1. THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS H HIV Prevention for Female Sexual Partners of People Who Inject Drugs: Evaluation Results Theodore M. Hammett, Ph.D. Abt Associates, Cambridge, MA USA Khuat Thi Hai Oanh, M.D., M.Sc. Centre for Supporting Community Development Initiatives (SCDI), Hanoi

2. The 6 th National Scientific Conference on HIV/AIDS Background Vietnam’s HIV epidemic is driven primarily by injection drug use Vast majority of PWID are male and most are sexually active IDUs’ female sexual partners (SPs) may be at high risk for HIV sexual transmission from PWID to SPs USAID/Health Policy Initiative Vietnam and the Global Fund supported HIV prevention interventions for SPs in Hanoi, Ho Chi Minh City, and Dien Bien

3. The 6 th National Scientific Conference on HIV/AIDS Sexual Partners Interventions Based on community-based organization (CBO) model Peer outreach and education Mobile HIV Testing and counseling (HTC) Encouragement to disclose status within couples Linkage to HIV treatment Overall, improve continuum of HIV care for SPs

4. The 6 th National Scientific Conference on HIV/AIDS Conceptual Model: CBOs Address 3 Key Domains Macro-environment: policy, program: reduce stigma, advocate for improved legal/policy framework Micro-environment: couples, social networks, peer social norms: social/network norms to promote and sustain positive behaviors Individual: self-efficacy: improve motivation, reasoning, behavior change Derived from: Wagner DK et al, 2010 Strathdee SA et al, 2010.

5. The 6 th National Scientific Conference on HIV/AIDS Objectives Present results of the evaluation of the SP intervention Focus on SPs’ level of knowledge of their male partners’ HIV status Make recommendations for improvement of interventions

6. The 6 th National Scientific Conference on HIV/AIDS Methods Evaluation of interventions based on serial cross-sectional surveys (behavioral interviews and HIV testing) In 2013, we conducted separate but linked surveys of male PWID and their SPs

7. The 6 th National Scientific Conference on HIV/AIDS Results and Discussion

8. The 6 th National Scientific Conference on HIV/AIDS HIV Prevalence Among PWID and Their SPs, 2013 HanoiDien BienHCMC PWID (n= 200) SPs (n=200) PWID (n=300) SPs (n=300) PWID (n=249) SPs (n=249) HIV Prevalence 43.5%26.5%30.3%10.0%46.2% 36.7%

9. The 6 th National Scientific Conference on HIV/AIDS Evaluation Results -- positive Interventions based on CBO model were effective in many ways –Successfully reached HIV-negative women in serodiscordant relationships with improvements identified in condom use and relationship characteristics (Hammett, AIDS Behav, 2013). –Consistent condom use associated with exposure to interventions in Hanoi (Hammett, AIDS Behav, 2013).

10. The 6 th National Scientific Conference on HIV/AIDS Condom use by exposure to interventions -- Hanoi Measure of Condom Use Not Exposed Exposed p-value (Chi- square test)* Used condom at last sex 23.7%38.0% <0.001 Used condom always or often in past 6 months 15.9%31.9% <0.001 Logistic regression: SP who received advice more likely to use condom at last sex: (OR = 1.647; 95% CI 1.206 – 2.248, p =<0.001). For condom use always/often in the past 6 months: (OR = 2.293; 95% CI 1.617 – 3.252, p < 0.001). *Data pooled across all 5 survey waves.

11. The 6 th National Scientific Conference on HIV/AIDS Condom use by exposure to interventions- Dien Bien Measure of Condom Use Not Exposed Exposed p-value (Chi- square test)* Used condom at last sex 39.7%58.5%<0.001 Used condom always or often in past 6 months 34.7%53.5%<0.001 Logistic regression: SP who received advice more likely to use condom at last sex: (OR = 2.480; 95% CI 1.587 – 3.876, p < 0.001). For condom use always/often in the past 6 months: (OR = 2.527; 95% CI 1.605 – 3.978, p < 0.001). *Data pooled across both survey waves.

