Pamela Wright

A hidden HIV epidemic among women in Vietnam

BackgroundThe HIV epidemic in Vietnam is still concentrated among high risk populations, including IDU and FSW. The response of the government has focused on the recognized high risk populations, mainly young male drug users. This concentration on one high risk population may leave other populations under-protected or unprepared for the risk and the consequences of HIV infection. In particular, attention to womens risks of exposure and needs for care may not receive sufficient attention as long as the perception persists that the epidemic is predominantly among young males. Without more knowledge of the epidemic among women, policy makers and planners cannot ensure that programs will also serve womens needs.MethodsMore than 300 documents appearing in the period 1990 to 2005 were gathered and reviewed to build an understanding of HIV infection and related risk behaviors among women and of the changes over time that may suggest needed policy changes.ResultsIt appears that the risk of HIV transmission among women in Vietnam has been underestimated; the reported data may represent as little as 16% of the real number. Although modeling predicted that there would be 98,500 cases of HIV-infected women in 2005, only 15,633 were accounted for in reports from the health system. That could mean that in 2005, up to 83,000 women infected with HIV have not been detected by the health care system, for a number of possible reasons. For both detection and prevention, these women can be divided into sub-groups with different risk characteristics. They can be infected by sharing needles and syringes with IDU partners, or by having unsafe sex with clients, husbands or lovers. However, most new infections among women can be traced to sexual relations with young male injecting drug users engaged in extramarital sex. Each of these groups may need different interventions to increase the detection rate and thus ensure that the women receive the care they need.ConclusionWomen in Vietnam are increasingly at risk of HIV transmission but that risk is under-reported and under-recognized. The reasons are that women are not getting tested, are not aware of risks, do not protect themselves and are not being protected by men. Based on this information, policy-makers and planners can develop better prevention and care programs that not only address womens needs but also reduce further spread of the infection among the general population.

Barriers to access prevention of mother-to-child transmission for HIV positive women in a well-resourced setting in Vietnam.

BackgroundAccording to Vietnamese policy, HIV-infected women should have access at least to HIV testing and Nevirapine prophylaxis, or where available, to adequate counselling, HIV infection staging, ARV prophylaxis, and infant formula. Many studies in high HIV prevalence settings have reported low coverage of PMTCT services, but there have been few reports from low HIV prevalence settings, such as Asian countries. We investigated the access of HIV-infected pregnant women to PMTCT services in the well-resourced setting of the capital city, Hanoi.MethodsFifty-two HIV positive women enrolled in a self-help group in Hanoi were consulted, through in-depth interviews and bi-weekly meetings, about their experiences in accessing PMTCT services.ResultsOnly 44% and 20% of the women had received minimal and comprehensive PMTCT services, respectively. Nine women did not receive any services. Twenty-two women received no counselling. The women reported being limited by lack of knowledge and information due to poor counselling, gaps in PMTCT services, and fear of stigma and discrimination. HIV testing was done too late for optimal interventions and poor quality of care by health staff was frequently mentioned.ConclusionIn a setting where PMTCT is available, HIV-infected women and children did not receive adequate care because of barriers to accessing those services. The results suggest key improvements would be improving quality of counselling and making PMTCT guidelines available to health services. Women should receive early HIV testing with adequate counselling, safe care and prophylaxis in a positive atmosphere towards HIV-infected women.

Holding the line: Family responses to pregnancy and the desire for a child in the context of HIV in Vietnam.

Health services around the world offer many guidelines for HIV‐positive women who are pregnant or who want to become pregnant, and for women with HIV infected partners. These guidelines are addressed to women and, increasingly, also to men, but pay little or no attention to the role of other members of the family in fertility decisions. This study looked at factors influencing decisions about fertility in families with an HIV‐positive member. In Vietnam, the whole family takes a crucial role in deciding whether a woman should become pregnant and whether she will keep her child. This decision is taken in the context not only of the close family but also under the influence of ancestors and the weight given to them within the culture. Key in this regard is the need for parents and grandparents to have male offspring. Health workers share these ideas about preferred family composition and support men and women in the quest for male offspring. Policies and guidelines should take into account these additional family factors and goals as a basis for the design of appropriate programmes to reduce HIV transmission.

Dealing with a positive result: Routine HIV testing of pregnant women in Vietnam

Abstract HIV testing is an essential component of PMTCT. It can be offered to pregnant women through different testing models, ranging from voluntary counseling and testing (VCT) to routine and mandatory testing. This study was conducted in Hanoi, Vietnam, where HIV-prevalence is low among the general population, but high among young, urban, sexually active, male intravenous drug users. Women who want to deliver in a state hospital are routinely tested for HIV in the absence of well-defined opt-out procedures. In-depth interviews with a convenience sample of 38 seropositive pregnant women and mothers and 53 health workers explored the acceptability of routine testing. Patients and healthcare workers appeared to accept routine ‘blood’ tests (including HIV tests) because they feel uncomfortable discussing issues specific to HIV/AIDS. To avoid having to inform women directly about their HIV status, health workers at routine testing sites rely on the official notification system, shifting the responsibility from the hospitals to district and commune health staff. The notification system in Hanoi informs these local officials about the HIV status of people living in their catchment area without patients’ consent. Our study shows that this non-confidential process can have serious social, economic and health consequences for the HIV-positive women and their children.

