2. INNOVATIVE STRATEGIES TO CONTROL HIV
AMONG YOUNG PEOPLE WHO USE DRUGS IN VIETNAM
Khuat Thi Hai Oanh, Nguyen Thuy Linh, Nguyen Kieu An
Laurent Michel, Olivier Phan

3. The baseline assessment

4. 584 16 - 24 Respondent-driven-sampling method participants Hanoi (168)
Hai Phong (213)
Ho Chi Minh City (203)
Aged
63 MSM, 15 TG, 84 SW (44 male, 33 female, 7 TG)
Recruited by CBOs of PUD, SW, MSM, TG
Hanoi
Hai Phong
Reached by CBO or a participant
Explained about the project and the study
Sign consent form
Give urine for drug test
F2F interview &
Short self-ques.ire
Blood sample for HIV, HCV test after counselling
Return for test results
Receive
Counselling & Treatment support
Ho Chi Minh City
Respondent-driven-sampling method

5. Male: 462, Female: 122, TG: 5, MSM: 61, FSW: 44
Sexual behaviors
Tattooing
Mental Health
Delinquencies
Knowledge on HIV and HCV
Experience with HIV testing
Demographic &
KP identity
Family and Adverse Childhood Experiences
Environment: Stigma & Discrimination
Use of internet
Network
Drug use: type, mode, consumption, transition
Level of dependence
ATS withdrawal level
Experiences with treatment
HIV sero-status
HCV sero-status

6. Key findings

7. HIV «Heat-map» Prevalence: 6.3%
Hai Phong
0.5%
Hanoi
3.6%
HCMC
14.8%
Tattoo 8%
Stigma
& Discrimination
12.2%
Only cannabis 0%
MSM not inject
16.4%
Meth only drug:
5.9%
This slide needs some rearragement. The boxes with same color are not related and it’s confusing.
Oanh; we call this «heatmap» as the colors represent the severity relating to the infection.
Age up to 18
0.7%
Age
6.5%
Age 23 – 24
9.5%
Inject
17.8%

8. HCV «Heat-map» Prevalence: 9.4%
Hai Phong
3.3%
Hanoi
10.8%
HCMC
14.8%
Tattoo
13.2 %
Stigma
& Discrimination
15.9 %
Only cannabis
0 %
Meth only drug:
6.6 %
MSM
2 %
Same comments as per previous slide
Age up to 18
0.2 %
Age
5.9 %
Age 23 – 24
14 %
Inject
35 %

9. Dependence, mental health and treatment
52% of people who ever used heroin ever injected, sharing occur. Injection almost exclusive to heroin but some meth users (being discrete, looking for enhancement). Almost all meth users shared pipe % meth users reported moderate to severe effects % reported severe level of dependence % needed drugs to work/enjoy, or lost control of use –only 7-20% ever got any treatment for drug dependence % reported moderate or severe level of depression, almost no treatment .
Why is there a range for the results? Different results from the sites?
Oanh: yes, differences from sites.

10. DRUGS
* % of “ever used”
Tested (+) at sites: 71% with meth, 43% wt cannabis, 18% wt heroin.
Heroin users are older.
Heroin being “the junkies stuff”.
Experienced meth users use heroin to mitigate effects of meth, or substitute if can’t afford meth.
Cannabis users are younger.
16 – 30% drink several times/week.
33 – 38% smoke daily >=10 cigarettes
Trajectories:
Cannabis  Meth, or
Heroin  Meth, or
Meth  +Heroin smoke  +Inject
I don’t understand the two bars : Only (+) wt & Use Only

11. 29.5% reported never had sex
80% of those who had sex reported having at least one unsafe sex behavior.
Under influence of meth: more likely to be forced, or force others, group sex, unusual practices…
SW have higher prevalence: FSW: 6.8% vs female: 2.6%; MSW: 13.4% vs male: 6.3%.

12. Some other findings
7.4% in HCMC and 8.6% in Hanoi don’t have a birth certificate; 19% in HCMC and 28% in Hanoi are not registered in the city; 7% in HCMC, 32% in HN, 44% in Hai phong currently in school; Just over 50% have parents married or live together; 10-20% had one or both parents passed away; 20 – 28% reported at least 4/10 adverse childhood experiences.

13. - well, but rather superficial
Connectedness
- well, but rather superficial
Although 95.2% reported using with others, median time spent on internet is 3 to 5 hours,
most were not able to recruit more than 1 or 2 for the study.

14. HIV and HCV knowledge and testing
43-54% had correct knowledge on transmission % on HIV treatment;
27-48% tested, most in last 6 months and knew results;
Not tested: 60-79% considered having no risk 8-32% reported not having access The rest: fear of drug use and/or HIV status disclosed.
3-9% had correct knowledge on transmission 29-58% on treatment;
7-17% tested.
HCV

15. Needs for clinical care
Hanoi
HCMC
Hai Phong
HIV and/or HCV (12.5%)
11.3%
22.7%
3.8%
Drug dependence treatment
59.1%
65%
83.2%
Meth withdrawal
45.8%
47.6%
60.1%
Depression
34%
47.3%
HIV and HCV should be separated. HCV fibroscan resutls should be presented if it’s done.
Oanh: there is no fibroscan. Here only want to present the needs for clinical care. HIV and HCV prevalences are presented in the previous slides.

16. intervention

17. Addressing direct risks
Support safe injection among injectors;
Support safe sex, including under influence, especially MSM;
Raise awareness about tattoo, including dangerous practices;
Address HIV:
Increase HIV testing among PWID, MSM, SW, & PUD who over 18;
Intensively support ARV treatment access among those who are HIV+.
Address HCV risk:
Raise awareness about HCV;
Advocate for access to HCV treatment;
Promote HCV screening and treatment for YPUD.

18. Addressing underlying, fundamental causes of risks factors
Prevent/delay transition to/addition of:
Young cannabis users: meth.
Heroin users: meth
Long-term, dependent meth users: heroin, and heroin injection
Prevent adverse effects of drug use on behaviors:
Promote harm reduction practices for meth users;
Promote treatment of drug dependence and mental health for YPUD;
Mitigate effects of environmental factors: stigma and discrimination, family situation…
Advocate for public health approach to drug users.

19. Intervention approaches
Differentiated interventions;
Reach YPUD through internet and game;
Support the formation of a community: mutual support, & creating healthy norms;
Community-driven interventions by CBOs;
Advocacy for evidence-based policies and program, especially drug dependence treatment and mental health;
Build synergy with other stakeholders and programs.

20. THANK YOU! Cám ơn! MERCI!