1. www.abtassociates.com
HIV Risk and HIV Prevention Among
Female Sexual Partners of IDUs in Vietnam
Theodore M. Hammett, Ph.D., Abt Associates Inc., Cambridge, MA USA; Son Dang, Abt Associates, Hanoi, Vietnam; Hoang Tran, M.D., Partners in Health Research, Hanoi, Vietnam;
Ryan Kling, M.A., Abt Associates, Cambridge, MA USA; Hoang Minh Tran, Partners in Health Research, Hanoi, Vietnam; Anh Doan, Partners in Health Research, Hanoi, Vietnam; Oanh
Khuat, M.D., M.P.H., Supporting Community Development Initiatives, Hanoi, Vietnam; Phong Nguyen, M.D., M.P.H., Abt Associates Inc., Hanoi, Vietnam
Background
 Vietnam’s HIV epidemic is driven by injection drug use but most IDUs are also
sexually active.
 IDUs’ female sexual partners (SPs) may therefore be at high risk for HIV.
 Sexual transmission from IDUs to SPs is the most likely avenue for HIV to enter the
“general population”.
 In several provinces with high HIV prevalence among IDUs, HIV prevalence among
antenatal women is >1%.
 USAID/Health Policy Initiative Vietnam and the Global Fund are supporting HIV
prevention interventions for SPs in Hanoi, Ho Chi Minh City, and Dien Bien, with
ongoing evaluation.
Conclusions
 Relatively few SPs are themselves IDUs, except in HCMC
 HIV prevalence among SPs is high in all provinces (~14% in Hanoi, Dien Bien), even
higher HCMC (30%)
 HIV prevalence much higher among SP who are also IDUs
 High rates of HIV serodiscordant/unknown status relationships
 In Hanoi and Dien Bien, SPs’ primary risk factor is sex with IDU partners
 In HCMC , 70% of SPs with HIV+ (by test) IDU partners did not have correct
knowledge of IDU partners’ status
 Generally <50% of SPs reported consistent condom use with IDU partners at baseline
 Consistent condom use increased over time in Hanoi, especially among HIV
serodiscordant couples
 Consistent condom use is associated with participation in interventions in Hanoi
HEALTH POLICY
INITIATIVEVIETNAM
This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through
the U.S. Agency for International Development (USAID) under the terms of the Contract #
GPO-I-00-05-0026-00.
 Cross-sectional surveys
 Hanoi: baseline (2008), 12-, 24-, and 36-month followup (2009-11); n=200 SPs
for all surveys
 Dien Bien: baseline only (2011); n=299 SPs
 HCMC: baseline only (2011); n=191 couples (IDUs and SPs) + 100 SPs with IDU
partners in drug detention (06) centers
 Behavioral interviews and biological tests
 HIV: all surveys
 Urine for opiates: HCMC and Dien Bien baselines; Hanoi 36-month only
Evaluation Methods
Logistic Regression:
 SP who contacted intervention more likely to use condom at last sex:
(OR=1.826; 95% CI 1.093, 3.050, p = 0.0215)
 For condom use always/often in the past 6 months: (OR = 1.764; 95%
CI 0.993, 3.135; p = 0.0529)
 Hanoi
 Baseline: SPs recruited from registered lists, referrals by Women’s Union, then snowball
 12- and 24--month follow up: seeds referred by interventions’ peer educators, then
snowball
 36-month: 200 SPs recruited by snowball technique - to maintain comparability with
previous follow-up survey rounds; 200 SPs recruited by IDUs’ referrals (IDUs were
recruited first by RDS)– intended to provide a more representative sample of SPs
comparable to baseline
 HCMC
 191 couples (SPs and IDUs); SPs referred by IDUs who were recruited by TLS method
 100 SPs whose male partners were in 06 centers recruited from registered lists of 06
center residents
 Dien Bien
 299 SPs recruited by “take-all” method; IDUs recruited first and asked to refer their
female partners
Sampling
Recommendations
 SPs remain a seriously at-risk population in need of HIV prevention services
 Consistent condom use is a challenging goal to achieve so alternative strategies are
needed as well – treatment as prevention, lower risk sex
Injection Drug Use Among SPs: Baseline
Hanoi
%
Dien
Bien
%
HCMC
SP of community
IDU
%
SP of 06
resident IDU
%
Current IDU
(confirmed by
opiate test)
NA 6.4 44.7 16.0
Current IDU
(self-reported)
17.6 2.0 40.3 13.0
HIV Prevalence and HIV Seroconcordance/Discordance
(Male Partners’ Status Based on SP Report): Baseline
Hanoi Dien Bien HCMC
% % SP of non-06
resident IDU
%
SP of 06
resident IDU
%
SP HIV prevalence 14.8 13.7 32.1 27.0
IDU HIV prevalence
(IBBS, 2009)
12.2 56.0 47.8
HIV concordance
among SPs who knew
their partner status
31.5 31.1 43.0 34.0
HIV discordance among
SPs who knew their
partner status
43.7 31.4 20.4 17.0
Male partner unknown 24.9 37.5 37.8 47.0
SPs in serodiscordant or
unknown status
relationships
69% 69% 58% 64%
HIV Prevalence Among SPs by Drug Use: Baseline
36.8
45
56.3
12.1
21.7 21.4
31.3
9.2
0
10
20
30
40
50
60
70
Hanoi Dien Bien HCMC- PSP of non-06
resident IDU
HCMC- PSP of 06
resident IDU
%
(+) with opiate test (-) with opiate test Current IDU by self report Not current IDU
SPs’ Belief About Partners HIV Status vs. Actual Test
Results of IDUs: HCMC Baseline
70% of SPs did not know of their
IDU partners’ HIV infection
IDU’s HIV test
results
(+) (-)
SP’s
belief re
IDU HIV
status
(+) 29.5% 5.4%
(- ) 28.7% 60.7%
Don’t
know
41.8% 33.9%
100% 100%
SPs’ Condom Use with IDUs: Baseline
Hanoi
%
Dien Bien
%
HCMC
PSP of non-06
resident IDU
%
In last sex 48.0 58.2 27.7
Consistent condom use In the last six
months (among who had sex in the
last 6 month)
25.4 45.7 14.6
SPs’ Consistent Condom Use with IDUs:
Hanoi Baseline to 36 Months
* P<0.001
19%
21%
38%
47%*
16% 15%
27%
45%*
0%
10%
20%
30%
40%
50%
Baseline 12-month 24-month 36-month *
In the last sex "Always" or often in the last 6 months
SPs’ Consistent Condom Use by HIV Concordance/Discordance:
Hanoi Baseline to 36 Months
15%
12%
24%
31%
17%
24%
29%
64%
17% 16%
27%
44%
0%
10%
20%
30%
40%
50%
60%
70%
Baseline 12-month 24-month 36-month *
HIV concordant HIV discordant Total
Condom Use by Contact with SP Interventions: Hanoi Baseline to 36 Months
Measure of Condom Use
Did not
Contact
Contacted
p-value
(Chi-square test)*
Used condom at last sex 19.6% 36.4% <0.0001
Used condom always or
often in past 6 months
16.2% 29.1% <0.0001
*Data pooled across all 4 survey waves.
PEPFAR
VIETNAMESE AND AMERICAN S
IN PARTNERSHIP TO FIGH T HIV/AIDS
*sample recruited by snowball technique. *sample recruited by snowball technique.