THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Male Sex Workers in Vietnam: Risk Factors & Preliminary Findings from a Sexual Health Intervention (SHEATH) Scientific Symposium on HIV and HCV Infections in Key Populations Hanoi, Vietnam November 2015

The 6 th National Scientific Conference on HIV/AIDS ACKNOWLEDGEMENTS National Institute on Drug Abuse Grant Number: DA National Institute on Drug Abuse / PEPFAR Grant Number:

The 6 th National Scientific Conference on HIV/AIDS RESEARCH COLLABORATION New York University, College of Nursing Lloyd Goldsamt, PhD Hanoi Medical Univ., CREATA Le Minh Giang, MD, PhD Center for Applied Research on Men and Community Health (CARMAH) Donn Colby, MD Bao Le, MSW Univ. of Puerto Rico, School of Public Health Michael Clatts, PhD

The 6 th National Scientific Conference on HIV/AIDS SUMMARY YMSWs in Vietnam evidence multiple, complex, and interacting sources of risk and multiple poor health outcomes. YMSW have limited contact with health services (including HIV testing and treatment) Lack of knowledge and stigma are key barriers to engagement and retention in care. It is possible to identify, reach, and engage YMSWs for participation in HIV & health services interventions. Targeting YMSW in these types of interventions may be expected to yield substantial individual and community level benefits across the full spectrum of HIV prevention and care.

The 6 th National Scientific Conference on HIV/AIDS HIV IN SE ASIA Global Burden of HIV: 35 million (2.1 million new infections in 2013 Asia/Pacific region has a “concentrated” HIV epidemic 350,000 new infections in Asia/Pacific region 2013 (little change in incidence in last 5 years) MSM populations account for a rapidly growing proportion of new STI/HIV infections throughout the region Behavioral risk is especially high among among young male sex workers (YMSW) Source: HIV and AIDS in the Pacific: UNAIDS Report 2013.

The 6 th National Scientific Conference on HIV/AIDS INCREASING STI/HIV MSM/MSW IN VIETNAM

The 6 th National Scientific Conference on HIV/AIDS EPIDEMIOLOGICAL STUDY YMSW IN VIETNAM 2010 – 2011 Community-based ethnographic mapping in Hanoi, Nha Trang, and Ho Chi Minh City Targeted/venue-based sampling (n=654) Cross-sectional survey and biological screening Eligibility: Age years of age Sex with a male client partner <90 days

The 6 th National Scientific Conference on HIV/AIDS DEMOGRAPHIC CHARACTERISTICS Mean Age: 22 (39% under the age of 21) Education: 58% had no completed high school 50% of monthly income from sex work Unstable housing <30 days: 88% Migrant: 53% 47% attracted to both men and women, 30% attracted exclusively to women, only 14% identify as “Gay”

The 6 th National Scientific Conference on HIV/AIDS HIGH RATES OF DEPRESSION Source: L Goldsamt, M Clatts, Le MG, G Yu (2014) Prevalence and Behavioral Correlates of Depression and Anxiety Among YMSW in Vietnam, Internat J. Sex. Hlth

The 6 th National Scientific Conference on HIV/AIDS SUBSTANCE USE (<30DAYS) Tobacco: 80% Alcohol: 98% Amphetamines: 38% MDMA: 37% Ketamine: 10% Opium: 8% Heroin (smoking): 8% Heroin (injection): 8% Source: Yu, G., et al. Substance use among male sex workers in Vietnam: Prevalence, onset, and interactions with sexual risk. International J. of Drug Policy (2014)

The 6 th National Scientific Conference on HIV/AIDS MULTIPLE, CONCURRENT SEX PARTNERS Source: Clatts MC, Giang LM, Goldsamt LA, Yu G Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health

The 6 th National Scientific Conference on HIV/AIDS HIGH RATES OF UNPROTECTED SEX & CONCURENT MULTIPLE PARTNERS Source: Clatts MC, Giang LM, Goldsamt LA, Yu G Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health

The 6 th National Scientific Conference on HIV/AIDS HIGH RATES OF STI/HIV Source: Clatts MC, Giang LM, Goldsamt LA, Yu G Sexual Practices, Partner Concurrency, & Prevalence of STIs/HIV Among Male Sex Workers in Vietnam. Sexual Health

The 6 th National Scientific Conference on HIV/AIDS COMPLEX (“SYNDEMIC”) SOURCES OF RISK SUBSTANCE USE DEPRESSION & ANXIETY BEHAVIORAL RISKS STI/HIV & POOR HEALH OUTCOMES POVERTY & LACK OF OPPRTUNITY LIMITED UNDERSTANDING OF HIV RISK STIGMA & ALIENATION FROM CARE

The 6 th National Scientific Conference on HIV/AIDS SHP interventions originally emerged as a challenge to risk factor model (placing greater emphasis on situational, contextual, & structural factors to understand dynamics of risk). SHP has been widely applied in structural, community, and individual level interventions, including HIV prevention and care, sexual decision-making, and health services SHEATH is a composite intervention in which we bundled content from multiple intervention sources, including Sexual Health Promotion (education) and Harm Reduction (risk reduction) Locally adapted for use in targeted YMSW populations and environments in Hanoi and HCMC Delivered by specially trained Health Educators, using Motivational Interviewing to enhance personalization and with an emphasis on protective factors and sources of resiliency SHEATH INTERVENTION (Sexual Health Education And Targeted Harm reduction)

The 6 th National Scientific Conference on HIV/AIDS CORE COMPONENTS 1. Sexual Health 2. Sexual Diversity and Sexual Rights 3. Detailed education STI/HIV (including symptoms, sources of transmission risk, interactions, and treatment options 4. Sexual Harm Reduction (including the full range of strategies to behavioral risk, including role selection, sero-sorting, partner selection strategies, condom use, etc.) 5. Substance Use (education about alcohol and drug use, modes of administration, interactions with sexual decision-making) 6. Stigma, bias, and social barriers to health care (including skills development in stigma management) 7. Role of health services in protecting sexual health, including habituation of HIV testing at 4-6 months intervals, HBV vaccination

The 6 th National Scientific Conference on HIV/AIDS STUDY DESIGN Two cites: Hanoi and Ho Chi Minh City Delivered by health educators using motivational interviewing techniques to increase personalization Community/venue-based outreach education (11,993 community interventions delivered) Random selection from the community for the clinic-based intervention Individual-level intervention using a 2-session format (matching conventional pre/post HIV testing infrastructure) (>1,000 interventions delivered) Community level evaluation: Repeated cross-sectional survey in diverse YMSW venues Clinic evaluation: Pre & post test measures

The 6 th National Scientific Conference on HIV/AIDS ACCEPTABILITY: Helpfulness & Relevance of Intervention Content

The 6 th National Scientific Conference on HIV/AIDS SIGNIFICANT IMPACT ON A BROAD RANGE OF HEALTH SEEKING INTENTIONS

The 6 th National Scientific Conference on HIV/AIDS MOST YMSWS HAVE NEVER HAD CONTACT WITH HEALTH SERVICES & LESS THAN HALF HAVE HAD AN HIV TEST Community Sample

The 6 th National Scientific Conference on HIV/AIDS SIGNIFICANT IMPACT ON KNOWLEDGE OF HIV STATUS--- (Critical Step in the HIV test & treat cascade) Community Sample Clinic Sample