MINISTRY OF EDUCATION AND TRAINING
MINISTRY OF HEALTH
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY
-----------------------------
TRAN VAN KIEM
RISK BEHAVIORS FOR HIV TRANSMISSION AND
EFFECTIVENESS OF PREVENTIVE INTERVENTION
AMONG INJECTING DRUG USERS
IN QUANG NAM PROVINCE
Specialization: Epidemiology
Code: 62.72.01.17
SUMMARY OF THE PHILOSOPHY DOCTOR THESIS
HANOI - 2014
The study was completed in
National Institute of Hygiene and Epidemiology
The scientific supervisors:
1. Prof. Nguyen Thanh Long
2. Assoc. Prof. Nguyen Thi Hong Hanh
Opponent 1: Assoc. Prof. Doan Huy Hau, Vietnam Military Medical
University
Opponent 2: Prof. Dao Van Dung, Central Party's Commission for
Popularization and Education
Opponent 3: Assoc. Prof. Nguyen Minh Son, Hanoi Medical University
The thesis will be defended at the meeting hall
of the National Institute of Hygiene and Epidemiology.
In …………………
The thesis is available at:
1. The National Library
2. The Library in National Institute of Hygiene and Epidemiology
ABBREVIATIONS
AIDS
Acquired Immune Deficiency Syndrome
ARV
Anti Retrovirus
ASP
Accidental sexual partner
EI
Effective indicator
FSW
Female sexual worker
HIV
Human Immuno deficiency Virus
IDU
Injection drug user
OR
Odds Ratio
STIs
Sexually Transmitted Infections
UNAIDS
Joint United Nations Programme on HIV/AIDS
WHO
World Health Organization
PUBLICATIONS
1. Tran Van Kiem, Tran Van Vu, Cao Minh Thong, Nguyen Thi Hong Hanh,
Nguyen Thi Thuy Duong, Phan Trong Lan, Nguyen Hoang Long, Nguyen
Thanh Long (2014) “The knowledge, behaviors about HIV/AIDS in the
injecting drug users in Quang Nam province 2011”, Vietnam Journal of
Preventive Medicine 4(153):99-105.
2. Tran Van Kiem, Tran Van Vu, Cao Minh Thong, Nguyen Thi Hong Hanh,
Nguyen Thi Thuy Duong, Phan Trong Lan, Nguyen Hoang Long, Nguyen
Thanh Long (2014), “Effective interventions to prevent transmission of HIV
among injecting drug users in Quang Nam province”, Vietnam Journal of
Preventive Medicine 4(153):106-111.
INTRODUCTION
HIV/AIDS pandemic was first recognized as a new disease in 1981 in
the Unites State. Nowadays, the HIV/AIDS pandemic has become a global
threat. According to the Joint United Nations Programme on HIV/AIDS, as of
2012, there were approximately 35.3 million people worldwide living with
HIV/AIDS. There are about 2 million deaths annually. HIV/AIDS pandemic
circulates mainly in the developing countries and causes directely economical,
political, and social burden in many countries.
In Vietnam, there were 216.254 people living with HIV in end of
2013,66.533 AIDS patients and 68.977 deaths due to AIDS. Due to not
available cureandvaccines preventable for HIV/AIDS, many countries in the
world have launched the strategic activities of prevention in order to limit the
HIV transmission into the community. One of the main cause for HIV/AIDS
transmission in Quang Nam provinve is the injecting drug users (IDUs) group
accounted for more than 65% of HIV infection cases diagnosed annually with
high-risk behaviors for HIV transmission and lack of knowledge on HIV
prevention. Targeting these subjects will play an important role in reducing
speed of the HIV/AIDS transmission. However, there has been no study
describing in detail the high-risk behaviors of HIV transmission among IDUs
and no effective intervention of HIV prevention for this group. Therefore, we
conducted the study:
1. To identify the HIV prevalence and risk behavior for HIV transmission
among IDUs in Quang Nam province in2011; and
2. To evaluate the effectiveness of intervention for HIV transmission
prevention among IDUs in Quang Nam province, 2012-2013.
