Micah Pepper
In 2010, the HIV epidemic is expected to shift in intensity from Sub-Saharan Africa to Asia, with Injection Drug Users (IDUs) playing a central role in the rapid growth of HIV prevalence (Hammett). Drug use in Vietnam started growing during the USA-Vietnam War, but intensified after the economic liberalization of the late 1980s and 1990s (Thanh). In 2007, UNAIDS estimated 290,000 people living with HIV in Vietnam, with a 45.2 prevalence of HIV among IDUs in major urban areas and a 23.7 prevalence outside of urban areas[1] (UNAIDS Epi). HIV IDUs make up the largest proportion of HIV cases reported in Vietnam (Thanh), and this population is a central risk factor in the spread of the epidemic. Efforts in HIV prevention among IDUs have been slow and continue to face many cultural, social and political barriers. However, HIV transmission among IDU populations has reduced since adapting harm reduction policies such as Needle Syringe Programs (NSP), Peer Educators, and Opioid Substitution Treatments (OST) (Hammett).
RISK BEHAVIORS
IDUs are at high risk of HIV transmission in Vietnam due to unsafe injection practices. While studies indicate that sharing injection equipment has decreased over the past few years (Thanh), over 30% of IDUs reported sharing syringes in Hanoi (Pankonin). In addition to equipment sharing, the reuse of equipment and leftover drugs are pivotal in HIV transmission. Shooting galleries––discrete locations where drugs are sold and injected––are associated with high risk behavior as they support an increased likelihood of equipment sharing, less access to safe injecting equipment, and limited access to clean rinse-water or a clean injecting environment (Hien). Other risk factors for HIV transmission include receiving injections from drug dealers, injecting on the streets and sharing drug pots (Hien).
SOCIAL, CULTURAL AND POLITICAL RESISTANCE
Drug use carries huge social and cultural stigmas in Vietnam, and drug users are widely considered a “social evil” (Hammett). IDUs and people living with HIV often face discrimination, isolation, and fear of rejection. One qualitative study highlighted four common HIV-related fears and stigmas shared by people living with HIV: personal feelings of shame, behavior changes directed towards people living with HIV, a stigmas regarding HIV transmission, and general stigma attached to being associated with a person living with HIV. These stigmas and fears are harmful to individuals, families, and communities, and discourage people from seeking testing and treatment (Gaudine).
The possession, sale and use of drugs are illegal in Vietnam; those who are found in violation of these laws face strict punishments including forced detoxification, mass arrest, and incarcerations (Hammett). Recognized injection locations are often raided by law enforcement, and IDUs have developed quick and unsafe routines for drug use in order to avoid arrest, including discarding injection equipment in public areas (Pankonin). Fear of being arrested is a barrier to IDUs seeking safer injection practices. Despite the availability of safe injecting equipment through needle-syringe programs, IDUs remain reluctant to carry needles because of fear of being arrested, putting pressure on IDUs to get drugs and equipment from dealers or to participate in high risk needle sharing or reuse (Thanh). Harm reduction as a priority response for HIV prevention among IDUs was slow to start in Vietnam due to law enforcement and police resistance, a lack of political support, and unsafe practices. However, the implementation of harm reduction into Vietnam’s cultural, social, and political responses to IDUs plays a pivotal role in HIV prevention.