Self-Help Groups Can Improve Utilization of Postnatal Care by HIV-Infected Mothers

&NA; HIV prevention within maternal‐child health services has increased in many developing countries, but many HIV‐infected women in developing countries still receive insufficient postnatal care. This study explored the experience of 30 HIV‐infected women in Vietnam in accessing HIV‐related postnatal care, the role of felt and enacted stigma in accessing services, and the effects of participation in a self‐help group on utilization of available services. Many HIV‐infected women were not provided with adequate information on postnatal care by health workers. Most women reported both felt and enacted stigma that affected their access to care. Involvement in self‐help groups improved the womens self‐esteem, increased knowledge about HIV, and had a positive effect on both felt and enacted stigma from family, community, and health services. These results suggest the need for better information provision and better referral systems within the health services and suggest that establishing self‐help groups can diminish felt stigma and facilitate access to services for women and their children.

HIV-positive mothers in Viet Nam: using their status to build support groups and access essential services

Abstract Various support and self-help groups for people living with HIV and their families have developed in Viet Nam in recent years. This paper reports on a case study of Sunflowers, the first support group for HIV positive mothers in Hanoi, begun in 2004, and a sister group begun in 2005 in Thai Nguyen province. From April 2004 to early 2007, we carried out semi-structured interviews with 275 health care workers and 153 HIV-positive women and members of their families, as well as participant observation of group meetings and activities. Sunflowers have successfully organised themselves to access vital social, medical and economic support and services for themselves, their children and partners. They gained self-confidence, and learned to communicate with their peers and voice their needs to service providers. Based on personal development plans, they have accessed other state services, such as loans, job counselling and legal advice. They have also gained access to school and treatment for their children, who had previously been excluded. Although the women were vulnerable to HIV as wives and mothers, motherhood also provided them with social status and an identity they used to help build organisations and develop strategies to access the essential services that they and their families need. Résumé Ces dernières années, plusieurs groupes de soutien et d’auto-assistance pour les personnes vivant avec le VIH et leurs familles se sont développés au Viet Nam. Une étude de cas a porté sur Sunflowers, premier groupe de soutien des mères séropositives créé à Hanoi en 2004, et un groupe apparenté lancé en 2005 dans la province de Thai Nguyen. D’avril 2004 à début 2007, nous avons mené des entretiens semi-structurés avec 275 agents de santé et 153 femmes séropositives membres de Sunflowers et leurs familles, et observé les participants aux réunions et aux activités des groupes. Les membres de Sunflowers sont parvenues à s’organiser pour bénéficier des services sociaux, médicaux et d’aide économique vitaux pour elles-mêmes, leurs enfants et leurs partenaires. Elles ont acquis de l’assurance et appris à communiquer avec leurs pairs et à faire connaître leurs besoins aux prestataires de services. Sur la base de plans de développement personnel, elles ont obtenu l’accès à d’autres services étatiques, comme les prêts, l’orientation professionnelle et les conseils juridiques. Elles ont aussi pu scolariser et faire soigner leurs enfants, auparavant exclus de ces prestations. Bien que les femmes soient vulnérables au VIH en tant qu’épouses et mères, la maternité leur confère un statut social et une identité dont elles se servent pour construire des organisations et définir des stratégies donnant accès aux services essentiels dont elles et leurs familles ont besoin. Resumen En los últimos años han surgido en Vietnam diversos grupos de apoyo y autoayuda para las personas que viven con VIH. Este artículo informa sobre un estudio de caso de Sunflowers, el primer grupo para madres VIH-positivas en Hanoi, fundado en el año 2004, y un grupo asociado iniciado en 2005, en la provincia de Thai Nguyen. Desde abril de 2004 hasta principios del 2007, realizamos entrevistas semiestructuradas con 275 trabajadores de salud y 153 mujeres VIH-positivas, quienes eran miembros de Sunflowers, y con los miembros de sus familias, así como observación participante de las reuniones y actividades del grupo. Las mujeres de Sunflowers han logrado organizarse para acceder al apoyo y los servicios vitales sociales, médicos y económicos para sí mismas, sus hijos y sus parejas. Adquirieron confianza en sí mismas y aprendieron a comunicarse con sus pares y expresar sus necesidades a los prestadores de servicios. Basándose en sus planes de desarrollo personal, han accedido a otros servicios estatales, como préstamos, orientación profesional y asesoría jurídica. También obtuvieron acceso a la escuela y tratamiento para sus hijos, que anteriormente habían sido excluidos. Aunque las mujeres eran vulnerables al VIH como esposas y madres, la maternidad también les dio posición social y una identidad que utilizaron para ayudar a crear organizaciones y formular estrategias para acceder a los servicios esenciales que ellas y sus familias necesitan.