New scientific contributions of the dissertation
The HIV prevalence and risk behaviors for HIV transmission among
IDUs have been identified in Quang Nam province, 2011. The effectiveness of
the prevention intervention program for HIV transmission among IDUs was
also evaluated in Quang Nam province, 2012-2013. The primary
inplementation of preventive intervention of HIV transmission among IDUs
has gained an effectiveness of HIV transmission prevention in Quang Nam
province.
The structure of the thesis
The thesis consists of 134 pages including Introduction (3 pages),
Chapter 1. Background (36 pages), Chapter 2. Objectives and Methods (21
pages), Chapter 3. Results (38 pages), Chapter 4. Discussions (33 pages),
Conclusions (2 pages), and Recommendations (1 page). There are 28 tables, 30
figures, 1 diagram, and 124 references.
CHAPTER 1
BACKGROUND
1.1. HIV/AIDS Epidemic Situation
The first HIV patient was diagnosed in December 1990 in Ho Chi Minh
City, Vietnam. There were 216.254 people living with HIV/AIDS in 2013,
66.533 AIDS patients and 68.977 deaths due to AIDS. According to the
HIVsentinel surveillance in 2013, the HIV prevalence among IDUs was 10.3%
, and much higher than female sexual workers groups (FSWs) (2.6%). Injecting
drug plays a principal role in HIV transmission in Vietnam. Almost of the HIV
cases in Quang Namwere IDUs (70%). There has been an increasing number of
unemployed young adults and adolescents suffered from social evil including
drug desire. The uncontrollablyincreasing number of HIV infection among
IDUs may lead to high risk of HIV/AIDS outbreak in Quang Nam province.
1.2. Risk behaviors for HIV transmission among injection drug users
Sharing syringes and needles when injecting drugs is the main reason of
HIV transmission in many countries in the local region and worldwide. The
HIV prevalence among IDUs is 5-10% in the world. However, thisprevalence
in some regions in Asia and Europe are over 50%. In Vietnam, the injecting
drug are different between urban area and rural area. In the last 15 years,
sharing syringes and needles is common among IDUs. The percentage of
sharing syringes and needles in the past six months among IDUs are 14-50%.
The studies show that there are 87%IDUs sharing syringe and needle, in which
40% IDUs consistently sharing syringes and needles. Cleaning syringes and
needles when injecting drugs are very casual and unsterilized. It is also risk
factor for HIV transmission among IDUs.
Other side, IDUs usually have other risk behaviors for HIV
transmission, leading to increase expose probability of HIV transmission by
having sex among IDUs and their sexual partners. The combination between
drug injection and having sex with FSWs increase risk of HIV transmission.
IDUs do not use condom frequently in having sex with FSWs and sexual
partners is the important reason of HIV transmission.
1.3. Prevention intervention programs for HIV transmission
1.3.1. Communication program for behavior change
Behavior change communication for HIV/AIDS is an approach in several
levels to encourage and maintain the behavior change in order to reduce risk of
HIV transmission for individual and community by broadcasting health
messages through different channels of communication.
1.3.2.Condom use promotion program
The foundation of this program includes effectively preventive solutions
for HIV transmission with low cost. It was estimated that if 1000 condoms are
bought and used, 03 HIV/AIDS cases will be prevented. The condom use
promotion program has been implemented in many countries and proved to be
effective.
1.3.3Needle and syringe exchange program
The needle and syringe exchange program has been implemented in
Europe since 1982. Until now, the program has been expanded worldwide and it
is an important activity of harm reduction intervention to prevent HIV
transmission for IDUs.
1.3.4. Substitution therapy with methadone program
This program has been recognized as a high effectiveness in prevention
of HIV transmission. Using oral methadone, drug users will reduce and stop
using needle and syringe, leading to reduce risk of transmitting HIV.
1.3.5. HIV voluntary counselling and testing program
HIV voluntary counselling and testing program is the start point for
assessible services and HIV/AIDS prevention. According to international
experiences, this program, which is one of important components in HIV/AIDS
control, plays a role in both prevention and care for HIV/AIDS patients.
CHAPTER 2
SUBJECTS AND STUDY METHODS
2.1. Subjects and settings
2.1.1. Study subjects
Subjects for cross-sectional study: men aged over 18, injected drug in the
last month and living in community and voluntary participating study.
Subjects for the intervention trial: Injecting drug users aged over 18 living
in family or community and voluntary participating study.
