Both surveillance and behavioral epidemiological studies show that young male sex workers (YMSWs) in Vietnam have high rates of unprotected sex with multiple, concurrent partners - including both male and female partners - contributing to high rates of STIs and HIV and amplifying already high HIV incidence. Exposure to existing prevention programming is low, with major gaps in HIV knowledge and sexual risk reduction skills. Existing community outreach activities have primarily reached gay-identified YMSM. Moreover, owing to profound risk for stigma and discrimination in health care settings, few YMSW are engaged and retained in protective health services (including STI/HIV screening, HBV/HPV vaccination, and early linkages to HIV care). Our collaborative US/Vietnam research team has been conducting NIDA-funded HIV research among high risk youth populations, including YMSWs, for the past eight years. Building on the substantial research capacity and health services infrastructure that has been achieved in our prior work, we propose to address these gaps in community outreach and health services access by implementing a composite intervention package targeted to YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). Using Sexual Health Promotion as a conceptual framework, we will combine already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services. Significant levels of outreach coverage will be achieved (with an estimated 12,000 outreach contacts) and substantial numbers of health services will be delivered (2,400 health services participants). Using a mixed-methods approach that includes anthropological ethnography, social and behavioral epidemiology, and health services assessments, process and outcomes evaluation of both the community outreach and health services intervention will be undertaken. Repeated cross-sectional surveys, administered both prior to and following implementation of the community outreach and health services intervention, will document community-level increases in exposure to outreach, increased knowledge and awareness of behavioral HIV risk, increased sexual risk reduction skills and participation in the clinic-based sexual health promotion intervention, thus demonstrating effective engagement and retention in health services. Of particular interest to implementation science, both qualitative and quantitative analysis will assess between-city differences in intervention uptake and effectiveness, data that will inform our understanding of the impact, adaptability, and generalizability of the intervention and guide future dissemination.

Public Health Relevance

Young male sex workers in Vietnam show high prevalence rates of HIV and other STIs, reflecting their involvement in multiple concurrent sex exchanges with both male and female partners, yet they have limited exposure to, or engagement in, health services, including community outreach, HIV/STI testing and treatment, and vaccination for HBV and HPV. Building on the substantial research capacity and health services infrastructure developed in our prior research collaboration in Vietnam, we propose to address these gaps in community outreach and health services access by using Sexual Health Promotion as a conceptual framework, and a research design based on principles of implementation science to deliver an intervention that combines already proven intervention technologies - community outreach nursing and sexual health promotion interventions - to enhance outreach coverage and to foster engagement and retention in health services among YMSWs in the two strategically selected cities in Vietnam (Hanoi and Ho Chi Minh City). It is anticipated that the intervention will significantly contribute to intervention capacity-building in Vietnam and may als contribute to intervention development in neighboring countries in Southeast Asia that face similar challenges.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA033673-04
Application #
8874184
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Jenkins, Richard A
Project Start
2012-06-01
Project End
2017-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
4
Fiscal Year
2015
Total Cost
Indirect Cost
Name
New York University
Department
Type
Schools of Nursing
DUNS #
041968306
City
New York
State
NY
Country
United States
Zip Code
10012
Goldsamt, Lloyd A; Clatts, Michael C; Giang, Le Minh et al. (2018) HIV and other STIs in male sex workers: Findings from a sexual health promotion intervention in Vietnam. Int J STD AIDS 29:540-546
Bui, Hao T M; Le, Giang M; Mai, Anh Q et al. (2017) Barriers to access and uptake of antiretroviral therapy among HIV-positive men who have sex with men in Hanoi, Vietnam: from HIV testing to treatment. Cult Health Sex 19:859-872
Carrico, Adam W; Nil, Ean; Sophal, Chhit et al. (2016) Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants. J Behav Med 39:502-10
Clatts, Michael C; Goldsamt, Lloyd A; Giang, LĂȘ Minh et al. (2016) Sexually transmissible infection and HIV prevention and treatment for young male sex workers in Vietnam: findings from the SHEATH intervention. Sex Health 13:575-581
Yu, Gary; Clatts, Michael C; Goldsamt, Lloyd A et al. (2015) Substance use among male sex workers in Vietnam: prevalence, onset, and interactions with sexual risk. Int J Drug Policy 26:516-21
Dixon, Thomas Crewe; Ngak, Song; Stein, Ellen et al. (2015) Pharmacology, physiology and performance: occupational drug use and HIV risk among female entertainment and sex workers in Cambodia. Harm Reduct J 12:33