Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam

Abstract

BackgroundSeeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men.MethodsIn-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected.ResultsStigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a “scare tactic” mainly focusing on drug users and sex workers, who were defined as “social evils” in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV.ConclusionsA comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the “social evil“ approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam

“…In this study, disclosure of sexual orientation to healthcare workers was significantly associated with increased sex-work related stigma. Discrimination towards MSM from the healthcare sector is particularly concerning, as health care stigmatization known to deter MSM from access services in the future (Thanh et al 2012; Ma et al 2012; Risher et al 2013). Non-engagement in care may place individuals at higher risk for HIV, STIs, and poor health outcomes (Ngo et al 2009; Thanh et al 2012).…”

“…Discrimination towards MSM from the healthcare sector is particularly concerning, as health care stigmatization known to deter MSM from access services in the future (Thanh et al 2012; Ma et al 2012; Risher et al 2013). Non-engagement in care may place individuals at higher risk for HIV, STIs, and poor health outcomes (Ngo et al 2009; Thanh et al 2012). It is important to note that peer outreach workers have played a key role in linking MSM with HIV counseling and testing and other related services in Ho Chi Minh City (Mimiaga et al 2012).…”

“…In other contexts, experiences of stigma and discrimination are associated with increased risk for HIV infection, possibly through social isolation, depression, and subsequent increase in risky sexual practices, such as engaging in unprotected anal sex (UAS) and drug or alcohol use during sex (Diaz et al 2001; Thomas et al 2012). In addition, stigma and discrimination have been shown to be associated with reduced care-seeking behavior in Vietnam (Thanh et al 2012). Individual experiences of sexual minority stigma, which is generally defined as lack of power, regard, and inferior status of members of sexual minorities, can be grouped into three categories: Enacted stigma, which includes explicit behavior including use of derogatory language and active shunning and discrimination, and sexual assault or violence; Felt stigma which refers to the expectation of enacted stigma; and Self-stigma, which incorporates stigma into one’s feelings towards the self (Herek 2007).…”

Healthcare avoidance by people who inject drugs in Bangkok, Thailand

“…In Vietnam, stigma in health care and the community was found to hamper utilization of HIV treatment, while family support was vital to outcomes following HIV diagnosis. 24 Interventions that aim to improve familial support, which may provide encouragement to access health care, and to reduce the view of IDU as dangerous 'social cheaters' 42 by healthcare workers and the public are needed.…”

Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

“…HIV-infected MSM who engage in transactional sex may delay care seeking as a result of social and structural stigma, and economic and psychosocial factors which may limit access to healthcare. [8][9][10][11][12] Recent evidence has demonstrated earlier initiation of antiretroviral treatment results in reduced sexual transmission of HIV. 13 Given the potential for substantial disparities in access to HIV medical care in populations of MSM who engage in transactional sex, and the importance of engagement in HIV-related medical care to reduce HIV transmission, addressing gaps in the literature to understand how MSM who engage in transactional sex are engaged in HIV-related medical care is important.…”