Criteria for exclusion from the study: aged under 18, women, prisoner,
person in center for education-social labor, person with mental disorder.
2.1.2. Study location: The study was conducted in five districts: Tam Ky, Phu
Ninh, Thang Binh, Que Son, and Phuoc Son.
2.1.3. Study time: from October 2011 to Mar 2014.
2.2. Study methods
2.2.1. Study designs: Cross-sectional study, retrospective review, and
community-based health intervention trial without control and with comparison
between before and after intervention.
- Cross-sectional study:
Data were collected using direct interview of IDUs with a questionnaire. Blood
sample of subjects was collected for HIV testing.
*Sample size was calculated using the formula for estimating a proportion:
p (1 – p)
2
n = Z (1-α/2)
d2
n: minimum sample; α = 0.05, Z(1-α) = 1.96; d = 0.05; p= 0.37-prevalence
of IDUs sharing syringe and needle in previous six months in Da Dang
province. The calculated sample size was 359 subjects. A total of 430 subjects were
recruited for the study.
*Sample collection:
Mapping locations where IDUs used drugs in 5 districts was performed to
estimate the IDUs number in each district. The subject number for each district
was proportionally assigned to the estimated number of IDUs in this district.
Study communes were recruited using a simple random sampling method.
- Community-based health intervention trial
* Stepts for intervention: Firstly, developing plan for HIV transmission
prevention. Next, selecting study site and implementing intervention. Lastly,
supervision and evaluation were conducted after intervention.
*Sample size was estimated using formula to compare two proportions in the
intervention group:
n: minimum sample; α = 0.05, Z(1-α) = 1.96; power = 0.9, Z(1-β) = 1.28; P1
was the percentage of IDUs sharing syringe and needle in the past six months
before intervention (P1 = 0.335); P2 was the percentage of IDUs sharing syringe
and needle in tthe pas six months after 2-year intervention (P2 = 0.235, 10%
reduction); P = (P1 + P2)/2 = 0.285. Estimated sample size was 416 subjects. A
total of 430 subjects were recruited for the intervention study.
2.2.4. Study content
Organizing meetings with local administrators, social organizer on
preventive intervention of HIV transmission.
Building networks of volunteers, homologous groups to implement
communication activities for behavior changes, condom delivery, and
sterilized syringe exchange.
Implementing broadcasting programs and radio in levels of province,
districts and communes. Delivery of materials.
Setting up communication for behavior changes in public areas.
Building sites for condom delivery, sterilized syringe exchanges in
community, pharmacy, and commune health station.
Conducting activities of HIV counselling and testing for study subjects in
the fixed location and mobile station in local areas.
Conducting surveys before and after intervention, mapping and selecting
samples in community.
2.2.5. Data collection: Using a quantitative questionnaire in surveys before and
after intervention.
2.2.6. Study indicators
Based on the objectives of the study, the study indicators were divided
into two groups with 16 indicators, including: HIV prevalence, proportion of
sharing syringe, proportion of drug injection, proportion of condom use in
sexual contact, proportione of always using condom when having sex with
partners, proportion of obtaining HIV counselling, proportion of receiving
communication on safe injection, proportion of receiving communication on
safe sex, proportion of receiving sterilized syringe and needle, proportion of
receiving free condom.
2.2.7. Materials
HIV testing was performed in Quang Nam Center for HIV/AIDS Control
and Provincial Center for Preventive Medicine in Quang Nam according to
procedure III with biochemical approved by Vietnam Ministry of Health for use
in Vietnam: Determine, Genscreen HIV -1/2 version 2, Vironostika Uniform II.
2.3. Data analysis: Data were entered, analyzed using softwares Epi Data,
STATA and M. Excel.
2.5. Ethnical consideration
The study was approved by local administration. Subjects were informed
before the study and they freely participated in the study.
CHAPTER 3
RESULTS
3.1. HIV Prevalence and risk behaviors for HIV transmission in the
injection drug users in Quang Nam province, 2011
3.1.1. Risk behaviors for HIV transmission
The study was conducted among 430 men in Quang Nam province
in2011. Of the total subjects, Kinh group were 96.3%, 20-29 age group
accounted for 52.8%, elementary education was 59.1%, and 54.4% had irregular
jobs.
