Thạc Sĩ Knowledge and behaviors at risk of hiv/aids transmission among ethnic minorities in quang tri provin

INTRODUCTION

1.1 Background
Research in various parts of the world has explored a wide variety of determinants affecting condom use by young people fromdifferent countries and cultures. From this research report briefly determinants can be categorized into the following major groups: intra-personal determinants, interpersonal determinants, and environmental determinants.
1.1.1 HIV/AIDS prevalence in Vietnam
Since the first HIV/AIDS case was reported in HCMC in 1990, the HIV epidemic in Vietnam has spread rapidly, primarily due to the expansion of injection drug use throughout the country. The VAAC reported in June 2009, the countrywide cumulative reported number of HIV infections had reached 149,653, including 32,400 AIDS cases and 43,265 AIDS deaths. The HIV prevalence is 176/100,000 PY[1]. In terms of gender, the proportion of HIV infections is four times higher among males than females (79% vs. 20.98%). However, the number of female cases has been increasing due to the risk of contracting HIV from their husbands or boyfriends.For the first half of the year 2009, male HIV cases have decreased to 74.4% while female cases have increased to 25.7%[1].
HIV transmitted through the blood transmission route pre-dominates accounting for 50-60% of the total reportedcases since the year 2000. HIV transmitted through the ***ual route has been increasing from 15% in 2005 to 28% by the end of June 2009[2]. Case distribution also indicated that ***ually transmitted HIV infections are more likely to be reported by southern and central provinces while IDU transmitted HIV cases are more concentrated in northern provinces[3, 4].
The HIV epidemic in Vietnam is still in the concentration stage. Injection drug use and *** work have continued to be the key drivers of the epidemic. National HIV sentinel surveillance data in 2008 indicated 20% HIV prevalence among IDUs, 3% among FSWs, 9.4% among men having *** with men (MSM) in Hanoi and 5.3% among MSM in HCMC. The number of FSWs with records (so-called registered FSWs) is much lower, about 3-4 times lower than the actual estimate number, with IDUs accounting for about half of the total cases reported[5].
The Vietnam Government has a National strategy for HIV/AIDS prevention and control till 2010 and a vision to 2020, which states the need to strengthen bilateral and multilateral cooperation and expand international cooperation with neighboring countries and other countries in the region in the field of HIV/AIDS prevention and control.
1.1.2 HIV/AIDS prevalence in Quang Tri
In Vietnam, 2010, there was an estimated 254,000 PLHIV. The prevalence of HIV in the general population is currently estimated to stand at 0.53% of the 616,000 inhabitants of Quang Tri Province, Central Vietnam[6]. Among them, few people have been tested for HIV. The results in 2010 showed that of the 215 people living with HIV, 160 were men and 55 were women with 116 living with AIDS.
The total number of 321 infected persons in the year 2010 compared to 185 in 2009 demonstrates that there are dramatically increasing situation in Quang Tri. It also shows that the local partners participated in an encouraging effort to provide more facilities to be tested and accompanied in the province[7, 8].
As reported elsewhere in the world, PLHIV face social and economic exclusion, discrimination and stigma by other members of the community.
In Quang Tri, the situation is more challenging due to the rural culture and the ignorance of the risks of HIV. As a result there have been many recent efforts to combat the HIV epidemic.
In 2002, a study conducted at five border area provinces (including Quang Tri province in the Vietnam - Laos border areas) found that the rate of condom use among FSWs atthe last time they had *** with regular or casual clients in the past 12 months, was higher than in other border areas (more than 90% if both kinds of clients combined; or 84.6% with casual clients and 66% with regular clients). However, only 10% of the women reported using condoms with their husbands/boyfriends. Meanwhile, this study also reported that only 20% of the LDDs in Quang Tri always using condoms with casual *** partners or with FSWs, and only 10% used condoms when having *** with their wives/girlfriends.
