HIV Knowledge and Risk Factors Among Men Who Have Sex With Men in Ho Chi Minh City, Vietnam

In 2001, more than 12,000 new HIV infections were reported in Vietnam. Sixty-six percent of the country's infections occur among intravenous drug users. Female commercial sex workers (CSWs) account for 4 percent of cases, while patients in STD clinics account for 3 percent. Twenty-five percent of infections have unknown risk factors, and 85 percent of infections occur in men and boys.

HIV surveillance in Vietnam targets six populations: IDUs, STD clinic patients, female CSWs, tuberculosis patients, pregnant women, and male military conscripts. Men who have sex with men are not included in routine surveillance.

The current study reports a cross-sectional survey of 219 MSM in Ho Chi Minh City (HCMC), conducted with a standardized questionnaire. The author's objective was to describe health risk behavior, knowledge and attitudes about HIV/AIDS among MSM in HCMC.

Colby notes that although HIV transmission outside western nations is thought to occur primarily through injection drug use and heterosexual sex, Asian countries that include MSM in their statistics report that MSM make up the following percentages of total AIDS cases: 29 percent in Singapore, 33 percent in the Philippines, 32 percent in Hong Kong, and 15 percent in Indonesia.

"The fact that surveillance and public health prevention efforts do not include MSM leads many individuals to believe that MSM in Vietnam are not at risk for HIV infection," Colby wrote. "That belief, combined with poor knowledge about HIV transmission and prevention, may make MSM less likely to protect themselves from HIV."

Four trained outreach workers recruited subjects for Colby's study. Eligible participants were those age 15 or older who were self-identified MSM who had sex with another man during the previous 12 months. The mean age of the 219 participants was 28.8. More than half had an income higher than 600,000 dong (approximately $41), the monthly average for workers in HCMC.

Sixty-seven percent of participants had ever used a condom, but only 32 percent had used one at their last sexual encounter. Of subjects whose last intercourse included anal sex, forty percent reported using a condom. Few reported drug use other than alcohol.

Most respondents knew the difference between high- and low-risk behaviors. Seventy-seven percent correctly identified at least three of four body fluids (blood, semen, and vaginal and pre-ejaculatory secretions) that could transmit HIV. However, only 47 percent knew that someone who looked and felt well could transmit HIV, and only 33 percent knew they could contract an STD from someone without symptoms.

Thirty percent agreed with the statement, "Homosexuals are at greater risk for HIV/AIDS than other people in Vietnam," while 31 percent disagreed and 39 percent were not sure. Forty-four percent of subjects were not sure how to rate their own HIV risk. Six percent rated their risk as high; 23 percent believed their risk was low; and 28 percent rated themselves at no risk.

Colby concluded that MSM in HCMC are at high risk for HIV, and suggested that, "HIV education specifically targeting MSM could improve knowledge and correct the false impression of low risk. Combined with the distribution of condoms and water-based lubricants in places where MSM meet and socialize, it might be possible to decrease high-risk sexual behavior and to prevent HIV transmission in this population."

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