
attitudes toward gay people.
In my opinion, it’s not a disease that is easy to spread like they say in newspapers and
magazines. I read Hoa Hoc Tro magazine. They wrote that if we play with
homosexual friends, we would become homosexual. It’s absolutely wrong. An Ninh
Thu Do newspaper also published an article about homosexuality among students as a
disaster. It’s not true that students who play together are homosexual. Even if you are
the friend of homosexual, you can never become a homosexual if you are a “genuine”
man. Honestly saying, by writing and publishing that way, they do not give any help.
They meant to push the gay people into a deeper pessimistic attitude and make them
hide themselves away more and more (Bao, 32 years old, Du’s friend).
Currently, there is an award-winning book and TV version of the book out in Vietnam called
A World Without Women by Bui Anh Tan that has been helpful for bringing homosexuality
out into the open. The novel deals with homosexuality and features a doctor who goes to
clubs frequented by gay people. While publishers edited much of the original transcript, the
existence of a popular book about homosexuality is a very positive development for MSM,
gays, and lesbians in Vietnam. However, when talking about the films or comic plays
recently shown, this bisexual man said that these films and plays were still not able to show
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the full reality of gay people’s life. He wished the media could portray positive images of gay
people and thus change people’s attitudes towards this community.
They can not, in fact, act to portray the real image of gays in real life. They only
understand cursorily and make fun of gay people in the show. (Ask: So what do you
think they need to show to really express it?) I hope that if they express it on TV that
they can act to make sure all TV audiences can understand about the everyday lives of
gay people to let people know that it’s not a pathologic disease or an evil thing. That
way, gay people can share their minds with other people. It’s just our need to be
respected by other people (Vu Long, 25 years old, bisexual).
3 CONCLUSIONS AND RECOMMENDATIONS
3.1 Conclusions and implications for sexual health interventions
This study showed that the MSM community in Hanoi is not a homogeneous group both
socially and sexually speaking. This diversity has several implications for their sexual health
and thus should be taken into account when designing and implementing sexual health
interventions for this group.
Regarding their social profiles, MSM in Hanoi come from different backgrounds. They
belong to different age cohorts. Their education is diverse. A large part of this community
comes from other cities or provinces and thus tends to work unstable job in service sectors or
entertainment enterprises. Many of them engage in the sex business either as pimps or sex
workers. It seemed that more and more MSM rely on the sex work as the main incomegenerating activity. The diversity in the socio-demographic backgrounds of MSM in Hanoi
implies that the sexual health interventions should not be the same but be differentiated
according to each subgroup’s characteristics. For instance, the IEC interventions for MSM of
different educational levels should be different. The IEC materials designed for MSM with
lower educational levels should not be as sophisticated as those for MSM with higher
education.
While most gay men can rely on economic and emotional support from their families, they
rarely expect the latter to accept their true sexual identity. Instead, they are constantly under
pressure to conform to the social norms about marriage and having children as well as to fit
gender stereotypes regarding masculinity. The majority of them always feel guilty and sorry
for their families because they do not fulfill their duty as a son. Many MSM very carefully
hide their true sexual identity from their (non-MSM) friends and the community because
what they have gotten so far is stigma and discrimination. The negative societal attitudes
toward bóng lộ deepen their fear of being discovered and thus push MSM underground. This
creates more difficulty for interventions to reach this group. The findings point out the
importance of educational interventions targeting families and communities to change
societal attitudes toward homosexuality and to reduce stigma and discrimination against
people with same-sex sexual orientation. Such interventions are possible because there is
evidence showing that when the families understand that their son does not have the power to
decide his sexual identity, they no longer bothering him with questions and do not push him
to get married. Some families even go as far as to willingly accept that their son will live with
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another man as a couple. Some close friends of gay men also show their understanding and
sympathize with the latter and willingly support them.
