A hidden HIV epidemic among women in Vietnam

Abstract

BackgroundThe HIV epidemic in Vietnam is still concentrated among high risk populations, including IDU and FSW. The response of the government has focused on the recognized high risk populations, mainly young male drug users. This concentration on one high risk population may leave other populations under-protected or unprepared for the risk and the consequences of HIV infection. In particular, attention to women's risks of exposure and needs for care may not receive sufficient attention as long as the perception persists that the epidemic is predominantly among young males. Without more knowledge of the epidemic among women, policy makers and planners cannot ensure that programs will also serve women's needs.MethodsMore than 300 documents appearing in the period 1990 to 2005 were gathered and reviewed to build an understanding of HIV infection and related risk behaviors among women and of the changes over time that may suggest needed policy changes.ResultsIt appears that the risk of HIV transmission among women in Vietnam has been underestimated; the reported data may represent as little as 16% of the real number. Although modeling predicted that there would be 98,500 cases of HIV-infected women in 2005, only 15,633 were accounted for in reports from the health system. That could mean that in 2005, up to 83,000 women infected with HIV have not been detected by the health care system, for a number of possible reasons. For both detection and prevention, these women can be divided into sub-groups with different risk characteristics. They can be infected by sharing needles and syringes with IDU partners, or by having unsafe sex with clients, husbands or lovers. However, most new infections among women can be traced to sexual relations with young male injecting drug users engaged in extramarital sex. Each of these groups may need different interventions to increase the detection rate and thus ensure that the women receive the care they need.ConclusionWomen in Vietnam are increasingly at risk of HIV transmission but that risk is under-reported and under-recognized. The reasons are that women are not getting tested, are not aware of risks, do not protect themselves and are not being protected by men. Based on this information, policy-makers and planners can develop better prevention and care programs that not only address women's needs but also reduce further spread of the infection among the general population.

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection

“…Although the HIV epidemic in Viet Nam is still in a concentrated stage, the potential for a generalized epidemic is increasing, as indicated by a very high prevalence of HIV infection among high-risk groups and by a hidden epidemic among females. [5][6][7][8] Moreover, resources for HIV services mainly involve funding from international donors, which is rapidly decreasing as Viet Nam emerges as a middle-income country. According to projections of the Vietnamese National HIV Strategic Plan for 2011-2015, over this period the total cost of HIV services will increase by 60%, to approximately US$ 150 million.…”

Women living with HIV in Vietnam: desire for children, use of sexual and reproductive health services, and advice from providers

“…21 Little is known about access to sexual and reproductive health services among people living with HIV, 22 and there is evidence that women who are not drug users or sex workers are not accessing HIV prevention, care and treatment. 23 A recent study in Hai Phong found that pregnant women do not get tested for HIV in the course of antenatal care, 24 suggesting that some women living with HIV (WLHIV) may lack the knowledge of and access to treatment and prevention of mother-to-child transmission services.…”

An old enzyme for current needs: adenosine deaminase and a dendritic cell vaccine for HIV

“…The importance of sustained prevention efforts in Asia was confirmed by a recent meta-analysis of available data in Viet Nam, which found that many low-risk women may be at considerable risk of HIV infection due to the high-risk sexual and drug-using behaviours of their male partners (Nguyen et al, 2008). (Lu et al, 2008).…”