Table 3.6. Duration of drug injection (n = 430)
Duration
< 1 year
1 - < 2 years
2 - < 3 years
≥ 3 years
N
51
62
74
243
%
11.9
14.4
17.2
56.5
The duration of drug injection more than 3 years was highest (56.5%),
followed by 2-3 year injection (17.2%), and drug injection under one year
accounted for 11.9%.
Table 3.7. Drug injection behaviors in previous month (n = 430)
Content
N
1. Frequency of drug injection (n = 430)
≥ 4 times/day
7
2 - 3 times/day
101
1 time/day
142
< 1 time/day
168
Don’t remember
12
2. Category of used drugs (n = 430)
Heroin
376
Opium
42
Synthetic drugs
51
%
1.6
23.5
33.0
39.1
2.8
87.4
9.8
11.9
Drug injection less than 1 time/day accounted for the highest proportion
(39.1%), followed by drug injection 1 time/day (33%), 2-3 times/day (23.5%),
and more than 4 times/day (1.6%). Heroin accounted for 87.4% and synthetic
drugs accounted for 11.9%.
Not sharing
syrines and
needles: 66,5%
Sharing syrines
and needles:
33,5%
Figure 3.4. The proportionof sharing syringes and needles in the past six
months (n = 430)
The proportion of sharing syringes and needles in the past six months was
33.5%.
Percentage
21.2%
30%
20%
10%
0%
Dùng
chung
Sharing
BKT
syrines and
needles
19.5%
Đưa BKT
Sending
used
syrines and
needles
18.4%
Nhận
BKT
Receiving
used
syrines and
needles
Figure 3.5. The proportion of sharing syringes and needles in the past month
(n = 430)
The proportion of sharing syringes and needles in the past month was
21.2%, in which 19.5 % was giving used syringes and needles, and 18.4% was
receiving used syringes and needles.
Percentage
60%
36.1%
41.7%
40%
20%
13.9%
8.3%
0%
Not
Notđủ
đủ Không
ThíchLike
dùng Không
sharing
enough
enough
tiền
BKT
chung
money
syrines
Others
Khác
Figure 3.7. Reasons for sharing syringes within the past six months (n=144)
The common reasons for sharing syringes were not enough syringes
(41.7%), not enough money (36.1%), and like sharing (13.9%).
Percentage
100%
80%
60%
40%
20%
0%
85.6%
7.2%
SúcBy
nước
clean
lạnh
water
SúcBy
nước
hot
nóng
water
10.3%
Súc By
cồn
alcohol
4.5%
Khác
By
others
Figure 3.8. Manners of cleaning syringes and needles (n = 43)
Clean water was the most frequently used to sterilized syringes (85.6%),
followed by alcohol (10.3%) and by hot water (7.2%).
Table 3.10. The proportion of condom use and having sex with female sexual
workers
Content
N
%
1 - 4 times
55
51.4
5- 9 times
29
27.1
10 times
23
21.5
Yes
71
66.4
No
36
33.6
1. Having sex in the past month (n = 107)
2. Using condom in the past month (n = 107)
3. Frequency of using condom when having sex in the past 12
months (n = 151)
Always
39
25.8
Almost
60
39.7
Rarely
37
24.5
Never
15
9.9
The proportion of using condom in having sex with FSWs in the past
month was 66.4%. The proportion of always using condom in having sex in the
past 12 months was 25.8%, 39.7% for almost of times. There were 24.5% IDU
using condom rarely and 9.9% never use condom.
Table 3.11. The proportion of condom use and having sex with casual partner
Content
N
%
1. having sex in the past month (n = 46)
1 - 4 times
39
84.8
5- 9 times
3
6.5
4
8.7
10 times
2. Using condom in the past month (n = 46)
Yes
27
58.7
No
19
41.3
3. Frequency of using condom when thaving sex in the
pas 12 months (n = 89)
Always
5
5.6
Almost
21
23.6
Rarely
51
57.3
Never
12
13.5
The proportion of using condom in having sex with casual partners in the
past month was 58.7%. The proportion of always using condom in having sex in
the past 12 months was 5.6%, 23.6% for almost of times. There were 57.3%
IDU using condom rarely and 13.5% never use condom.
