Injection and Sexual Risk Practices among Young Heroin users in Hanoi, Vietnam

Epidemiological data in Vietnam shows high HIV prevalence rates among injection drug users, especially in urban centres. However, there are limited data on specific practices used to prepare and inject drugs or on sexual practices among Vietnamese injectors. A street-based cross-sectional interview was conducted with 862 heroin injectors in Hanoi, Vietnam, to collect such data. Variability was seen in both injection and sexual risk, with 12.9% of current injectors reporting at least one unsafe method of drug sharing and 57.1% reporting unsafe sex in the past 30 days. These risks were strongly associated with those who engaged in unsafe injection significantly more likely to engage in unsafe sex (69.4% vs. 55.3%) and those engaging in unsafe sex significantly more likely to engage in unsafe injection (15.7% vs. 9.2%). These findings highlight the overlap of injection and sexual risk practices among Vietnamese heroin users and suggest the need for strong, broadly targeted HIV prevention activities among this population.

Heroin and other drug use and injection.

First heroin use – age	n
Mean	862	18.5
Range		11–27
First heroin use – mode of administration	n	%
Smoked	802	93.0%
Sniffed	3	0.3%
Injection	57	6.6%
First use – reason for using	n	%
Curiosity	459	53.3%
Wanted to get high	142	16.5%
Friends encouraged me	681	79.1%
Sex partner encouraged me	20	2.3%
Drug dealer encouraged me	22	2.6%
Other	127	14.8%
Time between initiation (smoking) and first injection	n	%
One month or less	29	3.6%
One month to one year	157	19.6%
More than one year	616	76.8%
First heroin injection – age	n
Mean	856	20.9
Range		11–29
First drug ever used to get high	n	%
Marijuana	16	1.9%
MDMA (Ecstasy)	4	0.5%
Amphetamine/methamphetamine	7	0.8%
Cocaine	2	0.2%
Morphine (Dolargan)	4	0.5%
Valium (Seduxen)	2	0.2%
Opium	120	13.9%
Heroin	707	82.0%
Ever used…	n	%
Tobacco	857	99.4%
Alcohol	765	88.7%
Marijuana	302	35.0%
MDMA (Ecstasy)	168	18.6%
Amphetamine/methamphetamine	298	34.6%
Cocaine	32	3.7%
Morphine (Dolargan)	106	12.3%
Valium (Seduxen)	290	33.6%
Opium	373	43.3%
Ketamine	16	1.9%
Ever injected …(among those who ever used …)	n (never used)	% (of ever used)
Amphetamine/methamphetamine	45 (298)	15.1%
Cocaine	4 (32)	12.5%
Morphine (Dolargan)	2 (106)	1.9%
Valium (Seduxen)	2 (290)	0.7%
Opium	92 (373)	24.7%
Ketamine	3 (16)	18.8%
Frequency of heroin use
Daily	707	82.0%
Fewer than half the days	64	7.4%
Used more than once on last day used	718	83.3%

Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

Current injection practices (past 30 days).

	n	%
Injected heroin	862	67.9%
Used syringe after someone else	42	4.9%
Gave used syringe to someone else	58	6.7%
Methods of drug division
Frontloaded to/from used syringe	44	5.1%
Backloaded to/from used syringe	6	0.7%
Mixed in cooker, everyone drew	25	2.9%
Any syringe sharing/unsafe drug division	111	12.9%
Frontloaded to/from sterile syringe	587	68.1%
Backloaded to/from sterile syringe	41	4.8%
Divided dry, each person prepared own	283	32.8%
Any safe drug division	737	85.5%
Shared syringe with more than one other person (injectors who shared only, n = 76)	49	64.4%
Injection groups
Usually inject alone	317	36.8%
Usually inject with different people (not same group)	359	41.7%
Usually inject with the same group	185	21.5%

Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

Current sexual practices among current heroin injectors.

	Males		Females
	n	%	n	%
Vaginal sex
Ever	720	90.1%	62	100%
Within the past month (among ever)	264	36.7%	50	80.6%
Within the past year (among ever)	528	73.3%	58	93.5%
Receptive anal sex
Ever	13	2.0%	6	9.7%
Within the past month (among ever)	6	46.2%	3	50.0%
Within the past year (among ever)	10	76.9%	5	83.3%
Insertive anal sex
Ever	39	5.1%	Na	Na
Within the past month	16	41.0%	Na	Na
Within the past year	26	66.7%	Na	Na
Last vaginal sex – age concordance
Partner was more than three years younger	161	23.9%	1	1.7%
Partner was 1–2 years younger	253	37.6%	3	5.0%
Partner was same age	133	19.8%	6	10.0%
Partner was 1–2 years older	57	8.5%	12	20.0%
Partner was more than three years older	69	10.3%	38	63.3%
Last receptive anal sex – age concordance
Partner was more than three years younger	1	8.3%	0	0.0%
Partner was 1–2 years younger	0	0.0%	0	0.0%
Partner was same age	2	16.7%	0	0.0%
Partner was 1–2 years older	0	0.0%	1	16.7%
Partner was more than three years older	9	75.0%	5	83.3%
Last insertive anal sex – age concordance
Partner was more than three years younger	4	12.5%	Na	Na
Partner was 1–2 years younger	7	21.9%	Na	Na
Partner was same age	4	12.5%	Na	Na
Partner was 1–2 years older	3	9.4%	Na	Na
Partner was more than three years older	14	43.8%	Na	Na
Condom use (among those who ever engaged in each specific practice)
Last vaginal sex	297	41.3%	30	48.4%
Last receptive anal sex	2	16.3%	1	16.7%
Last insertive anal sex	18	46.2%	Na	Na
Last vaginal sex work – client	Na	Na	18	81.8%
Last receptive anal sex work – client	1	14.3%	1	25.0%
Last insertive anal sex work – subject	4	36.4%	Na	Na
Exchanged sex for money
Ever	49	6.7%	31	50.0%
Last month	37	75.5%	27	87.1%
Sex work last month
Mean number of times (range)		9.1 (1–50)		31.2 (1–99)
Mean number of partners (range)		6.3 (1–40)		25.9 (1–60)

Numbers may not add up due to missing data; percentages have been adjusted to exclude missing data.

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By:  Goldsamt LA1, Clatts MC2, Le G3, Yu G1.

• 1College of Nursing (https://nursing.nyu.edu/), New York University, New York, NY, USA.
• 2School of Public Health, University of Puerto Rico, San Juan, Puerto Rico.
• 3Center for Research and Training on HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam. 
• Drugs (Abingdon Engl). 2015 Apr;22(2):166-172.

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