Barriers to access and uptake of antiretroviral therapy (ART) among HIV positive MSM in Hanoi, Vietnam

Stream: HIV Treatment: Issues in uptake and adherence
Date: Thursday, 31 March 2016
Time: 1.45 pm – 3.00 pm

Abstract

Objective: Approximately 20% of people living with HIV (PLHIV) in Vietnam are unaware of their status and only 40% of these have access to ART. Little is known about what happens when men who have sex with men (MSM) are diagnosed with HIV. This study aimed to explore barriers to access and uptake of ART among HIV positive MSM in Hanoi. Methods: We conducted 35 in-depth interviews with MSM receiving (n=20) and not receiving (n=15) ART. Participants were recruited using snowball sampling based on previous research and social networks. Interviews ranged from 60 - 120 minutes and were transcribed prior to thematic analysis. Results: Preliminary results highlight the role of syndemic conditions, including the dual stigma of HIV and same-sex relationships and a lack of community support, leading to fear of disclosure of HIV status. Health system barriers included reticence by providers to discuss risk behaviours and same-sex relationships, aggravated by limited time and space for clinical encounters. Many lacked knowledge about treatment at diagnosis and some reported reluctance to accept their diagnosis. Synergisms between these factors impede access to, and uptake of, ART. Conclusions: This is the first study to examine ART uptake among Vietnamese MSM. Results indicate a need to address stigma and discrimination and to build confidence and comfort in both the affected and broader community. Removing health system barriers to create a safe, confidential treatment environment for MSM will also be necessary if Vietnam is to achieve its stated goal of complying with UNAIDS 90-90-90 targets.

Authors

Bui Thi Minh Hao (Presenter), The Kirby Institute
Hao Bui is a PhD student with the Viral Hepatitis Epidemiology and Prevention Program at the Kirby Institute at UNSW. She completed undergraduate and postgraduate degrees in Public Health at Hanoi Medical University and her research interests include HIV, viral hepatitis and sexually transmitted infections among key population in Vietnam. Her thesis focuses on estimating HIV incidence and understanding HIV risk behaviour in a prospective cohort of men who have sex with men in Hanoi.

Le Minh Giang, Center for Research and Training on HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Dr Giang Le is the Principal Investigator of Center for Research and Training on HIV/AIDS and Vice-Head of Department of Scientific Research and Technology Management, Hanoi Medical University, Vietnam. Graduated from Hanoi Medical University as a general practitioner, Dr Giang got Masters and PhD training in Medical Anthropology and Socio-medical Sciences at Columbia University. Early in research career, he was awarded the Young Investigator Award at the 2006 Toronto International AIDS Conference. Over the past decade, he has managed and led many NIH-funded studies on substance abuse and HIV risk among key populations in Vietnam.

Iryna Zablotska-Manos, The Kirby Institute
Dr Zablotska is an epidemiologist at the Kirby Institute, UNSW Australia. She is an investigator on a number of studies on risk behaviour and behavioural surveillance. She leads the Institute’s work on PrEP, including the NSW demonstration study PRELUDE, and was involved in the development of the NSW and national PrEP guidelines.

Lisa Maher, The Kirby Institute
Lisa Maher is a Program Head at the Kirby Institute for infection and immunity, Professor in the Faculty of Medicine at the University of New South Wales, and a NHMRC Senior Research Fellow. Professor Maher is internationally recognised as a leading researcher on the ethnography and epidemiology of injecting drug use and related harms. She has extensive experience in research, program development and service delivery with drug users, sex workers, people living with HIV/AIDS and other vulnerable groups in North America, Asia, Australia and the Pacific. Her current research focuses on the prevention of infectious disease in vulnerable populations.