With regard to their lifestyle and the level of disclosure of their same-sex sexual orientation,
MSM in Hanoi can be categorized as bóng kín and bóng lộ. Bóng kín are the MSM who
carefully hide their same-sex desire and/or male-male sexual relations. Bóng lộ are mainly
gay men who openly live with their homosexual identity. Many bóng lộ dress and behave like
women. Because bóng kín are less visible, it is challenging to get access to them for
intervention efforts. Meanwhile, working with bóng lộ is not easy. They are more visible, but
because this group used to be heavily stigmatized, getting trust from its members and getting
support from community for the intervention activity may be difficult.
The world of MSM in Hanoi is characterized by lively networking and dating through the
entertainment activities of its members. Depending on their lifestyles and economic
situations, they may choose to frequent various venues such as bars, discotheques, and clubs
or in parks and public places where they make friends and look for sexual partners. The
Internet is increasingly becomeing an important means of communication and networking
among young MSM. Many gay men prefer to address each other as women and emphasize
sisterhood between members of a close circle. Gay men believe that they can identify each
other by appearance and manner, including bóng kín.
In terms of their sexual identity, the MSM community in Hanoi consists of three major
subgroups. Those subgroups are gay men, bisexual men, and straight (heterosexual) men.
Most gay men have sexual relations exclusively with men; a few of them tried to have sex
with women in order to examine their sexual identity. Bisexuals and straight men have sex
with women and men. If the bisexual men enjoyed sex with men, the straight men feel
uncomfortable and find it void of pleasure but do it because of money. Therefore,
interventions on sexual health should not be the same for all three subgroups but be different
according to the nature of their sexual activities and relations. For instance, with the MSM
who have sex with men and women, the interventions should address the difference between
male-male and male-female sexual practices as well as the potential risks of these practices.
Cross-infection also should be emphasized. The interventions for the MSM who engage in
sex work should improve their negotiation skills of condom use.
Most MSM have their first sexual experience with men during adolescence. The majority of
gay and bisexual men have mixed feelings of relief and anxiety after that. They enjoy having
sex with men but felt shame and guilt. Most of them continue wrestling with internal doubts
about their sexual identities for a long time. Conforming gender norms for many of them
becomes an obsession. This creates a psychological drama that may remain all of their lives
and affect their self-esteem and push them deeper into depression. The interventions should
address this issue by providing this group with information and knowledge about sexuality
and sexual rights. Participatory approaches should be applied to empower members of this
group and to support them in understanding and securing their sexual rights.
Although MSM know about HIV/AIDS and major STIs such as syphilis and gonorrhea, and
although many are aware of the risk of infection of these diseases, they still have
misconceptions and myths surrounding male-male sex. Many of them believe that male-male
sex is safer than male-female sex and that women are the sources of STIs. There are myths
that anal intercourse and oral sex would be safe if the penetrating man ejaculates outside.
Some people are confident that they can identify healthy or unhealthy men by their
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appearance. Specific interventions to address these misconceptions and myths should provide
detailed information about the anatomy of male and female sex organs and the different risks
of male-male sex compared to male-female sex.
Sexual behavior of MSM in Hanoi is characterized by lively dating, a high frequency of
sexual intercourse, multiple sexual partners, and diverse sexual practices in which condoms
are used either inconsistently or not at all. This pattern of sexual behavior poses greater risk
of infection by STI and HIV/AIDS to MSM. The myths of the safety of male-male sex are the
main factors explaining this risky practice. Poor negotiation skills pose another important
barrier to the safe sex behavior of many men, especially those who engage in sex work. Few
MSM know about and use lubricant for anal intercourse. This may increase the risk of
infection due to scratches or bleeding caused by lack of lubrication.
Few MSM are aware of and use voluntary counseling and testing. Perhaps having an STI is
still stigmatized, so people who get infected with diseases tend to keep it confidential. While
self-treatment is very common in primary healthcare, self-treatment of STIs by MSM can be
a way to avoid stigma. When self-treatment turns inefficient, the men are more likely to use a
private clinic to avoid being discovered. Some health providers may not be aware of the
existence of MSM or their sexual health issues. This may affect their ability to identify the
specific needs of MSM clients and thus limit their opportunity to provide them with more
relevant advice and treatment.
