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BACKGROUND METHODS
The HIV epidemic in Vietnam is primarily concentrated among key
populations (KPs): people who inject drugs (PWID), female sex workers
(FSWs), and men who have sex with men (MSM). Results from the 2009
Integrated Biological and Behavioral Survey (IBBS)
,
showed that these
populations have high levels of HIV/AIDS knowledge, but still are not
practicing safe injecting and sexual behaviors. For example:
! one-quarter of PWID reported needle and syringe sharing in the last
six months in Ho Chi Minh City (HCMC) and Dien Bien.
! fewer than 40% of FSWs in HCMC reported consistent condom use
with one-time clients in the last month.
! only one-third of MSM who sold sex reported consistent condom use
with either commercial and non-commercial sex partners in HCMC.
Uptake of prevention and HIV testing and counseling (HTC) services also
remained low. For example, one-third or fewer PWID, FSWs, and MSM
in HCMC had ever received an HIV test and got the result. These
statistics suggest there is room to strengthen HTC and other HIV
prevention services tailored to these populations.

This qualitative descriptive study was conducted in 2012 in HCMC and
Dien Bien provinces using in-depth interviews (IDIs) and focus group
discussions (FGDs) with the following groups:
1. Program users (n=40) and non-users (n=40):
! Program users are those who received prevention commodities (clean
needles and syringes for PWID, condoms and lubricant for FSWs and
MSM) provided by a prevention program in the past 6 months.
! Program non-users are those who did not obtain commodities from a
prevention program in the past 6 months.

PARTICIPANT QUOTES
A. BARRIERS TO ACCESS AND UPTAKE OF HIV PREVENTION
SERVICES AMONG KPS
1. Lack of information about the program I heard someone said that there were needles and
syringes (N/S) distributed free, however, I dont know how and where I should go to get them (IDU in
HCMC)
2. Perception of being at low-risk. If I have to say about my risk [HIV risk], I think it is only 30%
because my clients are not drug users. They are also reliable. I myself do not have many clients so I
think it is not possible (to get infected) (FSW in HCMC).
3. Fear of being identified as KPs. Yes, because I was so scared, obviously someone sees me to go
there, they would think she must be FSW, people who are not FSWs would go to other hospitals, they
dont go to those clinics, I thought that, I dont know if it is right or wrong, I dont know (FSW in HCMC)
4. Limited amount of freely distributed commodities and preference for other types of
commodities.
They [PE] gave me only 2 N/S each time, however, I inject 4 times a day. It is not enough for me (IDU
in Dien Bien)
I did not like to use the N/S from the programs because their needle is very big. When I injected, the
first time was OK. If I reused it, it was very blunt and caused pain or left obvious marks on my
hand (IDU in HCMC)
5. Complicated registration procedure. A peer educator explained to me that I need to have
residence registration book to prove that I am a resident in that district. There are also many other
papers. I dont have residence registration book so I cannot register (IDU in HCMC)
B. FACILITATORS TO ACCESS AND UPTAKE OF HIV PREVENTION SERVICES
AMONG KPS
1. Perception of being at high risk. Yes. I believe I was at risk [of HIV]. I shared N/S with some
friends before. Now one of them has HIV infection. So, I think I can be, too. (IDU in Dien Bien)
2. Awareness of the program and its benefits facilitated KPs access to and uptake the services.
From your opinion, are there any difficulties in receiving clean N/S?
No, not at all since they give us the N/S at a certain distribution place and at a certain time, we just
follow that (IDU in HCMC)






The table below summarizes the most common barriers and facilitators
mentioned by KPs:

CONCLUSIONS AND RECOMMENDATIONS
This study identified several key barriers to access and uptake of HIV
prevention commodities and services among KPs, such as lack of
information about the program, preference for other types of
commodities, perception of being at low-risk, fear of being identified as
KPs, and complicated registration procedures. Facilitators to accessing
prevention services were the awareness of the program and its benefits,
perception of being at high risk, as well as friendly and supportive peer-
educators and service providers.
Recommendations for improved HIV prevention program uptake and
utilization are to:
! Expand communication activities to increase HIV risk awareness and
available prevention programs and their benefits among KPs;
! Diversify commodity selection to meet the needs of different KPs; and
! Simplify administrative procedures to encourage more KPs to use
prevention services.
REFERENCES
1. VietnamAdministration of AIDS Control (VAAC). Sentinel Surveillance Survey 2009. http://www.vaac.gov.vn.
2. Ulin, P; Robinson, E; Tolley, E (2005). Qualitative Methods in Public Health: A Field Guide for Applied Research. Jossey-
Bass: San Francisco.
3. Guest G, Bunce A, Johnson L (2006). How many interviews are enough? An experiment with data saturation and
variability. Field Methods 2006;18(1):59-82

ACKNOWLEDGEMENTS
The authors would like to thank all participants who shared their experiences with us. We also thank Ho Chi Minh and Dien
Bien Provincial AIDS Centers, who provided significant support for study implementation as well as individuals and
organizations who provided comments, input, and support for the completion of the report.
This study is made possible by the support of the American people through the United States Agency for International
Development (USAID). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID
or the United States Government.
Presented at the 2014 International AIDS Conference
OBJECTIVE
Province IDU FSW MSM Total
Program
user
Program
Non-user
Program
user
Program
Non-user
Program
user
Program
Non-user

HCMC 10 10 10 10 10 10 60
Dien Bien 10 10 N/A N/A N/A N/A 20
To identify barriers to and facilitators of access and uptake of HIV
prevention services among KPs in two Vietnamese provinces.

2. Peer educators and outreach workers of HIV prevention and
service programs: 2 FGDs in Dien Bien and 3 FGDs in HCMC
3. Key informants including program managers, facility based staff
and staff working in the community: 10 IDIs in Dien Bien and 15 IDIs in
HCMC
All interviews and focus group discussions were conducted using semi-
structured interview guides in Vietnamese and were audio-recorded. Data
were analyzed using qualitative content analysis methods
80%
and Atlas.ti
(version 5.2) as a qualitative research software program.


KEY FINDINGS
Barriers Facilitators
Barriers and facilitators to
access and uptake of HIV
prevention commodities and
services among KPs
Lack of information about the
program
Limited amount of freely-
distributed commodities
Preference for other types of
commodities
Perceived stigma
Perception of being at low risk

Perception of being at high
risk
Availability of free-of-charge or
low-price commodities

Barriers and facilitators to
access and uptake of HTC and
STI screening services
Perception of being at low risk
Limited knowledge about the
availability and benefits of
HTC and STI screening
services
Fear of being identified as KPs
and possible HIV(+) test result
Awareness of program and its
benefits
Perception of being at high
risk
Accessible and confidential
services
Friendly and supportive peer
educators and service
providers.
Barriers and facilitators to
access and uptake of MMT
services
Lack of information about the
program
Complicated registration
procedures
Awareness of program and its
benefits

3. Friendly and supportive peer-educators and service providers In general, the PEs are
enthusiastic. Most of them understand IDUs as they used to be drug addicted. Someone who has
experienced drug addiction can understand us more. (IDU in Dien Bien)
4. Accessible and confidential services. Very confidential, got my test result by myself. They kept
it confidential and did not ask my name. (FSW in HCMC)




Figure 1 Vietnam and location of Dien Bien and Ho Chi Minh City