Coalition building by drug user and sex worker community-based organizations in Vietnam can lead to improved interactions with government agencies: a qualitative study.

Leah T Le,Oanh Hai T Khuat,Lauretta E Grau,Huong H Nguyen,Robert Heimer

doi:10.1186/s12954-015-0070-1

Abstract

BackgroundDrug users and female sex workers are among the groups most vulnerable to HIV infection in Vietnam. To address the HIV epidemic within these communities, former drug users and sex workers established the first community-based organizations (CBOs) in 2009. The study provides a focused assessment of CBOs’ expanding efforts to advocate for their members that identifies existing collaborations with Vietnamese government programs. This assessment explores the barriers to and facilitators of expansion in order to propose recommendations to improve the working relationship between CBOs and government programs.MethodsThirty-two individuals from drug user and sex worker CBOs (n = 24) and relevant government programs (n = 8) participated in face-to-face interviews in Hanoi, Ho Chi Minh City, and Hai Phong. Coded interview transcripts were analyzed qualitatively concerning the purpose of CBOs, the interactions between CBOs and government programs, and the perceived barriers, facilitators, and feasibility of future CBO-government program collaborations.ResultsServices provided by the CBOs were considered to improve members’ quality of life. The formation of coalitions among CBOs increased efficiency in meeting members’ specific service needs, in addition to internal capacity building. Government field staff interacted with CBOs by providing CBOs with technical and legal support. CBOs and methadone maintenance treatment (MMT) clinics collaborated to help the clinics meet patient enrollment quotas and facilitate entry into treatment for CBO members. Barriers to CBO-government program collaboration included perceived conflicting missions on how to address drug use and sex work in the community, limited CBO-government program communication, CBO mistrust of the MMT system, and lack of legal status for CBOs.ConclusionTo reduce these barriers, we recommend (1) introduction of CBO consultative services at government healthcare centers, (2) enlistment of CBO outreach to ensure full access to the imminent scaled-up MMT program, and (3) establishment of standards by which CBOs can obtain legal status.

Highlights

Drug users and female sex workers are among the groups most vulnerable to Human immunodeficiency virus (HIV) infection in Vietnam
Among 2986 sex workers participating in a survey in 12 provinces, 2.7 % reported a history of injecting drugs, of whom 30 % reported living with HIV/ Acquired immunodeficiency syndrome (AIDS) [9]
We estimated that 24 interviews with peer educators would ensure geographic representation from the three cities with Community-based organizations (CBO) (Hanoi, Ho Chi Minh City, and Hai Phong)

Summary

Introduction

Current status of HIV in Vietnam The first reported case of HIV in Vietnam occurred in 1990; the annual rate of HIV case ascertainment from 2009 to 2013 has been approximately 14,000 per year, and as of 2013, there were 254,000 people living with HIV/AIDS countrywide [1, 2]. This figure is relatively low, given a total population of nearly 90 million, it is consistent with a concentrated epidemic in which prevalence is high among people who inject drugs (PWID) and female sex workers [1]. In 2013, the national HIV average prevalence among sex workers was 2.6 %, ranging from 0.3 % among venue-based sex workers to 23 % among streetbased sex workers in part because street-based sex workers were more likely to inject drugs than were venue-based sex workers [1]

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