Social Context, Diversity & Risk among Women Who Inject Drugs in Vietnam: Descriptive Findings from a Cross-Sectional Survey

Women who inject drugs (WWID) are neglected globally in research and programming yet may be likelier than males to practise sexual and injecting risks and be infected with HIV and more stigmatised but seek fewer services. Little is known about characteristics, practices and nexus between drugs and sex work of WWID in Vietnam, where unsafe injecting has driven HIV transmission, and commercial sex and inconsistent condom use are prevalent. This was the first quantitative investigation of Vietnamese WWID recruited as injecting drug users. This article summarises descriptive findings.

A cross-sectional survey was conducted among WWID in Hanoi (n = 203) and Ho Chi Minh City (HCMC) (n = 200) recruited using respondent-driven sampling. Characteristics varied within and between sites. Twenty-two percent in Hanoi and 47.5 % in HCMC had never sold sex. Almost all commenced with smoking heroin, some as children. Most injected frequently, usually alone, although 8 % (Hanoi) and 18 % (HCMC) shared equipment in the previous month. Some had sex—and sold it—as children; most had multiple partners. Condom use was high with clients but very low with intimate partners, often injecting drug users. HIV knowledge was uneven, and large minorities were not tested recently (or ever) for HIV. Nearly all perceived intense gender-related stigma, especially for drug use.

This ground-breaking study challenges assumptions about characteristics and risks based on anecdotal evidence and studies among men. Most WWID were vulnerable to sexual HIV transmission from intimate partners. Interventions should incorporate broader sociocultural context to protect this highly stigmatised population.

Below:  Reasons given (%) for starting to use drugs (>1 response acceptable)

Below:  Sequence of using drugs, selling sex (among those who had sold sex) (%) (Hanoi n = 158, HCMC n = 106)

Table 4
Injecting behaviour by site
	Hanoi % (95 % CI)	HCMC % (95 % CI)
Who introduced you to drug use?	n = 203	n = 200
Friend	70.6 (62.3–78.8)	72.6 (66.0–79.0)
Boyfriend/husband	24.6 (17.1–31.5)	11.6 (7.0–17.0)
Drug dealer	0.0 (0.0–0.0)	0.6 (0.1–1.2)
Sibling	1.8 (0.0–4.5)	5.8 (2.7–9.4)
Client	1.5 (0.0–4.4)	1.4 (0.0–3.6)
Age first drug use	n = 203	n = 200
<16	0.5 (0.1–0.9)	12.1 (7.3–18.0)
16–20	27.8 (18.7–37.7)	49.7 (41.4–56.4)
21–25	40.3 (30.3–50.4)	29.4 (23.4–37.6)
26+	31.4 (22.7–40.7)	8.8 (4.4–12.8)
Two most common injecting locations	n = 203	n = 200
Own house	87.1 (82.0–93.5)	50.2 (41.0–58.1)
Public toilet	37.8 (29.0–49.6)	29.2 (21.7–36.3)
Street or park	18.4 (10.1–26.0)	37.6 (30.5–45.9)
Guesthouse or hotel	40.6 (33.4–50.6)	5.7 (2.9–9.1)
Home of male partner	20.1 (12.6–30.3)	4.5 (2.6–6.9)
Frequency of injecting (past month)	n = 203	n = 200
4–6 times a week	4.7 (0.0–6.6)	1.0 (0.0–1.6)
About once daily	8.8 (5.1–13.0)	18.3 (10.7–25.8)
2–3 times daily	60.7 (50.6–71.0)	59.2 (50.8–67.6)
4+ times daily	19.2 (12.3–27.6)	21.5 (15.4–28.5)
Shared needles and syringes (NS) in past month	n = 196	n = 199
	8.3 (1.8–14.8)	18.4 (12.9–24.7)
At last injection	n = 203	n = 198
No others present	68.0 (57.5–77.4)	61.4 (52.8–69.8)
One or more others present	32.0 (22.7–42.6)	38.6 (30.2–47.3)
Shared drugs a	34.9 (17.2–67.3)	39.1 (21.4–53.0)
Shared mixing water a	38.0 (7.9–72.7)	59.7 (43.6–88.0)
Shared NS occasion a	24.8 (2.9–50.2)	33.6 (15.8–50.8)

a Among those who did not inject alone

Khuat et al.

Khuat et al. Harm Reduction Journal 2015 12:35   doi:10.1186/s12954-015-0067-9

Full article at: http://goo.gl/SrGnBS

By: Oanh TH Khuat^1*, Martha Morrow², Trang NN Nguyen³ and Gregory Armstrong²

¹Center for Supporting Community Development Initiatives (SCDI), Hanoi, Vietnam

²Centre for Mental Health, University of Melbourne, Victoria, 3010, Australia

³Center for Promotion of Quality of Life (Life Center), Ho Chi Minh City, Vietnam

  

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