title: Có vay có tra (What goes around comes around): culture, risk and vulnerability to blood-borne viruses among ethnic Vietnamese injecting drug users.
abstract: OBJECTIVE
  Ethnic and cultural differences in vulnerability to drug-related harms have received little attention in Australia. The current study aimed to explore the influence of cultural beliefs and practices on vulnerability to blood-borne viral infections (BBVIs) among ethnic Vietnamese IDUs and to identify barriers to this group accessing health and preventive programmes.
  
  
  METHODS
  Observational fieldwork and in-depth interviews (n = 58) were conducted in South Western Sydney. Participants were recruited using a mix of snowball and theoretical sampling strategies. Open coding was used to inductively classify data into themes and data examined for regularities and variations in relationships between and within themes.
  
  
  RESULTS
  Participants embraced pluralistic approaches to prevention, diagnosis and treatment, relying on co-existing layers of beliefs and utilising both traditional and western remedies. Four main cultural characteristics influenced vulnerability to BBVIs: trust and obligation, stoicism, the importance of 'face' and beliefs in fate. Other factors influencing injecting risk included low levels of knowledge, being in a state of withdrawal, availability of sterile injecting equipment and environmental constraints. Barriers to accessing services included stigma and discrimination, concerns in relation to confidentiality, long waiting times, resistance to pharmacotherapy treatment and language and financial barriers.
  
  
  CONCLUSIONS
  Results indicate a need for interventions based on culturally specific meanings and contexts of health, illness and risk. By understanding how culture impacts risk and protective behaviours among ethnic Vietnamese IDUs, clinicians and other service providers will be better equipped to meet the needs of this vulnerable group.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia and Hanoi School of Public Health, Vietnam.
authors.forename: Hien Thi
authors.initials: HT
authors.lastname: Ho
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D000328:Adult; D017848:Blood-Borne Pathogens; D003466:Cultural Characteristics; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D012309:Risk-Taking; D013240:Stereotyping; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D014744:Vietnam / Q000208:ethnology; D014777:Virus Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000635:transmission