Key Findings


Average self reported baseline CD4 was 291.7 cells/mm3

Only 9.6 % of respondents received a viral load test 

The average duration between HIV diagnosis and first CD4 test was 16.8 months (median: 3.6 months, range: 0-162 months)

13.5 % of those taking ART had experienced some delay in treatment initiation.

20.1% respondents reported having been sick in the 6 months prior to the interview and 77.5% of them required hospitalisation 

Average cost of treatment was 1,370,098 VND (64.5 USD) which is almost a double of an monthly income of respondents. 

Only 49.4% of participants reported being able to get condoms whenever they needed.

3% of participants reported having had their HIV status disclosed by a health care professional without their consent. 

Among 704 PWID interviewed, 32.4% had no steady partner but 60% of those without a steady partner were sexually active and only 20% always used condoms.  

Among PWID with steady partners, only 59.4% of those steady partners were known to be HIV positive. Only 54.6% always used condoms.

24.8% of respondents or their spouse were pregnant since their HIV diagnosis and 41.9% of these were unintended.

33% were advised not to have children.0.5% reported being coerced to terminate pregnancy due to HIV status of mother

16.6% of respondents were still on a stavudine

Study Outline


 Since 2001, the Asia and the pacific region, has seen a 20% drop in the new HIV infections. In that same time the number of people living with HIV/AIDS who have access to ART has tripled. Despite this progress, access to ART, remains very low, with over 60% of PLHIV not having access to treatment. Overall, the East, South and South East, Asian region has some of the lowest levels of access in the world. For many years PLHIV groups were raising voice against a lack of rigorous research and information on the barriers and enablers to access to treatment, care and support. Historically studies in the region have been ad-hoc, and not representative of the needs and experiences of those affected by the disease.

Study Objectives 


 The overall objective is to monitor and document the issues related to PLHIV’s access to HIV treatment, care and support services in Asia and the Pacific region. The specific objectives of this study is to assess the HIV treatment-related issues such as access to pre-ART care, ART, ART adherence, treatment literacy, high risk behaviours, mental health status, health seeking behaviours, etc. and, to monitor changes in key issues in community access to treatment, care and support services.

Country Context 


The HIV epidemic in Vietnam continues to be concentrated among three populations defined by high levels of HIV-transmission risk behaviours: people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM). Decreasing or stabilizing trends in HIV prevalence among PWID and FSW in certain provinces over the past three years suggest that the epidemic is stabilizing. In some provinces, however, the number of detected HIV cases has actually been increasing, particularly in the Northern mountainous provinces and some provinces bordering Laos. The 2012 sentinel surveillance data from 39 provinces shows that HIV prevalence among PWID and FSW remains high, at 11.4% and 3% respectively. Similarly, the 2009 Integrated Biological and Behavioral Surveillance (IBBS) survey measured HIV prevalence among MSM in 4 cities. Prevalence ranged from 4.9% among non-male sex workers to 19.8% among male sex workers. According to results of the 2012 Vietnam HIV/AIDS Estimates and Projections, HIV prevalence among adults aged 15 – 49 years was 0.46% in 2012. There were an estimated 258,500 people living with HIV (PLHIV) in 2013, a number expected to rise to 263,317 by 2015. Roughly 14,000 new infections have been reported annually from 2009-11. AIDS case reports and related mortality have also remained fairly steady since 2009.

 

Methods  


Screen Shot 2014-07-18 at 8.29.03 PMSample size was determined using proportionate sampling method with error allowance of 0.004 and a target of 1615 people living with HIV was set for Vietnam. The sample size was then distributed based on geographical caseload reported by National AIDS Program. Risk-group and gender specific seeds (initial respondents) were recruited, using convenience sampling. Thereafter, a snow-ball sampling technique was used to enroll study respondents with seeds recommending their peers to the study. 

