Sex, Drugs and Health of Men who have sex with Men in Vietnam

Abstract

This thesis assessed patterns of amphetamine-type-stimulants (ATS) use and their association with condomless anal intercourse (CAI), HIV infection and mental health issues, particularly depression, among men who have sex with men (MSM) in Vietnam. The thesis employed a socio-ecological framework with a community-based survey conducted in 2014 in Hanoi and Ho Chi Minh City, Vietnam and a systematic review and meta-analysis of the relationship between ATS use and HIV infection in MSM. A substantial proportion of Vietnamese men (30.4%) had used ATS and 20.3% had used ATS recently. Methamphetamine was the most popular substance. The majority of recent methamphetamine and ecstasy users were classified as moderate to high-risk users, according to WHO guidelines. Methamphetamine use was associated with higher sexual sensation seeking, engagement in recent sex work and the perception that methamphetamine use was popular among other MSM. A high prevalence of CAI with male partners in the last three months (75.7%) was reported. CAI was associated with methamphetamine use before or during sex, higher sexual sensation seeking, and belief in the safety of withdrawal as an HIV prevention strategy. Voluntary HIV tests conducted for 210 men in Hanoi found a moderate HIV prevalence of 6.7%. Men who used methamphetamine before or during sex, who had engaged in sex work and perceived more homosexuality-related stigma were more likely to have an HIV positive test. A sizable proportion of men (11.3%) were classified as having major depression which was associated with ever having used ATS and higher enacted (i.e. experienced) homosexuality-related stigma. The systematic review and meta-analysis demonstrated a significant pooled estimate of ATS use and HIV infection in MSM across longitudinal, case-control and cross-sectional studies, but not for ecstasy use in cross-sectional studies. Methodological shortcomings of current studies of drug use and sexual behaviour were identified. This thesis suggests a comprehensive HIV prevention package, that includes treatment for methamphetamine use, is needed for MSM in Vietnam to address drug use and the risks of HIV at the individual, community and societal levels. Recommendations for further research on drug use and sexual behaviours are suggested, including periodic assessment of ATS use.