3.1.2. HIV Prevalence among injection drug users in Quang Nam
Non HIV
infection:
93.7%
HIV
infection:
6.3%
Figure 3.11.HIV prevalence among injection drug users in 2011 (n=430)
The HIV testing results showed that the HIV prevalence among IDUs was
6.3% in Quang Nam province, 2011.
3.2. Effectiveness of prevention intervention for HIV transmission among
injection drug users in Quang Nam province after two years of intervention
3.2.1. Effectiveness of HIV testing and counselling
Percentage
100%
74.2%
88.2%
Before…
intervention
Trước
Sau
canintervention
thiệp
After
25.8%
50%
1.8%
0%
Required
Được
yêu cầu
Voluntary
Tự nguyện
Figure 3.13. Effectiveness on HIV testing methods
The proportion of IDUs had voluntary HIV testing increased from 74.2%
before intervention to 88.2% after intervention (p < 0.01).
Percentage
75.1%
80%
63.3%
60%
31.8%
40%
Before intervention
Trước can thiệp
40.2%
After intervention
Sau can thiệp
20%
0%
Counselling
Tư vấn trướcbefore
xét
nghiệm
HIV
testing
Counselling
Tư
vấn sau xétafter
nghiệm
HIV testing
Figure 3.14.Effectiveness of counselling before and after HIV testing
The proportion of IDUs obtained counselling before HIV testing
increased from 31.8% before intervention to 63.3% after intervention (p<0.01);
the effective indicator (EI) was 99.1%. The proportion of IDUs obtained
counselling after HIV testing increased from 40.2% before intervention to
75.1% after intervention (p<0.01, EI=86.8%).
3.2.2. Effectiveness of care and support for injection drug users
Table 3.24. Effectiveness of communication for behavior changes (n = 430)
Indicator
Before
intervention
N
%
After
intervention
N
%
Effective
indicator
P
Safe injection
64
14.9
252
58.6
293.8
0.0001
Safe sexual contact
121
28.1
310
72.1
156.2
0.0001
After 2-year intervention, the proportion of IDUs receiving
communication on safe injection in the past six months increased from 14.9% to
58.6% (p<0.01, EI=293.8%). The proportion of receiving communication on
safe sex increased from 28.1% to 72.1% (p<0.01, EI=156.2%).
Percentage
60%
40%
20%
0%
58.2%
19.8%
Before
Trước
can thiệp
intervention
Sau After
can thiệp
intervention
Figure 3.15. The proportion of injection drug users receiving free condom
After intervention, the proportion of IDUs receiving free condom in the
past six months increased from 19.8% to 58.2% (p < 0.01, EI=193.9%).
Percentage
40%
30%
20%
10%
0%
32.3%
1.4%
Trước Before
can thiệp
intervention
Sau After
can thiệp
intervention
Figure 3.17. The proportion of injection drug users receiving sterilized
syringes and needles
The proportion of IDUs receiving sterilized syringes and needles in the
past six months increased from 1.4% to 32.2% (p<0.05, EI=2207%).
3.2.3. Effectiveness of accessible services for HIV prevention
Percentage
75.6% 82.3%
100%
80%
40.9%
38.4%
60%
40%
1.4%
2.5%
20%
0%
Collaborator
Đồng đẳng Cộng
Hiệu
thuốc Homologous
tác viên
Pharmacy
partner
viên
Trước
thiệp
Beforecan
intervention
Sau
canintervention
thiệp
After
Figure 3.20. The proportion of injection drug users know place to buy/receive
sterilized condom
After intervention, the proportion of IDUs know place to buy/receive
sterilized condom from peer educator and collaborator increased from 1.4% to
38.4% and from 2.5% to 40.9%, respectively.
Table 3.27. The proportion of injection drug users know place to buy/receive
sterilized condom (n=430)
Before
After
Effective
intervention intervention indicators
(%)
N
%
N
%
392 91.2 401 93.3
2.3
58
13.5 112 26.0
93.1
76
17.7 137 31.9
80.3
122 28.4 154 35.8
26.2
Pharmacy
Peer educator
Collaborator
Health officer
p
0.1247
<0.0001
<0.0001
0.01
After intervention, the proportion of IDUs know place to buy/receive
sterilized condom from peer educarors increased from 13.5% to 26% (p<0.01,
EI=93.1%), from collaborator increased from 17.7% to 31.9% (p<0.01, EI= 80.3%).