 Respondents were recruited from 7 provinces across Vietnam Thai Nguyen, Dien Bien, Hai Phong, Ha Noi, Nghe An, HoChiMinh city and An Giang. A structured questionnaire was used to collect data. There were 14 sections and an interview in an average took 69 minutes to complete. A total of 15 data collectors were used. Ethical clearance was given by an ethical review panel at Ha Noi School of Public Health.

All respondents were provided standard information on the study and a written consent was obtained. Data collection was carried out between  4th December 2012 and 21st March 2013.

Soco-Demographics


Screen Shot 2014-07-18 at 8.31.13 PMThe mean age of respondents was 34 years. 

53.1% of respondents were male, 46.6% female and 0.4% TG. 

20.6% live in a rural area, 9.9% live in a small town and 69.5% in a large town or city. 

49.9% of respondents had a partner or spouse and were living with that person, 40.9% were single, divorced or widowed.

26.3% of all respondents reported being members of NGO or CBO and 12.2% did work in a HIV program. 

80.9% of respondents earned some form of income, on averaged 3,113,117VND (146.9 USD) per month.

Almost half of the respondents had completed secondary school (45.3%), and 37.4% had  completed higher secondary or college level education. 

The average household size for all respondents was 3.8 people.

The most common self-identified risk group was injecting drug user (43.6%). [Multiple choice question]

HIV Diagnosis and Pre-ART Care 


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The most common reasons given for going for a HIV test was due to a self identified risky behaviour (33.2%). 

The most common place for getting a HIV test was in a government hospital (43.3%). 

91.5% of respondents reported having had a CD4 test done, 

Less than one tenth reported having had a viral load test done (9.6%). 

The average baseline CD4 was 291.7 cells/mm3 

55%) of the study respondents sought government hospitals or government clinics for HIV consultation while 36% went to NGO Clinic 

The average duration of time that CD4 test was done  after HIV diagnosis was 16.8 months (median: 3.6 and 162 months)

Health Seeking behaviour and associated costs


75.6% visited their doctors, nurses or health workers at least once a month and 4.6% visited only when they are sick. 

20.1% respondents reported of being sick within 6 months prior to the interview. 

22.5% of those required hospitalisation, and the average amount spent on treatment was 1,370,098 VND (64.5 USD). 

Only 9.3% of those who were sick mentioned that they received some sort of subsidy. 

72.2% reported that they paid out of their pocket for their treatment. 

39.6% of respondents had some kind of health insurance.

15.5% had received home-based care services.

Stigma and Discrimination


52% of respondents had disclosed their HIV status to someone other than their spouse, close family member or health care worker. 

2.9% (37) of respondents who disclosed their status had been forced to change their residence or were unable to rent accommodation because of their HIV status.

Less than 1.5% of respondents reported having been denied health services due to their HIV status. 

3% of respondents reported having had their HIV status disclosed by a health care professional without their consent.

48% of respondents had not disclosed their HIV status to their health care provider and only 48.7% of respondents were confident that their medical records were being kept completely confidentially.

Relationship with Health Care Provider


Only 2.9% of respondents on ART agreed or strongly agreed that they were sometimes insulted when talking to their HCP.

48.3% of respondents on ART agreed or strongly agreed that their HCP made them feel comfortable when discussing any issues.

77.1% of respondents on ART agreed or strongly agreed that their HCP had told them of the possible side effects of their ARVs.

81.6% of respondents on ART agreed or strongly agreed that their HCP had told them of the changes to expect in their health when taking ARVs.

HIV Risk Behaviours


150 respondents reported to be current injecting drug users.

36% of PWID reported that they were able to get access to clean syringes whenever they needed them. 26% reported never being able to access clean syringes

33.8% of respondents with a spouse or partner reported that the HIV status of their partner was negative or unknown.

49.4% of respondents reported being able to get condoms whenever they needed them. 14.2% were never able to get condoms.

Among 704 PWIDs interviewed for the study 67.6% had  a steady partner. 48 % of those without a steady partner were sexually active and only 60% always used condoms. Condom use was also low amongst PWID interviewed with only 54.6% of those with a steady partner reporting consistent condom use with their partner. Only 40.1% of PWID with a HIV positive partner reported consistent condom use.