The increased need for economic exchange and cooperation in Vietnam’s recent past has led to the growth of infrastructure development and investment at regional and national levels. Inter-country roads are among the top infrastructure development priorities and have contributed to the process of regional integration. In the Mekong sub-region, the EWEC is one of the three routes drawing the attention of such donors as the ADB and the Japanese government. The 1,600km corridor connects the Indian and Pacific Oceans. In Vietnam, the corridor has been built on the route that was known during the Vietnam War as “Route Number Nine.” The completion of EWEC construction has increased regional mobility and has helped generate trade opportunities for the region, especially between Laos, Thailand and Vietnam.
The development of road infrastructure in rural residential areas has led to an increase in trade and accessibility and has therefore spurred economic and social development. Local people are increasingly able to access previously inaccessible services and trade opportunities. The development of routes, however, has influenced the social habits of affected communities in oft-unexpected ways. Many of these changes have the potential to negatively affect the public health, especially by increasing the risk of contracting HIV and STDs.
In 2004, HMU was sponsored by The Rockefeller Foundation to conduct research to evaluate the public health risks and emerging disease vulnerabilities brought about by the EWEC development in Vietnam. This anthropological research was conducted in three sites: (1) Lao Bao border town, which is the border gate to Vietnam from Laos; (2) Dakrong commune, located at the junction of EWEC and the Ho Chi Minh Route; (3) Ango commune, located by Ho Chi Minh route and is 50km away from the newly-constructed EWEC.The development of routes, however, has influenced the social habits of affected communities in oft-unexpected ways. Many of these changes have the potential to negatively affect the public health, especially by increasing the risk of contracting HIV and ***ually transmitted diseases (STDs). The research has shown risks and vulnerability of local people in different geographic areas.
In May 2008, HMU’s sponsorship by The Rockefeller Foundation was renewed to conduct research geared at increasing awareness of HIV and STDs related risks in the three aforementioned sites.
1.2 Research Question
What are the factors associated with behavior at risk of HIV/AIDStransmission among ethnic minorities in Quang Tri, Vietnam?
1.3 Research Objectives
1.3.1 General objective
To identifybehaviors at risk of HIV/AIDS transmissionamong ethnic minorities inQuang Tri province, Vietnam.
1.3.2 Specific objectives
ã To assess characteristics of socio-demographicvariables,knowledge, perception, source of information and condom use to prevent HIV/AIDS among ethnic minorities in Quang Tri Province.
ã To determine factors associated with behaviors at risk of HIV/AIDS transmission among ethnic minorities.
1.4 Conceptual Framework:
The conceptual framework of the study has displayed with the variables as follow:
1.4.1. Outcome variables:
Behavior at risk of HIV/AIDS transmission: unsafe *** behaviors:
ã Prevalence of having *** with non-co-resident partner without condom
ã Prevalence of incorrectly condom using when had *** with non-co-resident partner
1.4.2. Exposure variables:
ã Knowledge on HIV/AIDS
ã Knowledge on STDs
ã Knowledge on safe *** behavior
ã Attitude on HIV prevention
ã Accessibility with information of HIV prevention (communication, health worker, social media )
ã Travel
1.4.3. Potential confounders:
ã Education level.
ã Current age.
ã Ethnic group.
ã Marriage status.
Conceptual framework
1.5 Variables and operation definition
1.5.1 Outcome variables
ã Prevalence have *** with non-co-resident partner without condom refer to total people who reported had *** with non-co-resident partner without condom within the last 12 months divide to all people responded.
ã Prevalence use condom incorrectly when had *** with non-co-resident partner within the last 12 months divide to all people responded.
