HANOI, Vietnam (Thomson Reuters Foundation) - Long overshadowed by the government's attention to other at-risk groups, Vietnam is failing to stem HIV among men who have sex with men (MSM), a group that is hidden due to social stigma.
"The evidence clearly shows that MSM in Vietnam are a population at a higher HIV risk that requires focus,” Christopher Fontaine, an adviser for the Joint UN Programme on HIV/AIDS (UNAIDS) in Vietnam, said.
“Out of all of Vietnam’s sub-epidemics, the epidemic among MSM appears to be rising the fastest.”
Driving the MSM-HIV emergence are Vietnam’s two largest cities: Hanoi (6.5 million people) and Ho Chi Minh City (7.4 million).
The HIV prevalence rate of MSM in Hanoi soared from 11 to 20 percent, while in Ho Chi Minh City it more than doubled from 6 to 14 percent between 2006 and 2009, according to the 2012 Integrated Biological and Behavioural Surveillance (IBBS) survey.
MSM with HIV are primarily seen as an urban problem, but high levels of stigma toward men having sex with men across the country can allow the virus to thrive, health experts warn.
“Although same-sex relationships aren’t illegal in Vietnam, they are not well accepted by Vietnamese society,” Fontaine said. “Men who have sex with men must enter an underground system in order to form sexual relationships. This is a huge barrier to reaching them with HIV services."
Vietnam still lacks an accurate countrywide HIV prevalence rate for MSM as IBBS data was only collected in four “hotspot” cities, three of which had rates of over 10 percent.
After having unprotected sex for some time, Kien Nguyen*, a gay university student living in Hanoi, tried to donate blood last September but instead discovered that he had HIV.
His post-graduation dreams of working for the Vietnamese government, which requires a medical screening before employment, are now uncertain, he said.
Ever since, he has been careful not to reveal his HIV status or sexual orientation as he is afraid of double stigma in a country where people with HIV face discrimination and traditional parents often disown homosexual offspring, he said.
“In my situation, I decided not to share my status,” he said. “I’m not sure what kind of difficulties I will face as a gay man with HIV.”
This fear of shame shared by others like Nguyen makes it particularly hard for outreach workers to debunk false or low perceptions of HIV risk found within Vietnam’s MSM population, estimated at 285,000.
“New infections are increasing for MSM but there are a limited number of them seeking services,” said Son Minh, executive board member of the Vietnamese Network of MSM and Transgender People, launched last year to assist and coordinate efforts of more than 90 local MSM groups.
“It’s our biggest concern since we cannot educate them on safe sex.”
On May 17, the International Day Against Homophobia and Transphobia activists will focus their attention on the Vietnamese government, which is considering to legalise same-sex marriage in its review of marriage and family laws.
But with homosexuality described by state-run media as a “social evil” as recently as 2002, it is unclear how the conservative nation will handle the change.
LACK OF RESOURCES
Despite an outspoken gay rights movement, men having sex with men have only recently been targeted and do not receive the full-range of programs and services compared to female sex workers (FSW) and injecting drug users (IDU), two other at-risk groups.
In 2010, only 2 percent of total HIV prevention funding was earmarked for MSM and there is no specific strategy yet, a 2012 joint UN report says.
Condom use among stood at 64 percent in 2012, although FSW and IDU groups had already surpassed the 80-percent goal set for 2015, according to the Vietnam Administration of HIV/AIDS Control.
“More cases of MSM with HIV will likely happen in the future due to the lack of attention it receives,” Dung Vu, a project officer for the Vietnam Network for People Living with HIV/AIDS, said.
The 2014 AIDS progress report did not break down MSM funding but noted a US$8 million decrease in expenditures for at-risk groups from 2009 to 2011.
Overall, HIV services have been reduced as a result of Vietnam’s new middle-income status, which has led to multi-million dollar funding cuts by foreign donors, which are responsible for more than 70 percent of the country’s HIV spending.
“The challenge faced by Vietnam’s health authorities is to [now] convince senior government leaders to invest domestic resources on evidence-based HIV programs that target key populations,” Fontaine said.
The 2014 report mentioned earlier stated that HIV among MSM has gained “greater recognition” in recent years while data on the epidemic is increasing. But only 42 percent of MSM receive HIV prevention services and 29 percent had an HIV test in the past year, the report added.
"Vietnam’s health authorities fully acknowledge the need to focus on MSM, but they struggle to address it,” Fontaine said.
*Not his real name