12. The 6 th National Scientific Conference on HIV/AIDS Condom use by exposure to interventions -- HCMC Measure of Condom Use Not Exposed Exposed p-value (Chi- square test)* Used condom at last sex 27.9%31.4%0.4287 Used condom always or often in past 6 months 23.9%30.3%0.1451 Logistic regression: SP who received advice more likely to use condom at last sex: (OR = 1.185; 95% CI 0.768 – 1.829, p = 0.4287). For condom use always/often in the past 6 months: (OR = 1.381; 95% CI 0.882 – 2.163, p = 0.1451). *Data pooled across both survey waves.

13. The 6 th National Scientific Conference on HIV/AIDS Evaluation Results – the down side Despite improvements, deficiencies in information regarding HIV status within couples pose problems for durable risk reduction. Correct knowledge of HIV status does not guarantee that appropriate risk reduction measures will be followed but lack of correct information almost certainly increases likelihood that risky behavior will continue.

14. The 6 th National Scientific Conference on HIV/AIDS SPs’ beliefs about PWID partner’s HIV status vs. actual test results SP’s belief re PWID’s HIV status PWID’s HIV test result (+)(-) (+) Hanoi Dien Bien HCMC 55.7% 68.1% 56.0% 18.1% 43.3% 27.5% (-) Hanoi Dien Bien HCMC 17.9% 17.6% 25.0% 53.2% 39.4% 35.9% Don’t know Hanoi Dien Bien HCMC 26.4% 14.3% 19.0% 28.7% 17.3% 36.6% Total for each site100% Hammett et al., JAIDS, 2015

15. The 6 th National Scientific Conference on HIV/AIDS SPs’ beliefs about PWID partner’s HIV status vs. previous test results SP’s belief re PWID’s HIV status PWID’s previous HIV test result (self-reported) (+)(-) (+) Hanoi Dien Bien HCMC 79.2% 77.5% 67.3% 22.6% 34.8% 27.7% (-) Hanoi Dien Bien HCMC 0.0% 15.0% 21.8% 54.8% 48.3% 36.9% Don’t know Hanoi Dien Bien HCMC 20.8% 7.5% 10.9% 22.6% 17.0% 35.4% Total for each site100% Hammett et al., JAIDS, 2015

16. The 6 th National Scientific Conference on HIV/AIDS Estimated Number of SPs at High Risk for HIV in Vietnam %Number Number of PWID ~200,000 HIV+ PWID27.5%55,000 Sexually active PWID50%27,5000 SPs with incorrect knowledge of male partners’ HIV status 40%11,000 Hammett et al., JAIDS, 2015

17. The 6 th National Scientific Conference on HIV/AIDS Recommendations Add SPs to the list of key affected populations. Address both sexual and injecting behaviors in interventions. Give more emphasis to ARV treatment as prevention, with early treatment initiation. Improve HTC services and strategies to increase mutual disclosure of HIV status within couples. Increase focus on empowerment of SPs --individually, in couples, and as “communities” -- and couples’ interventions. These findings and recommendations are relevant to HIV epidemics in which injection drug use is playing a major or emerging role, such as those in Vietnam and elsewhere in Asia, Eastern Europe, the Middle East, and parts of Africa. Also relevant to reaching SPs of other key populations.

18. The 6 th National Scientific Conference on HIV/AIDS Acknowledgements USAID/PEPFAR for support and encouragement Centre for Supporting Community Development Initiatives (SCDI) for intervention design and implementation Provincial HIV/AIDS Centers/Committees in Hanoi, HCMC, and Dien Bien Abt-Vietnam staff and local data collectors Ryan Kling (Abt Cambridge) for statistical analysis All SPs and PWID who participated in the interventions and evaluation

19. The 6 th National Scientific Conference on HIV/AIDS Cam On! Thank-you! For further information: ted_hammett@abtassoc.com ted_hammett@abtassoc.com oanhkhuat@scdi.org.vn