Abstract
Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ (‘out,’ transgender, or effeminate MSM). Lower-income, ‘hidden’ MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.
Highlights
HIV prevalence among men who have sex with men (MSM) in Asia is greater than 10% among certain communities [1,2,3], and recent research suggests emergent epidemics in countries as varied as Thailand [4], India [5], and the Philippines [6]
Participants ranged in age from 18–58, and the majority came from rural areas where homosexuality-related stigma was high
Vietnam provides an example of the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide
Summary
HIV prevalence among men who have sex with men (MSM) in Asia is greater than 10% among certain communities [1,2,3], and recent research suggests emergent epidemics in countries as varied as Thailand [4], India [5], and the Philippines [6]. This includes MSM in Vietnam who are in urgent need of effective HIV prevention. In Vietnam’s two largest urban settings, Hanoi and Ho Chi Minh City, a 2015 HIV sentinel surveillance survey
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