Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions

Abstract

Introduction: The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. Methods: A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16-24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. Results: Seven hundred and three YPUD aged 16-24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had "ever" injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with nonconsistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at "low-risk" as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. Conclusions: The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.

Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam

“…The city of Hai Phong started to develop peer-supported interventions many years ago with the involvement of the city health authorities, national NGOs and international agencies, targeting key and hard-to-reach populations. 33,51 It clearly participated in the success of the intervention presented here and this raises the question of the reproducibility of this type of mobilization of actors in other provinces. Cost and cost-effectiveness of the intervention need to be compared with the classic model of care to develop advocacy toward health authorities.…”

Development and assessment of a community‐based screening tool for mental health disorders among people who inject drugs

“…Considering only moderate to severe depression, a recent meta‐analysis focusing on PWID showed a pooled prevalence of 59.7% [95]. Similarly, a recent survey conducted among young people who used drugs in Vietnam showed that criteria for moderate to severe depression were found in 50% of the subjects [98]. These data therefore suggest that the proportion of people who need to be referred to a psychiatrist would be higher in the target population and positive predictive value will be greater.…”

The effect of migration, location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014-2021: a retrospective cohort study

“…[11] In Vietnam HIV prevalence was 6.3% among young people (15-24 years) predominantly using methamphetamines and higher (15%) among those with a history of injecting. [12] In Myanmar, people using methamphetamines in Shan State frequently reported inconsistent condom use and multiple sex partners pointing to the potential for sexual transmission of HIV. [7]…”

“…[11] In Vietnam HIV prevalence was 6.3% among young people (15-24 years) predominantly using methamphetamines and higher (15%) among those with a history of injecting. [12] In Myanmar, people using methamphetamines in Shan State frequently reported inconsistent condom use and multiple sex partners pointing to the potential for sexual transmission of HIV . [7] There is a growing body of evidence documenting high HIV prevalence (34.9%) among PWID in Myanmar ranging from 7.6% to 61% and higher in rural areas of Bhamo and Waingmaw (61-56%) in Kachin State.…”