What are the risk factors for HIV in men who have sex with men in Ho Chi Minh City, Vietnam?- A cross-sectional study

Le et al. BMC Public Health (2016) 16:406 DOI 10.1186/s12889-016-3088-8 RESEARCH ARTICLE Open Access What are the risk factors for HIV in men who have sex with men in Ho Chi Minh City, Vietnam?- A cross-sectional study Thi My Dung Le1, Patricia C. Lee2,3*, Donald E. Stewart2,4, Thanh Nguyen Long5 and Cuong Nguyen Quoc6 Abstract Background: The number of people living with HIV (PLWH) in Vietnam was estimated to rise from 156,802 in 2009 to 256,000 in 2014. Although the number of new HIV reported cases has decreased by roughly 14,000 cases per year from 2010 to 2013 a concerning increase in HIV prevalence has been identified among men who have sex with men (MSM) from 1.7 % in 2005 to 2.4 % in 2013. There are signs of increased HIV (+) prevalence among MSM in a number of cities/provinces, especially in the two largest cities, Ho Chi Minh City (HCMC) and Hanoi. HCMC is the country’s major “hot spot” for HIV/AIDS, with over a third of the total national AIDS patients. This paper is based on a secondary analysis of Integrated Biological and Behavioural Surveillance (IBBS) data collected in Vietnam in 2009 to examine the research question “Do behavioural risk factors contribute to HIV infection among the MSM population in HCMC?”. Methods: A cross-sectional design was employed to sample males aged over 15 from communities in HCMC, who reported having any types of sex with another man at least once during the last 12 months. Participants (399) were recruited using the respondent driven sampling (RDS) method and provided both biological data (specimens) and behavioural data collected through a questionnaire survey. Results: The study found high HIV prevalence (14.8 %) among the MSM sample from HCMC. Multivariate analysis found age and level of formal education completed, to be significantly associated with HIV infection. MSM aged over 25 were more likely to be HIV (+) than the younger group (OR = 7.82, 95 %CI = 3.37–18.16, p < 0.001); as were participants who had low educational (OR = 2.74, p < 0.05) and medium educational levels (OR = 2.68, p < 0.05). In addition, those participants who had anal sex with male partners (OR = 2.7, p < 0.05) and whose sexual partners injected drugs (OR = 2.24, p < 0.05) and who felt at risk of HIV infection (OR = 2.42, p < 0.01) had a higher risk of HIV infection. Conclusions: The high proportion of HIV (+) MSM in our sample from HCMC indicates that we need a better understanding of MSM behaviour patterns, risk practices and social networks as well as improved HIV prevention and control measures. More targeted and relevant HIV prevention programs for older and less educated MSM are urgently needed to address the key risk factors we have identified. MSM engaging in drug-related risk behaviours require multi-strategy HIV interventions relating to both sex and drug behaviour among MSM and their partners who engage in drug use. Further work is needed to identify locations and strategies where these high-risk individuals can be accessed as well as to reduce barriers related to social discrimination and stigma. Targeting high risk individuals and groups should supplement existing efforts aimed at the MSM population in HCMC. Keywords: HIV, Men who have sex with men (MSM), Ho Chi Minh City (HCMC), Risk factors * Correspondence: 2 Menzies Health Institute Queensland, Southport, Queensland, Australia 3 School of Medicine, Griffith University Gold Coast campus, Parklands Drive, Southport, Queensland 4222, Australia Full list of author information is available at the end of the article © 2016 Le et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Le et al. BMC Public Health (2016) 16:406 Background Globally, the HIV epidemic appears to have stabilised in recent years and the annual number of new HIV infections has slightly declined [1, 2]. However, the epidemic picture varies greatly in different regions and remains critical in South-East Asia with 4.8 million people living with HIV/AIDS (PLWH) in 2010. Vietnam, together with six other countries in Asia, namely India, China, Thailand, Indonesia, Malaysia and Myanmar contributed over 90 % of the total number of PLWH in the region in 2009 [3]. HIV has spread across Vietnam since the first case was identified in 1990 [4, 5]. The number of PLWH in Vietnam was estimated to rise from 156,802 in 2009 to 256,000 in 2014 (accounting for 0.26 % of the general population) [6, 7]. Although the number of HIV newly reported cases has decreased in Vietnam (roughly 14,000 new cases per year from 2010 to 2013), a growing concern about the HIV epidemic is the very high prevalence of HIV among sub-populations such as intravenous drug users (IDU), MSM and female sex workers (FSW) [8–10]. There have been significant falls in HIV prevalence among IDU from 29.35 % in 2002 to 22 % in 2013 and among FSW from 5.9 % in 2002 to 5.3 % in 2013 [8, 11, 12]. However, there are signs of an increase in HIV prevalence among MSM. HIV infection among MSM was projected to increase from 1.7 % in 2005 to 2.4 % in 2013, but a recent HIV sentinel survey showed a significant increase from 2.26 % in 2012 to 3.69 % 2013 [8]. This trend was even more serious in the two largest cities, HCMC and Hanoi. Statistics showed a growing HIV epidemic among MSM in these two cities with prevalence changing from 5.3 % and 9.4 % in 2006, to 14 % and 20 % in 2009 respectively [13–15]. In recent years, with rapid social and cultural changes, a growing number of men have openly identified themselves as MSM in Vietnam [4]. Further, recent studies show that the MSM populations are largely concentrated in urban areas especially in HCMC and Hanoi [14, 15]. The proportion of the MSM population in these two cities is much larger, with 3 % of total male population over 15 years old, compared with only 1.5 % in other cities/ provinces [11, 14]. HCMC is the biggest city in Vietnam and the major “hot spot” of the HIV/AIDS epidemic, with a prevalence of about 2 %, accounting for 36.5 % of the total national HIV/AIDS patients [16, 17]. The annual number of new HIV infections among MSM is projected to be higher than the new infections among IDU and FSW in HCMC [15]. While a wide range of studies and reports related to the HIV/AIDS epidemic is available for IDU and FSW in Vietnam, there are few studies, intervention programs and reports published on the MSM population [4, 11, 13, 16–19]. Although MSM are now a target Page 2 of 10 group for (...truncated)