As rates of HIV increase in Viet Nam, there is a need for data on social relations and sexual risk and protective behaviors among Vietnamese adolescents in a context of rapid social and economic changes. We report findings from our qualitative interviews with 159 Vietnamese adolescents living in Ha Noi, Nha Trang City and Ninh Hoa District and survey of 886 adolescents in these same three sites. In the qualitative interviews, youth report a strong adherence to ideals and values regarding abstinence outside of marriage. Youth reported low rates of engagement in vaginal, anal, and/or oral sex with a significant difference in reported behaviors between males (29/469, 6.2%) and females (7/416, 1.7%) [p=.000]. 15/32 (46.9%) sexually active youth reported "rarely" or "never" using condoms. Females had significantly higher scores for perceived sexual stigma than males [t=−10.22 (95% CI −3.72 to −2.52), p=.000] while males scored significantly lower than females on a scale of perceived self-efficacy for abstinence [t=5.31 (95% CI 0.27 to 0.59), p=.000]. The stigmatization of sexual relations outside of marriage particularly for young women reinforces abstinence, however these same values decrease adolescents' abilities to obtain accurate information about sexuality and HIV/STIs, and engage in safer sex.

BackgroundClients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods.MethodsWe examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients.ResultsFollowing the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects.ConclusionsThe intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.

Corresponding Author: Linda M. Kaljee, Ph.D., Associate Professor, Wayne State University, Pediatric Prevention Research Center, Hutzel Building, Suite W534, 4707 St. Antoine, Detroit, MI, 48201, Phone: 301 873-1203, Fax: 313 745-4993, lkaljee@med.wayne.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods-185 randomly selected parent-youth dyads in four communes in Ha Noi and Khanh Hoa Province. Descriptive and comparative analysis included chi-square tests, independent samples t-tests, and ANOVA. Linear regression analysis was utilized to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy. NIH Public AccessResults-Seventy-six percent of parents and 44% of youth were female. Youth mean age was 17.2 years. For parental "reproductive health knowledge" mean score was 24.74 (SD 3.84: range 15-34). Lower parental reproductive health knowledge was positively associated with lower levels of education [F=2.983, df 184: p=0.014]. Data indicate a linear model in which knowledge is related to "comfort" (β =0.17; p=0.048) and "comfort" to frequency of "talk" (β =0.6; p<0.0001).Frequency of "talk" is not related to parents' discordant perceptions regarding their child's reported involvement in relationships (β =0.002; p=0.79) or sexual touching (β =0.57; p=0.60).Conclusions-Parent and youth in Viet Nam are engaged in limited communication about reproductive health. There is need for more data to assess the impact of these communication patterns on youths' engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.

In Vietnam, between 2000 and 2006, HIV rates among 15- to 49-year-olds in the general population have increased from 27% to 53%. The HIV epidemic is occuring in a context of rapid socioeconomic changes, which have brought about conflicting ideals and norms between "traditional" and "modern" gender roles. We discuss the processes for developing the Exploring the World of Adolescents gender-specific HIV prevention curricula for 15- to 21-year-old adolescents living in both rural and urban Vietnam. The curricula are modeled after an existing HIV prevention program previously adapted and evaluated in Vietnam (Vietnamese Focus on Kids) and based in social learning theory (prevention motivation theory) contextualized within socioeconomic changes. The overall capacity building and participatory strategies for program development included (a) review of the HIV/AIDS and socioeconomic conditions in Vietnam, (b) review of the Vietnamese Focus on Kids curriculum themes and the theoretical constructs from the protection motivation theory, () analysis of qualitative and quantitative needs assessment data to incorporate culturally significant issues of gender and sexuality, and (d) a review of themes and activities from existing evidence-based adolescent reproductive health curricula.

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The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women's opportunities beyond reproductive and domestic activities, and environmental sustainability. 1 In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission. 2In South Africa, free contraceptives are available at public sector health care facilities, and contraception use is high: an estimated 65% of sexually active women use a method.3 The method mix comprises predominantly short-acting methods -primarily injectable contraceptives. Long-acting contraceptives, such as the intra-uterine device (IUD), are highly effective among typical users owing to consistency of function, yet are underutilised in South Africa's public sector facilities. Of importance, especially in South Africa's high HIVprevalent setting, is that the IUD can be safely used on clinically well HIV-positive women. 4 The 2004 Demographic and Health Survey showed that 10% of sexually active women were sterilised, while less than 1% of women were using the IUD. 3 In preparation for an intervention aimed at improving contraceptive options, including long-acting and permanent methods (LAPM), for all postpartum women, we assessed women's knowledge and attitudes to LAPM. We report on findings from our baseline survey, which have prompted the question: Where is the 'planning' in family planning services? MethodsA cross-sectional study, approved by the University of Cape Town Health Science Faculty Human Research Ethics Committee, was conducted at five public sector primary care facilities in Cape Town between February and April 2009. Trained interviewers using a structured questionnaire collected data on: socio-demographics, contraceptive use, future fertility desires, and knowledge and attitudes towards LAPM, from 538 women of whom 265 were HIV-positive and 273 HIV-negative. The sample included HIV-positive and negative women to enable a comparison to be made of the uptake of an LAPM promotion intervention between prevention of motherto-child transmission (PMTCT) and non-PMTCT clients. All study participants were attending child health services, had received antenatal care during their most recent pregnancy, and had delivered less than 6 months before the interview. ResultsThe median age of the women was 26 years (interquartile range (IQR) 22 -31), 63.9% had achieved Grade 8 -12 without matric, 29.5% had post-matric qualifications, and the vast majority (94.2%) reported to be either married or single but in a stable relationship. Participants had a median number of 2 (IQR 1 -2) living children. Overall, 67.3% of the women did not want another child in the future, 39% reported that their partners did not want another child, and 62.4% reported that their most recent pregnancy was unplanned. Of ...

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