Depression, anxiety, and suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study

BackgroundThere is a rapidly growing public awareness of mental health problems among Vietnamese secondary school students. This study aims to determine the prevalence of anxiety, depression, and suicidal ideation, to identify related risk factors, and to explore students’ own proposals for improving their mental health.MethodsA cross-sectional study was conducted among 1161 secondary students in Can Tho City, Vietnam during September through December, 2011. A structured questionnaire was used to assess anxiety, depression, suicidal ideation and proposed solutions. Depression was measured using the Center for Epidemiology Studies Depression Scale.ResultsThe prevalence estimates of symptoms reaching a threshold comparable to a diagnosis of anxiety and depression were 22.8% and 41.1%, respectively. Suicide had been seriously considered by 26.3% of the students, while 12.9% had made a suicide plan and 3.8% had attempted suicide. Major risk factors related to anxiety and depression were physical or emotional abuse by the family, and high educational stress. As proposed solutions, nearly 80% of students suggested that the academic workload should be reduced and that confidential counselors should be appointed at schools. About half the students stated that the attitudes of their parents and teachers needed to change. A significant majority said that they would visit a website that provided mental health support for students.ConclusionsAnxiety, depression, and suicidal ideation are common among Vietnamese secondary school students. There are strong associations with physical and emotional abuse in the family and high educational stress. Academic curricula and attitudes of parents and teachers need to be changed from a punitive to a more supportive approach to reduce the risk of poor mental health. An internet-based mental health intervention could be a feasible and effective first step to improve students’ mental health.

Perceptions of climate change and its impact on human health: an integrated quantitative and qualitative approach

Background The World Health Organization emphasized that climate change is a significant and emerging threat to public health, especially in lower income populations and tropical/subtropical countries. However, people in Asia and Africa were the least likely to perceive global warming as a threat. In Vietnam, little research has been conducted concerning the perceptions of effects of climate change on human health. Objective The aim of this study was to explore the perceptions on climate change and its impact on human health among people in Hanoi. Design We applied a combined quantitative and qualitative approach to study perceptions on climate change among people in Hanoi. A total of 1,444 people were recruited, including 754 people living in non-slum areas and 690 people living in slum areas of Hanoi. A structured questionnaire was used to collect quantitative data on their perceptions. In a parallel qualitative study, two focus group discussions and 12 in-depth interviews (IDs) were carried out involving 24 people from both slum and non-slum areas. Results The majority of the respondents in the study had heard about climate change and its impact on human health (79.3 and 70.1% in non-slum and slum areas, respectively). About one third of the respondents reported that members of their family had experienced illness in the recent summer and winter compared to the same seasons 5 years ago. The most common symptoms reported during hot weather were headaches, fatigue, and dizziness; hypertension and other cardiovascular diseases were also reported. During cold weather, people reported experiencing cough, fever, and influenza, as well as pneumonia and emerging infectious diseases such as dengue and Japanese encephalitis. Conclusions The observed high level of awareness on the links between climate change and human health may help to increase the success of the National Prevention Program on Climate Change. Moreover, understanding the concerns of the people may help policy makers to develop and implement effective and sustainable adaptation measures for Hanoi City as well as for Vietnam as a whole.Background The World Health Organization emphasized that climate change is a significant and emerging threat to public health, especially in lower income populations and tropical/subtropical countries. However, people in Asia and Africa were the least likely to perceive global warming as a threat. In Vietnam, little research has been conducted concerning the perceptions of effects of climate change on human health. Objective The aim of this study was to explore the perceptions on climate change and its impact on human health among people in Hanoi. Design We applied a combined quantitative and qualitative approach to study perceptions on climate change among people in Hanoi. A total of 1,444 people were recruited, including 754 people living in non-slum areas and 690 people living in slum areas of Hanoi. A structured questionnaire was used to collect quantitative data on their perceptions. In a parallel qualitative study, two focus group discussions and 12 in-depth interviews (IDs) were carried out involving 24 people from both slum and non-slum areas. Results The majority of the respondents in the study had heard about climate change and its impact on human health (79.3 and 70.1% in non-slum and slum areas, respectively). About one third of the respondents reported that members of their family had experienced illness in the recent summer and winter compared to the same seasons 5 years ago. The most common symptoms reported during hot weather were headaches, fatigue, and dizziness; hypertension and other cardiovascular diseases were also reported. During cold weather, people reported experiencing cough, fever, and influenza, as well as pneumonia and emerging infectious diseases such as dengue and Japanese encephalitis. Conclusions The observed high level of awareness on the links between climate change and human health may help to increase the success of the National Prevention Program on Climate Change. Moreover, understanding the concerns of the people may help policy makers to develop and implement effective and sustainable adaptation measures for Hanoi City as well as for Vietnam as a whole.

Recreating Kinship: Coping Options of HIV+ AIDS Widows in Vietnam

In this retrospective study we explore the life trajectory of Vietnamese HIV-positive AIDS widows over a period 2 years after their husbands’ deaths in a patrilinear and patrilocal setting where HIV is stigmatized. Some options, such as widows living with their eldest son, are not available to young HIV-positive widows, but the women in our study furthered their own interest by joining support groups, looking for new partners, and strengthening relations with their own family. Most women who returned to live with their family found a new intimate relationship through support groups for HIV-positive persons.