3.2.4. Effectiveness on changes of risk behaviors
Percentage
6%
5.6%
3.3%
4%
2%
0%
Trước Before
can thiệp
intervention
After
Sau can
thiệp
intervention
Figure3.22. The proportion of sharing syringes and needles in the last
injection
The proportion of sharing syringes and needles in the last injection
decreased from 5.6% before intervention to 3.3% after intervention (p > 0.05).
Percentage
30%
21.2%
13.7%
20%
10%
0%
Trước can
thiệp
Before
intervention
Sau After
can thiệp
intervention
Figure 3.23. The proportion of sharing syringes and needles in the past
month (n = 430)
After intervention, the proportion of sharing syringes and needles in the
past month decreased from 21.2% to 13.7% (p<0.01, EI=35.2%).
Percentage
40.0%
30.0%
20.0%
10.0%
0.0%
33.5%
22.6%
Trước Before
can thiệp
intervention
Sau can thiệp
After
intervention
Figure3.24. The proportion of sharing syringes and needles in the past six
months (n = 430)
The proportion of sharing syringes and needles in the past six months
decreased significantly from 33.5% (before intervention) to 22.6% (after
intervention) (p<0.01, EI=32.6%).
Percentage
71.4%
80.0%
60.0%
40.0%
20.0%
0.0%
41.7%
TrướcBefore
can thiệp
Sau can
thiệp
After
intervention
intervention
Figure 3.25. The proportion of cleaning syringes and needles
After intervention, the proportion of cleaning syringes and needles
increased from 41.7% to 71.4% (p<0.05, EI=71.4%).
Percentage
100.0%
87.8%
65.4%
75.0%
54.3%
50.0%
Trước
can
thiệp
Before
Before
intervention
intervention
Sau
canintervention
thiệp
After
After
intervention
0.0%
Phụ
nữ mại
dâm
Female
sexual
worker
Bạn
tình bất
Accidental
chợt
partner
Figure 3.27. The proportion of using condom with sexual partner
The proportion of using condom with FSWs in the ast time increased
from 65.4% (before intervention) to 87.8% (after intervention) (p<0.01, EI=:
34.1%). This proportion with casual partner increased from 54.3% (before
intervention) to 75% (after intervention), (p < 0.05, EI=38.0%).
Percentage
86.1%
100%
65.6%
80%
60%
40%
20%
Before intervention
Trước can thiệp
After intervention
Sau can thiệp
56.1%
29.2%
13.3% 15.6%
0%
Vớifriend Với
phụ nữ
Với bạn
tình
Female
sexual
Accidental
Wife/girl
vợ/người
mạiworker
dâm
bất chợt
partner
yêu
Figure 3.28. The proportion of injection drug users always using condom in
the past 12 months
After 2-year intervention, the proportion of IDUs always using condom
when having sex with female sexual worker in the past 12 months increased
from 65.6% to 86.1% (p<0.01, EI=31.3%). This proportion when having sex
with casual partner increased from 29.2% to 56.1% (p<0.01, EI=92.2%).
3.2.5. HIV Prevalence among the injection drug users before and after
intervention
Percentage
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
6.3%
4.4%
Trước Before
can thiệp
intervention
Sau can
thiệp
After
intervention
Figure 3.29. HIV Prevalence among injection drug users before and after
intervention (n = 430)
After 2-year, interventive solutions for HIV transmission in IDUs could
contribute partly to decreasing HIV prevalence in the study. The HIV
prevalence among IDUs decreased from 6.3% (before intervention) to 4.4%
(after intervention) (p<0.05, EI=29.6%).
CHAPTER 4
DISCUSSION
4.1. HIV Prevalence and risk behaviors for HIV transmission among
injection drug users in Quang Nam province
4.1.1.Risk behaviors for HIV transmission
The results of the survey in 2011 showed that the duration of drug injection of
IDUs was not long time in this study. Drug injection over 2 years accounted for
73.7%, and drug injection less than 2 years was 26.3%. Our results were much lower
than those in other provinces: durations of drug injection over 2 years were 82.5% in
Dong Thap province, 94.5% in Kien Giang province, and 96.4% in Lai Chau
province. Through the survey, we have recorgnized that many young men have just
sufferd from drug injection; they were unemployed, like imitating others and strange
sensation. We called them as “Amateur group”. This group has high risk of HIV
transmission because they had not only drug injection but also strongly when having
sex. Some studies indicate that IDUs have a strong sexual desire caused by narcotics
at the beginings. However, sexual need reduces significantly after 1.5-2 years later
and it is replaced by a desire for using narcotics. Some people lose sexual desire.
