Vietnam is disproportionately affected by the HIV epidemic
amongst countries in Southeast Asia (Colby and Cao 2004; Rao et al. 2010; Garcia et al. 2012). The HIV epidemic in
Vietnam is concentrated in high-risk populations, including injection drug
users, male and female sex workers, and men who have sex with men (MSM) (Hoang et al. 2006; Hoang et al. 2009). Male sex workers (MSWs),
who are men who exchange sex for money, goods, or other drugs primarily with
other men in Vietnam, are at particularly high risk for HIV acquisition and
transmission, and are a crucial group for focusing HIV prevention efforts (Hoang et al. 2006;Nguyen et al. 2007; Hoang et al. 2009; Mimiaga et al. 2012). A large proportion of
MSW in Vietnam are in urban areas, are frequently migrants from other regions,
and have unstable housing (Clatts et al. 2007; Biello et al. 2013). MSW in Ho Chi Minh City
tend to be young, with the majority of individuals under the age of 30 (Biello et al. 2013).
Sex work, drug use, and male-male sexual behavior are
considered to be “social evils” in Vietnam (Tran et al. 2005; Luong 2006; Rao et al. 2010), introducing stigma and discrimination
for this population. Stigma can broadly be defined as negative attitudes,
relative powerlessness, and loss of status related to a particular
characteristic (King et al. 2013). In other contexts,
experiences of stigma and discrimination are associated with increased risk for
HIV infection, possibly through social isolation, depression, and subsequent
increase in risky sexual practices, such as engaging in unprotected anal sex
(UAS) and drug or alcohol use during sex (Diaz et al. 2001; Thomas et al. 2012). In addition, stigma and
discrimination have been shown to be associated with reduced care-seeking
behavior in Vietnam (Thanh et al. 2012). Individual experiences of
sexual minority stigma, which is generally defined as lack of power, regard,
and inferior status of members of sexual minorities, can be grouped into three
categories: Enacted stigma, which includes explicit behavior including use of
derogatory language and active shunning and discrimination, and sexual assault
or violence; Felt stigma which refers to the expectation of enacted stigma; and
Self-stigma, which incorporates stigma into one’s feelings towards the self (Herek 2007). Among female sex workers, both
stigma has been shown to be independently associated with HIV testing;
HIV-related stigma (stigma related specifically to being HIV-infected) has been
shown to be associated with decreased HIV testing and sex work-related stigma
(stigma related specifically to being a sex worker) with increased testing (King et al. 2013). Male sex workers in
particular may experience stigma from multiple dimensions.
Few studies have specifically assessed sex work-related
stigma among men. The aim of the present study was two-pronged. First, to
better understand factors related to sex work-related stigma among Vietnamese
MSW, we assessed correlates of sex work-related stigma in this population.
Second, to understand how sex work-related stigma affects mental health and
vulnerability to HIV, we assessed the association between sex work-related
stigma and depression and sexual risk-taking behavior.
Table 1
Participant responses to questions regarding experience with stigma
| Question | Response, N(%) |
|---|---|
| How often have you been made fun of or called names for engaging in sex work? | Never – 190 (63.8%) Once or twice – 26 (8.7%) A few times – 45 (15.1%) Many times – 37 (12.4%) |
| How often have you been hit, beaten, or sexually assaulted for engaging in sex work? | Never – 259 (87.2%) Once or twice – 20 (6.7%) A few times – 11 (3.7%) Many times – 7 (2.4%) |
| How often have you heard that sex work or sex workers are not normal? | Never – 54 (18.1%) Once or twice – 48 (16.1%) A few times – 93 (31.1%) Many times – 104 (34.8%) |
| How often have you felt that people would dislike you if they know that you are a sex worker? | Never – 75 (25.3%) Once or twice – 54 (18.2%) A few times – 90 (30.4%) Many times – 77 (26.0%) |
| How often have you felt afraid of being harassed or arrested by the police for engaging in sex work? | Never – 116 (38.9%) Once or twice – 32 (10.7%) A few times – 62 (20.8%) Many times – 88 (29.5%) |
| How often have people’s comments and actions toward sex workers affected your emotional and mental wellbeing? | Never – 115 (38.5%) Once or twice – 45 (15.1%) A few times – 75 (25.1%) timesMany times – 64 (24.1%) |
Full article at:
By:
1Department of Epidemiology, Harvard School of Public Health, Boston, MA
2The Fenway Institute, Fenway Community Health Boston, MA
3Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
4Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam
5Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA
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