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Introduction Edward H. Kaplan and Ron Brookmeyer. Merson and Julia M. Holtgrave and Steven D. Padian and Stephen C. Owens, Donna M. Edwards, and Ross D. Part Three Case Studies. Verster, and Carlo A.
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Kahn, Elliot Marseille, and Joseph Saba. Longini Jr. Hudgens, and M. Elizabeth Halloran. Satten, Robert S. Janssen, Susan Stramer, and Michael P. Shiboski and Nancy S. Within each group, consistent condom use was highest when having sex with a client, with proportions ranging from a low of Additionally, the differences in consistent condom use between intervention and comparison participants were greatest with client sex partners for both FSW Less than one-half This difference remained significant for FSW overall Qualitative data see Table 3 support these findings of effective messaging by outreach workers.
Several participants revealed less than consistent condom use, however. More than half of respondents reported receiving pre-test counseling Among those tested, We found significant differences between intervention and comparison participants for each service except for receipt of results. The intervention group was significantly more likely to have been tested for HIV There were no differences in reported receipt of results or sharing of results.
Within populations encompassing intervention and comparison groups , testing ranged from Testing was highest among FSW sub-groups, for both the intervention The qualitative data underscored both the impact of outreach efforts on encouraging HIV testing, and persistent barriers in reaching key populations with testing services; attitudes towards health workers revealed a strong sense of continued stigmatization of individuals suspected of engaging in sex work, gay sex, and drug use see Table 3.
Several IDI participants admitted continued fear of learning their status. One PWID in Ha Noi noted that sometimes he lied to the outreach workers, saying that he had been tested when that was not true; he remained too fearful to be tested. This mixed methods evaluation provides important evidence of the value of community outreach interventions deploying peers and other health educators for improving knowledge of HIV transmission, prevention, and treatment. Intervention participants were more likely to have been tested for HIV and to have received counselling before and after testing.
Likewise, outreach programs appear to have reduced risky sexual behaviors and increased uptake of HIV testing services among high-risk populations.
As Vietnam and development partners plan funding and programmatic priorities to meet the targets by and to end new infections by , gaps in treatment knowledge, HIV testing, and consistent condom use demand sustained focus and funding. Our — evaluation data, combined with other recent research, offer critical guidance for national strategy and future program implementation. While intervention participants had higher levels of treatment knowledge than comparison participants in this study, treatment knowledge was still low among those receiving outreach. At the time of this evaluation, outreach workers were not regularly giving treatment information to clients, which may explain the low scores on HIV treatment knowledge questions among those receiving outreach [ 11 ].
However, recent research suggests that this gap in treatment knowledge persists [ 17 , 24 ]. Looking forward, education about both the benefits and management of side effects of ART must remain a top priority. On the topic of HCT, we found that the intervention group was significantly more likely to receive voluntary pre- and post-test counseling, and HIV testing than the comparison group. These findings suggest that community outreach is a valuable strategy for increasing uptake of HIV testing services across key populations.
This observation is consistent with findings from another study in Vietnam, which found that receiving voluntary HIV testing services, condoms, and injection equipment from the local HIV prevention program was significantly associated with lower reported HIV risk behavior [ 27 ]. Previous research has also found that HCT is an effective prevention strategy, and can be an entry point to support and care for key populations [ 28 , 29 , 30 ]. Nonetheless, key populations may still be reluctant to seek HIV testing even though they are aware of its importance [ 31 ].
Interventions focused on improving consistent condom use with all partners will also need to remain a high priority looking forward to the goal of ending AIDS. This is worrisome given more recent evidence that condom use has remained low in Vietnam [ 32 , 33 ]. Assessments from India are informative, indicating similar patterns of low condom use among regular partners, and by men when having sex with women [ 34 , 35 ].
Other approaches—such as empowerment, increased self-esteem, and community mobilization—may have a role in increasing condom use among regular sexual partners, and might be considered when developing interventions [ 36 ]. Strategies shown to be successful in increasing condom use with regular partners include providing high-intensity peer and clinical services for high-risk MSM and transgender people, and increasing condom availability among key populations [ 35 ]. Regardless of specific approach, prevention programs need to stress the importance of consistent condom use with all partners, regardless of sex, sexual orientation, or gender identity.
Several study limitations may bear on these findings. First, while the mixed methods approach allowed for triangulation of findings, the survey was cross-sectional, and thus cause and effect cannot be confirmed. Second, because sampling was respondent-driven rather than randomized, our results may be biased due the socio-demographic composition of either or both key population groups intervention or comparison. In particular, reliance on social networks to recruit participants may have produced a sample with similar characteristics and similar behavioral tendencies, thus leading to skewed results [ 41 ].
Third, due to the self-reporting nature of the study, social desirability may have influenced our findings, as participants may have answered questions based on what they thought interviewers wanted to hear. Fifth, it is conceivable that participants had benefited from other interventions beyond the peer-outreach programs we assessed. However, to our knowledge, there were no other similar programs operating in Vietnam at that time. There may have been small programs distributing condoms in some of these places, but the individuals who participated in our study were all engaged in one or more illegal and heavily-stigmatized behaviors that meant they were a fairly hidden population and receiving HIV-related information and support primarily through the outreach programs.
Moreover, were there other programs, individuals in both groups would have accessed them, and thus they would not be the source of systematic bias. Finally, the study was conducted over 10 years ago, and its relevance may be questioned. Given that little has been published on HIV prevention outreach programs in Vietnam, where the epidemic continues to pose a major challenge and key populations continue to be highly vulnerable, we believe our findings may inform efforts to improve outcomes in the HIV care cascade in Vietnam and perhaps elsewhere in Asia.
The program appeared successful on numerous fronts, including increased HIV knowledge, high-risk injection and sexual behavior, and uptake of testing services. However, our evaluation identified important gaps which must be addressed in future prevention efforts, whether through large-scale community-outreach or through more intensive and clinic-based programming. Priorities should target low knowledge of HIV treatment among key populations, the complexity of sexual patterns and low condom use with regular partners, and inadequate awareness of and engagement with HCT services.
The datasets generated and analysed during the current study are not publicly available currently because analyses of data by team members are still underway. Once these are completed, we will make data available from the corresponding author on reasonable request. The World Bank. Accessed 7 Aug Socialist Republic of Vietnam.
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Engagement with peer health educators is associated with willingness to use pre-exposure prophylaxis among male sex workers in Ho Chi Minh City, Vietnam. Ministry of Health - Vietnam. Cited 17 Mar Int J Drug Policy. Cited 16 Mar Condom use measurement in 56 studies of sexual risk behavior: review and recommendations. Arch Sex Behav. Excel as a qualitative data analysis tool.
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Digit Cult Educ. Facebook over face-to-face time: using social media to access hard-to reach populations of men who have sex with men in Ghana. Homophily and contagion are generically confounded in observational social network studies. Sociol Methods Res. Download references. We also acknowledge the Vietnamese government officials who provided their support and assistance to this project.
We are grateful to our exceptional team of data collectors in Vietnam based at the Ho Chi Minh City Statistical Office and to the the many individuals in Vietnam who provided information by participating in a survey or interview. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.
Agency for International Development. All authors read and approved the final version of the manuscript.