Therefore, in the first period of the 2-year drug injection with strong sexual desire,
they have a risk of double HIV transmission among them and between them and
other sexual partners.
Of the drugs used by injection drug users, heroin accounted for the
highest proportion (87.4%), followed by synthetic drugs (11.9%), and opium
(9.8%), indicating that heroin was the most common used among them.
The results showed that the proportion of IDUs sharing syringes and
needles in the past 6 months was common (33.5%). The proportion of sharing
syringes and needles in the past month was 21.2%, in which 19.5 % was giving
used syringes and needles, and 18.4% receiving used syringes and needles.
Reasons lead to sharing syringes and needles were not enough money, low HIV
knowledge, discrimination of their family and society toward IDUs let them
have sneaky injection. To satisfy the drug addiction, they were willing to use
syringes and needles of their partners or reuse unsterlized syringes and needles.
In the present study, the proportion of IDUs sharing syringes and needles in the
past six months was lower than that in Da Nam (37.2%), Lao Cai (35.3%) and
higher than that in the 10 provinces of the 2009 IBBS survey: Nghe An
(28.3%), Dong Nai (27.1%), Yen Bai (25.1%), Ho Chi Minh City (24.6%)…
This is a very dangerous behavior and it make HIV easy to transmit among
injection drug users.
The proportion of IDUs not using condom with FSWs and casual partners
33.6% and 41.3%, respectively. Different to wife/girlfriend, using actively
condom when having sex with FSWs was mainly decided by injection drug
users. That the IDUs play an active role in drug injection shows a good sign for
improving behavior using condom in sexual contact. However, relative low
proportion of always using condom when having sex with FSWs and casual was
65.5% and 29.2%, respectively. This indicates the high risk of HIV transmission
from IDUs to FSWs, casual partner, and among them due to unsafe sexual.
4.1.2. HIV prevalence among injection drug users
HIV prevalence among IDUs was 6.3% at baseline survey in 2011. This
prevalence is much lower than that in whole country in 2011 (13.4%) and many
provinces in South and North of Vietnam. This prevalence is higher than that in
neighbouring provinces in the same region. For instance, the HIV prevalence
among IDUs was 1% in Da Nang according to the second round of IBBS survey
in 2009. In 2010, Tran Kim Phung reported the HIV prevalence among IDUs
was 3.9% in Quang Tri. Results from current supervision in Quang Nam
showed very high HIV prevalence among IDUs, which accounted for 65.8% of
the total HIV infection cases detected within the last 5 years. The present study
also reflects that the real status of HIV transmission pathways in Vietnam is
mainly done through IDUs with data from intensive supervision from 1996 to
2014.
4.2. Effectiveness of prevention for HIV transmission among injection drug
users in Quang Nam
4.2.1. Effectiveness of counselling and HIV testing
The study showed that the proportion of IDUs had voluntary HIV testing
increased from 74.2% to 88.2% after 2-year intervention (p < 0.01).
The proportion of IDUs received counselling before HIV testing
increased from 31.8% before intervention to 63.3% after intervention (p<0.01);
the effective indicator was 99.1%. The proportion of IDUs received counselling
after HIV testing increased from 40.2% before intervention to 75.1% after
intervention (p<0.01); the effective indicator was 86.8%. After 2-year
intervention, voluntary counselling and testing for HIV has been changed
significantly. Studies on cost and home-based voluntary counselling and testing
for HIV in several countries have a conclusion that home-based voluntary
counselling and testing for HIV is a important component in the strategy of care
and prevention of HIV/AIDS in countries.
4.2.2. Effectiveness of care and support for injection drug users
After 2-year intervention, the proportion of receving communication on
safe injection in the past six months increased from 14.9% in 2011 to 58.6% in
2014 (p<0.01), and its effective indicator was 293.8%; the proportion of
receiving communication on safe sex increased from 28.1% in 2011 to 72.1% in
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