Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access

Abstract

Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ (‘out,’ transgender, or effeminate MSM). Lower-income, ‘hidden’ MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.

Pre-Exposure Prophylaxis Knowledge and Perceived Effectiveness to Prevent HIV Among Deaf Gay, Bisexual, and Queer Men

“…from fear that their sexual identities and activities could be exposed as a result of stigma from their loved ones, including family members, friends, and partners. [24][25][26] This parallels our findings regarding the strong relationship between deaf GBQ male respondents' level of PrEP knowledge and being accepted by close family and friends. Within this context, deaf GBQ men who are able to be open, maintain close relationships with loved ones, and be accepted by loved ones are more likely to be able to interact with their communities to gain stronger PrEP knowledge.…”

Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries

“…Besides encouraging antiretroviral therapy (ART) initiation and adherence among PLHIV, U=U could also recalibrate social norms among non-HIV populations, given that transmission risk is a major source of fear/stigma. [9][10][11][12] The U=U message has been incorporated into numerous public health campaigns and clinical guidelines. 3 4 13 Discussing U=U in clinical settings is vital because patients perceive information they hear directly from their healthcare providers (HCPs) as being more believable.…”

“We are not gays… don’t tell me those things”: engaging ‘hidden’ men who have sex with men and transgender women in HIV prevention in Myanmar

“…In Myanmar, as in other Asian countries, a number of indigenous and diverse gender and sexual identities exist among same-sex attracted men. Unlike typical Western characterizations that utilize separate categories to define sexual and gender identities, one set of labels are often used across Asia to characterize both sexual and gender identities, such as Kothis in India and Bóng lộ in Vietnam [11, 12]. These labels typically encompass sexual positioning, power dynamics, and gender expression and are reflective of one’s willingness to disclose their sexual preferences, behaviors and gender identity [4, 13].…”