Reproductive Health


63.3% of respondents have children, of whom 9.8% are known to be HIV positive. 

51.4% of  respondents with a spouse/steady partner had received counselling on child baring since being diagnosed with HIV.

Only 7 respondents reported being coerced into being sterilised. 

 

24.8% of respondents in a relationship, or their spouses, had become pregnant since being diagnosed.

Only half of those pregnancies were intended (51%).

Treatment of Co-Infections (TB and HCV)


36.9% were diagnosed with TB after being diagnosed with HIV.

80.5% of those received treatment and 94.2% of those had completed treatment.

57.6% of respondents were provided with information on Hep C.

52.8% of respondents were offered a HCV test.

28.4% (188) of those tested were found positive for Hep C.

Only 15 of whom had received treatment for Hep C.

 

The average cost of Hep C treatment was 3,800,000 VND (178.9 USD)

Treatment Literacy


Screen Shot 2014-07-18 at 8.43.43 PMHIV Treatment literacy was measured by respondents answers to 25 questions. The higher score represents a higher knowledge of HIV prevention and treatment. The mean score for HIV treatment literacy was 19.5. Less than 3% of the total respondents had low treatment literacy, scoring below 5. 23.9% of respondents had used the internet to search for HIV related information. 

ART Regimen and Self-reported Adherence


The average time on ART was 3.7 years. Of the 1390 who were taking ART, 55.5% were taking ART for three years and above. 

48.5% of respondents on ART had changed regimen at least once since starting treatment. 

2% of respondents did not know what ART is.

13.5% of those on ART had experienced some delay in treatment initiation.

 

86.1% of respondents were on ART and those were not currently on ART were not eligible at the time of the interview. The most common regimen was Ziudovudine + Lamuvudin + Nevirapine (34.9%). 16.6% of respondents were still on a Stauvoidine..

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ART Regimen and Self-reported Adherence


Among the current ARV users,70.1% (974) reported taking 95-100% of their ARV drugs while 29.9% (416) reported taking less than 95% of their drugs.

60.3% of respondents on ART reported to have never missed a dose of their ARVs. 

The mean self-reported proportion of ARVs taken in the last month was 95.6%

12.7% reported to have missed an appointment with HCP in the 3 months prior to interview. 56.8% of those who missed an appointment cited being busy as the reason.

Long Term Side Effects (self reported)


95% of respondents on ART experienced at least one of the listed long-term side effects.

31.7%  were told by a clinician that their body fat has changed due to side-effects of ARV

49.4% reported to have felt numbness in the limbs

84.7% reported to have had problems with the liver

National Network of People Living with HIV/AIDS Vietnam (VNP+)


Website: wwww.vnpplus.com

Email: vnpplus2008@gmail.com

VNP+ is the Vietnam Network of People living with HIV and AIDS (PLHIV) that represent PLHIV individuals, groups and provincial networks in Vietnam. It is an organization run, by and for people living with HIV and AIDS. VNP+ works to advocate for the rights of positive people, to fight stigma and discrimination, and for better access to treatment, care and support. VNP+ is also involved in implementing prevention programmes.

VNP+’s Operation Principals are: Voluntary, Democracy, Equality, Development, Sustainability, Unity, Creativity and Transparency. Based on these principals, VNP+ has created a great unity and consent, gathered many strong local groups and networks with a support of PLHIV from different classes and backgrounds (even including foreign PLHIV). Many members have experience of managing and implementing HIV/AIDS related projects/ programs.

Mission:


By 2018, VNP+ will have been recognized by national and international organizations for its meaningful engagement in and contribution to HIV/AIDS prevention and control in Viet Nam; its human resources will be strong enough for its tasks of training, consulting and policy advocacy related to HIV/AIDS, serving to protect the rights and realize the duties of PLHIV in the response to the epidemic..

Legal status: 


VNP+ was legally registered in 2009.

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