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Researches Community health care

Vũ Thị Minh Hạnh, Hoàng Thị Mỹ Hạnh, Trần Vũ Hiệp, Vũ Thị Mai Anh,
Trần Hồng Cẩm, Tường Duy Trinh, Hoàng Ly Na, Ngô Phương Thảo
Place of publication: Health Strategy and Policy Institute
The Project “Strengthening HIV/AIDS/STI preventive     interventions in Vietnam”, DKT Vietnam
Year of publication: 2011

In 2006, the German government extended a financial grant to Vietnam through the German reconstruction banking group (KfW) to implement the Project “Strengthening HIV/AIDS/STI preventive interventions in Vietnam” for a 3-year cycle of 2006-2009. Part of the project activities involve targeted social marketing of condoms (OK brand) via traditional and non-traditional channels in 15 project provinces. The target group was the general public, young people, female sex workers, sex workers’ clients, injecting drug users (IDUs) and mobile workers. After five years into operation, to measure behavioral change in condom use among the target groups, this post-intervention study “Condom use knowledge, attitude and behavior among female sex workers (FSW), FSW clients, mobile groups and IDUs” was conducted in Nam Dinh, Quang Binh and Dak Lak provinces. The study was done by the Health Strategy and Policy Institute from September to December 2011.
1. To assess knowledge, attitude and practice for sexual HIV/STIs transmission prevention and condom use of high-risk groups, including female sex worker, clients,  mobile groups and IDUs. 
2. To evaluate  changes in the knowledge, attitude and practice for sexual HIV/STIs transmission prevention and condom use of target groups pre and post interventions; 
3. To assess w the availability of condoms and condom use, including OK brand condoms, of the target groups; 
4. To understand  the role of and situation of multi-sectional cooperation in communication, advertisement and provision of condoms, including OK brand condoms, in the community.
As recommended by the DKT project, the study was conducted in 3/15 provinces where the “Strengthening HIV/AIDS/STI preventive interventions in Vietnam” project took place, including Nam Dinh, Quang Binh and Dak Lak. These were also the three provinces selected for the baseline survey in 2007. A cross-sectional descriptive study approach, combining qualitative and quantitative data collection methods, was used. 

Knowledge on HIV/AIDS and personal HIV infection risks: There was still 1% of respondents reported having never heard of HIV/AIDS and 4%  refused to believe that HIV was  preventable, most of them were female sex workers at restaurants and hotels, mostly in Quang Binh. Although female respondents’ knowledge on HIV transmission prevention was incomplete, their basic understanding in this area was better than males. The mobile group’s knowledge was the worst. More than half of female sex workers, male clients and mobile workers reported that they were at risk of HIV infection; compared to the IDUs, these groups was likely to rate their risk of HIV infection as 3 times higher than that of the IDUs.
Condom use knowledge, attitude and behavior: Most of the groups understood the benefit of condom use in the prevention of sexually transmitted disease (STDs). Gender and education were associated to knowledge on STDs prevention benefit of condom use. By and large, the understanding of various types of STDs of the interested groups seemed inadequate. The risker the partner was, the better condom use and behaviour were reported. e attitude and behaviors have improved depending on the level of exposure of sex partners. There was a directly proportional relation between education and attitude on using condoms while having sex with different partners, but no relation was found between education and safe sexual behaviors in practice. Among males, married people tended to consistently use condoms when having sex with female sex workers 2-3 times more often than unmarried or separated/divorced/ widow ones. Safe sexual behavior among men was lower than women by 2-4.4 times. IDUs were the ones with the lowest consistent condom use when having extramarital sex. When having sex with female sex workers, nearly 20% of male clients and 21% of IDUs did not use condoms. Safe sex practice among respondents in Quang Binh was higher than those in Dak Lak and Nam Dinh provinces. 
All the five groups had better knowledge on three categories: faithfulness to one partner and that partner did not had sexual relationship with anyone, having contacts with HIV infected people  would not transmit HIV, and having less partners; and poorer knowledge on using clean syringe and needle every injection. Perception on personal HIV infection risks of female sex workers, clients and mobile workers was much higher than the baseline survey, while it was on the contrary much lower among IDUs.
General understanding of HIV preventive benefit of condom use of respondents in this survey was higher than that in the baseline by 0.6% points (98.6% vs. 98%). Males’ knowledge on the preventive benefit of condoms (against HIV and sexually transmitted disease was consistently lower than from the baseline. In respect of the benefit of sexually transmitted diseases prevention, the overall knowledge was lower by 4.4 % points. The knowledge of street female sex workers in this study for each disease among all the six sexually transmitted diseases was interestingly higher than that of restaurant/hotel-based female sex workers. This was entirely contrary to the baseline. A further analysis across the five target groups indicated a substantial statistically significant difference on condom use with different partners, and not just small difference as in the baseline. The percentage of respondents believing that it was necessary to use condoms on having sex with any type of sexual partner in Nam Dinh was higher than the 2007 baseline. On the contrary, Quang Binh continued to be the province with the narrowest gap in difference, followed by Dak Lak (for random partners and female sex workers/clients groups). Condom use in the last sex was lower by about 7 % points. Mobile workers reported the highest rate of not using condoms in the last intercourse (43%), whereas in the baseline, IDUs reported the highest rate (26%). Claims for not using condoms due to unavailability dropped by 10 percentage points. Restaurant/hotel-based female sex workers continued to be a vulnerable group, as a group with high proportion of not using condom because of the partners’ disagreement, despite a 20 percentage point declined.
Pharmacies were a major channel of condom supply (for 81.6% of the respondents). About 7.5% of the respondents bought condoms from clinics and 7% from entertainment establishments, with another 4.6% from hotels and 2% from convenience stores/street-side beverage vendors. 
OK was a popular brand and has been known and used the most in the three provinces. Over 88.5% of the respondents knew the OK brand and 70.5% of them used OK condoms regularly in the last month. Females tended to less use OK condoms than males by 1.5 times. 
In Quang Binh and Nam Dinh, the consensus of relevant agencies, especially the police, with harm reduction interventions and condom supply to high-risk groups was higher than in Dak Lak. The health sector continued to lead the receiving and disbursement of funds for education, advertisement and free condom supply for some high-risk groups. Wholesale and retail channels maintained by DKT as a transition from the social marketing efforts in 2006-2009 through the traditional sale system (and in part non-traditional channels) continue to function well. The DKT project had proven to play an important role in making condoms a friendly  safe sex instrument. DKT’s various communication channels reached people in need.

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