The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: moving toward effective harm reduction.
BACKGROUND
Injection drug users represent the largest proportion of all HIV reported cases in Viet Nam. This study aimed to explore the perceptions of risk and risk behaviours among HIV-positive injection drug users, and their experiences related to safe injection and safe sex practices.


METHODS
This study used multiple qualitative methods in data collection including in-depth interviews, focus group discussions and participant observation with HIV-positive injection drug users.


RESULTS
The informants described a change in the sharing practices among injection drug users towards more precautions and what was considered 'low risk sharing', like sharing among seroconcordant partners and borrowing rather than lending. However risky practices like re-use of injection equipment and 'syringe pulling' i.e. the use of left-over drugs in particular, were frequently described and observed. Needle and syringe distribution programmes were in place but carrying needles and syringes and particularly drugs could result in being arrested and fined. Fear of rejection and of loss of intimacy made disclosure difficult and was perceived as a major obstacle for condom use among recently diagnosed HIV infected individuals.


CONCLUSIONS
HIV-positive injection drug users continue to practice HIV risk behaviours. The anti-drug law and the police crack-down policy appeared as critical factors hampering ongoing prevention efforts with needle and syringe distribution programmes in Viet Nam. Drastic policy measures are needed to reduce the very high HIV prevalence among injection drug users.
Thanh
Duong Cong
DC
Centre for International Health, University of Bergen, Bergen, Norway. congthanhnihe@yahoo.com
Moland
Karen Marie
KM
Fylkesnes
Knut
K
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D055030:Drug Users / Q000331:legislation & jurisprudence / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D035846:Law Enforcement; D008297:Male; D016485:Needle Sharing; D012309:Risk-Taking; D012650:Self Disclosure; D011477:Sex Work; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000821:virology*; D014744:Vietnam; D055815:Young Adult