1.5.2 Exposure variables
1.5.2.1 Knowledge of HIV/AIDS
ã Correct knowledge of HIV/AIDS:
o AIDS is an infection caused by a virus named after HIV
o HIV reduce healing capacities when contracting other diseases
o HIV lives in blood
o HIV is present in men’s sperm
o Existence of vaccine to prevent HIV/AIDS transmission
o Being able to self-prevent HIV/AIDS transmission
o There are medicines, which can cure HIV/AIDS
ã Correct knowledge of HIV/AIDS transmission:
o Transmission from mother to child during pregnancy
o Via unsafe ***ual relationship
o Blood path (sharing syringes and needles when injecting drugs/transmitting HIV-infected blood)
1.5.2.2 Knowledge of STDs
ã Correct knowledge of the cause of STDs:
o Due to unsafe ***
o Personal hygiene not well maintained
o Health care not in a right way
o Due to bacteria /virus/parasites
ã Correct knowledge of the sign of STDs;
o Pain/red swollen
o Discomfort/painful/difficult urination
o Itching genitals
o Ulcer/vesicular
o Genital discharge/abnormal menstruation (for women)
o Discharge (for men)
o Pain during ***
1.5.2.3 Accessibility of information on HIV/AIDS prevention
ã Prevalence of recorded know any information on HIV/AIDS
ã Number sources of information on HIV/AIDS prevention
1.5.3 Potential confounders: current age, education level, ethnic
ã Current age: age was calculated from the subtraction of date of interview and date of birth.
ã Education level: treated as ordinal variable stratified into 5 levels: elementary, secondary, high school, vocational school/college, university degree.
ã Ethnic: Vietnam is a multi-nationality country with 54 ethnic groups. The Viet (Kinh) people account for 87% of the country’s population. The other 53 ethnic minority groups, totaling over 8 million people, are scattered over mountain areas (covering two-thirds of the country’s territory) spreading from the North to the South.
1.6 Significance of the study
The increased need for economic exchange and cooperation in Vietnam’s recent past has led to the growth of infrastructure development and investment at regional and national levels. Inter-country roads are among the top infrastructure development priorities and have contributed to the process of regional integration. In the Mekong sub-region, the East-West Economic Corridor (EWEC) is one of the three routes drawing the attention of such donors as the Asian Development Bank (ADB) and the Japanese government. The completion of EWEC construction has increased regional mobility and has helped generate trade opportunities for the region, especially between Laos, Thailand and Vietnam. The development of road infrastructure in rural residential areas has led to an increase in trade and accessibility and has therefore spurred economic and social development. Local people are increasingly able to access previously inaccessible services and trade opportunities.In May 2008, Hanoi Medical University’s sponsorship by The Rockefeller Foundation was renewed to conduct research geared at increasing knowledge and behaviors at risk of HIV/AIDS transmission in Dakrong district, Quang Tri province.
Scope of studies
ã Data were derived from a cross-sectional study, so we could only examine the association between some factors associated with behaviors at risk of HIV/AIDS transmission. We cannot confirm a causal
Strengths
ã The study focused on the age group from 14-45.This group has regular ***ual activity. In Vietnam, in some ethnic minorities we have “DI SIM’ manners. When the boy is over 14 years old, he can find lovers over 14 years old in other family. They can sleep or have ***. If they don’t feel happy so the boy can find other the girl. This is high risk group of HIV/AIDS transmission in ethnic minorities.


Contents
CHAPTER 1 1
INTRODUCTION 1
1.1. Background 1
1.2. Research Question 4
1.3. Research Objectives 4
1.4. Conceptual Framework: 4
1.5. Variables and operation definition 6
1.6. Significance of the study 7
CHAPTER 2 9
LITERATURE REVIEW 9
2.1. Overview of HIV epidemics in Vietnam 9
2.2. HIV risk-related ***ual behaviors in Vietnam 10
2.3. Ethnic differences in ***ual Risk Behavior 19
2.4. Ethnicity, Risky ***ual Behaviors, and HIV 20
CHAPTER 3 22
MATERIALS AND METHODS 22
3.1. Research design: 22
3.2. Research site: 22
3.3. Population samples: 23
3.4. Sampling methods. 24
3.5. Research Instrument 24
3.6. Data analysis 25
3.7. Ethical consideration 25
Annex 1: Questionnaire 32