title: Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.
abstract: BACKGROUND
  Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices.
  
  
  METHODS
  Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used.
  
  
  RESULTS
  Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk.
  
  
  CONCLUSIONS
  The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.
authors: School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia. tanvir.ahmed@griffithuni.edu.au.
authors: Tanvir
authors: T
authors: Ahmed
authors: Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam. longvaac@gmail.com.
authors: Thanh Nguyen
authors: TN
authors: Long
authors: Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam. huongphanmoh@gmail.com.
authors: Phan Thi
authors: PT
authors: Huong
authors: School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia. donald.stewart@griffith.edu.au.
authors: Donald Edwin
authors: DE
authors: Stewart
mesh_terms: D000328:Adult; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D035846:Law Enforcement; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D036301:Qualitative Research; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D014744:Vietnam / Q000453:epidemiology
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