This study documented and confirmed a close connection of migration and homosexuality.
Many gay men choose migration as a strategy to escape stigma and discrimination in their
hometown or village and to live openly with their true sexual identity. This finding suggests
that special attention be paid to the male migrants and that specific measures be taken to
approach this population because they are mobile and can scatter.
The male-male sex business in Hanoi is currently very ebullient. Besides local men, migrants
are an important source of supply for this market. These include not only gay men but also
straight men who come to Hanoi from different cities and provinces. A number of them
choose sex work as their main way of income generation. Sex workers are diverse in terms of
their social profiles. They are students, workers, soldiers, drug users, unemployed people, or
urchins who run from their homes. Reaching these different subgroups with interventions that
are appropriate to each of them requires a lot of work.
Clients of the male-male sex business also come from different social backgrounds. This
means that there is a big community of homosexual men and MSM in Hanoi. They hide their
true identities and lifestyles in order to avoid the shame and discrimination associated with
homosexuality. Many of them live like other community members and get married and have
a family in order to conform to social norms. The concern of living a double life is the
potential of contracting HIV/AIDS through male-male sex and subsequently bringing the
disease home to his wife. This vast but invisible population poses a great challenge for safesex promotion programs. General education about male-male sex issues in mass media is one
possible way to raise awareness of the risks of HIV/STI infection. Improving negotiation
skills for sex workers can be another way to make sex work safer.
3.2 Recommendations
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A golden principle is that all interventions targeting MSM should respect the diversity
of the MSM community and involve all of its members in the entire process.
Involve policy makers
All of the programs targeting MSM, whether they include research or intervention or both,
should involve policy makers throughout the process.
Advocate for reduction of stigma and discrimination against MSM
Interventions for the improvement of sexual health and prevention of HIV and STI for MSM
should be combined with advocacy to reduce stigma and discrimination against this
community. One effective way of doing this is to use the media to disseminate information
and advocate about sexuality and sexual rights in general and homosexuality and the rights of
people with same-sex identities in particular. This involves training for media professionals
and designing and disseminating media programs to change public discourse about
homosexuality and homosexuals. Sexual health education should include a section about
homosexuality and the rights of homosexuals.
Use familiar venues
Interventions can be integrated in some appropriate entertainment activities and venues such
as a quiz on HIV/AIDS and STI and prevention methods. Brochures and leaflets may be more
suitable in public places such as parks or lake areas. Involvement of peers is essential for
access to the target group.
Use the Internet as an educational channel
Educational messages and counseling can be disseminated through the Internet. Specific Web
sites for this purpose should be designed and introduced to the community of MSM.
Set up counseling centers and a hotline where MSM can find information and
advice
The counseling centers and hotline should be run by experts in the field of sexuality and
sexual rights, including the area of homosexuality. Knowledge of legal issues regarding
identity and civil rights is also important for a counselor to know.
Make sexual health services MSM friendly to increase testing and access to
treatment
Train sexual health providers both in public and private sectors to be aware of issues of MSM
and to be able to identify and meet the specific needs of these clients.
Improve the quality of condoms and diversify methods of distribution
The inconsistent or lack of use of condoms has partly resulted from the poor quality of some
brands of condoms available in the Hanoi market. Those who used condoms prefer highquality condoms with colors and scents. Thin texture and a shape that is suitable for
containing semen are also favorable features of a condom. The promotion of condom use
should take this into account. Condoms should be made available in the venues where MSM
often meet for sexual encounters. A network of outreach collaborators can also promote and
distribute condoms.
Raise awareness of lubricant and make it available
Incorporate information about lubricant and its use in educational activities and printed
materials. Distribute a lubricant sachet together with a condom.
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Khuat Thu Hong. 1998. Sexuality Study in Vietnam: The Known and Unknown Issues.
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Tim Bergling. 2001. Syssyphobia: Gay men and Effeminate Behavior. Hawroth Press
Herdt, Gilbert and Boxer, Andrew 1993. Children of Horizons: How Gays and lesbian teens
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