Transcript How do Vietnamese youth learn about sexuality in the family?

Sex work - drug use
combination
and HIV/AIDS
Khuat Thi Hai Oanh, MD, MSc
Institute for Social Development Studies
Hanoi, Vietnam
Why care?
“Can HIV epidemics among IDUs
“trigger” a generalised epidemic?”
(Wiessing & Kretzschmar. 2003)
Sexual mixing with IDU is the pathway
to a generalised epidemic
This presentation is about…
Men and women poorly researched,
highly stigmatized against and usually
ignored for intervention:
– Sex workers who use drug
– Drug users who sell sex
– Sex-worker and drug-user companion
Current approach for
intervention
• Segmented:
– Injecting drug users = clean needle and
substitution
– Sex worker = condom
• Gender-biased
– IDU = male
– SW = female
Real life is more
complex
SW do inject
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In Vietnam: 20 – 40% FSW injected
58% FSW in Yunnan reported using drug
In Pakistan: 3% of FSW reportedly injected
In India: around 2% reported injecting in past
year; in Manipur: 19% FSW injected
• Among MSW: 3% in Cambodia, 4% in SE
Bangladesh reportedly injected
• (Tran 2005, Chen 2005, Moses 2006)
IDU do sell sex
• Two third of FIDU in Manipur exchange sex
for money/drug
• 80% FIDU in Guangxi involved in sex work
• 4% male IDU at Chiangmai drug treatment
center reported male-male sex, were paid for
• ISDS study on MSM in Hanoi: a number of
respondents reported buying sex from IDU.
• (Panda 2001, Reid & Constigan 2002, Beyer
2005)
MIDU – FI/SW companion
• IDU as regular/non-paying partner: 34% FSW
in Hanoi, 15% FSW in Pakistan
• Anthropological study in Vietnam: MIDU –
FI/SW couple for love, intimacy, sympathy,
protection, financial support, sex (Lam 2003)
• Frequent partner change (arrested, sent to
detox, financial difficulty, death...)
• Both SW and IDU far less use condom with
regular partner
Sharing: trust and more
• Sharing equipment in injecting couples:
– Symbol of trust and commitment
– Matter of convenience
– Economic reason
– Physical enjoyment
Condomless for intimacy
• Condom is associated with risk  perceived
as minor to sharing needle
• Condom perceived as inhibition to intimacy,
non-use of condom as expression of intimacy
committed couples don’t use condom
• Some senior male injectors have erectile
problem  hesitate to use condom
Higher risk to HIV
• Vietnam, HIV prevalence among MIDU
is declining to 25%, that among injecting
FSW increase 4 folds between 2000 –
05, reached 20 – 40% (MOLISA, 2006)
• In Yunnan, HIV prevalence among FIDU
significant higher than among MIDU
(Zhang et al, 2002)
Drug use –sex work combination
fuel HIV epidemic
MSM
IDU
SW
General population
An increasing phenomenon
• In Vietnam:
– Before: “05-centers” were for SW, “06centers” were for drug users; Now: “05” for
female, “06” for male
– Observing an increase in MSM population
– Increasing phenomenon of men selling sex –
a certain number are IDU
• Likely to happen in other Asian countries?
Some knowledge about
female injectors
• Many female injectors share
• Many end-up selling sex
• Many have drug users as regular
partners
Still many questions
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How and why they start?
Why and with whom they share?
What affect condom use?
How gender plays in sharing and condom
use?
• Which intervention(s) will help to
prevent/reduce FIDU selling sex?
• How interventions can be delivered to
them?...
Even more unknown about
MIDU selling sex
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Their sexual behaviors?
Who among MIDU sell sex?
To whom?
At which degree condom use?
What effect condom use?
How gender interplay with condom use
and sexual practices?
• ...
and about FI/SW-MIDU
companion
• What considered important to their
relationship?
• What effect it?
• Gender relation between couple?
• How to promote safe-sex?
• ...
Some
considerations for
Interventions
Layers of stigma
• Social:
– Sex work
– Drug use
• Fear:
– HIV-infection
• Gender-based:
– Female injecting
– Male selling sex
• Legal:
– Being arrested/imprisoned
• The association with the group
Programmatic implications
of stigma
• Heavier the stigma more difficult to
have supportive policy
• More stigmatized more hidden
• Stigma likely to push vulnerable groups
together
Gender difference in drug use
• Men more exposed to drug
• Given opportunity women will equally use it and
equally become addicted
• FIUD are more problematic: younger, more exposure
to unfavorable social factors, more health problems
• FIDU are more likely to have sex with an IDU
• MIDU more likely to commit crimes
• Double identify: sex work and drug use in women
• Drug use is twice more likely to be associated with
AIDS in women than in men
(NIDA 2000, Tran 2005, Chiang 2007)
Health needs
• Women: pregnancy, child-bearing
• Men: sexual function, use of other
substances (alcohol, tobacco...)
• Men selling sex: STIs, especially
anal/rectal STIs, injury...
• HIV and AIDS
Objectives for intervention?
• To prevent a generalised epidemic:
effective interventions = cut the link drug
use - sex work (prevent sexual mixing)
• To reduce vulnerability of both drug use
and sex work to HIV
Some thoughts for intervention
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SW, IDU are human being, have feeling & dignity
Reduce stigma and gender stereotype
Raise awareness of FSW on drug use, & addiction
Promote safer-sex in SW-IDU relationship
Gender-specific/sensitive HR activities
Reduce HIV infectivity (primary infection, AIDS...)
Study impact of different interventions
(substitution?) in reducing IDU selling sex
Examples of intervention for
sex work–drug use combination
in Asia?