Evaluation of HIV Prevention Programs in Vietnam: Key Findings June 2008 Dr. Davidson Hamer Center for International Health and Development Department of International Health Boston University School of Public.

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Transcript Evaluation of HIV Prevention Programs in Vietnam: Key Findings June 2008 Dr. Davidson Hamer Center for International Health and Development Department of International Health Boston University School of Public.

Evaluation of HIV Prevention
Programs in Vietnam:
Key Findings
June 2008
Dr. Davidson Hamer
Center for International Health
and Development
Department of International Health
Boston University
School of Public Health
1
Evaluation Team Members
and Affiliations
Boston University School of Public Health
Lora Sabin, MA, PhD
Mary Bachman DeSilva, MS, ScD
Davidson H. Hamer, MD
Taryn Vian, M.Sc.
Danielle Lawrence, MPH
Kelly McCoy, MPH
Jordan Tuchman, MPH
Ho Chi Minh City Statistical Office
Le Thi Thanh Loan, PhD
Abt Associates Inc.
Theodore Hammett, PhD
Funding provided by: PEPFAR/USAID: Country Research Activity GHS-A-00-03-00020
Additional acknowledgments: Ahmar Hashmi, Jen Beard, Wayland Bergman, Bill MacLeod,
2
Matt Fox, Don Thea, Jill Costello, Jon Simon, and Deirdre Pierotti
Presentation Outline
•
•
•
•
•
•
Background
Evaluation questions
Methodology and limitations
Findings
Summary
Recommendations
3
Background
• Vietnam’s 2004-National Strategic Plan focus:
• VCT, ART, harm reduction, other best practices
• Harm reduction programs include community
outreach programs that aim to:
• Distribute information about HIV transmission,
prevention, and care among most at-risk populations
(MARPs)
• Reduce risky behaviors, increase safe behaviors
relating to drug use and sexual practices
• Promote use of VCT, STI, social, and other available
support services
• Outreach programs employ 2 approaches:
• Peer educators and
• Health educators
4
Primary Research Questions
HE and PEs in Hoang Mai, Hanoi
1. Are outreach workers
well prepared to
deliver services
among MARPs?
2. Are outreach workers
identifying and
communicating well
with clients?
3. Is BCC effective in
changing behaviors?
5
Design & Methods
Qualitative and quantitative methods:
1. Review of program information
2. Qualitative:
223 in-depth interviews with
outreach workers, MARPs,
other key informants (6
provinces)
3. Quantitative:
Cross-sectional survey of 2,222
MARPs & 272 PEs/HEs (4
provinces)
PE demonstrating needle cleaning
6
Study Population
• “Intervention” – contact with
PE or HE in last six months
• “Control” – no contact with
PE or HE in last six months
• Snowball sampling to
identify both populations
7
Methodology: Limitations
• Cross-sectional survey: cause and effect
cannot be inferred between Intervention and
Control groups
• Possible social desirability bias
• Differences between PEs and HEs not
relevant to all programs
• Sample sizes of MARP groups different from
sizes of MARP groups in Vietnam overall
• Potential bias from snowball sampling
approach
8
QN:
CDC/LG,
FHI, CARE
HN:
AllCDC/LG,
4
HP:
programs
FHI
QN:
CDC/LG,
FHI, CARE
HP: CDC/LG,
FHI
AG: CDC/LG,
FHI, CARE
HC: All 4
CT: CDC/LG,
programs
FHI, CARE
HC: All 4
programs
9
Evaluation
Findings
10
Characteristics of MARP
Respondents
•
Few differences in demographic characteristics:
•
•
•
•
58% female
Mean age ~29 years
About 1/3 had a high school education or higher
Some differences in previous behaviors between
Intervention group (Int) and Control group (Con)
•
•
•
•
22% of Int vs 16% of Con had tested + for HIV
13% of Int vs 6% of Con had had sex with HIV+ person
24% of Int vs 15% of Con had had sex with an IDU
Among MSM:
• 14% of Int vs 23% of Con had ever bought sex
• 31% of Int vs 40% of Con had ever sold sex
11
Research Question 1:
How prepared are outreach
workers?
•
•
•
•
•
Training and skills
Knowledge and qualifications
Supplies
Supervision and support
Financial support
12
Training & Skills
• Most PEs/HEs felt training was appropriate
and adequate preparation for job
• Before I knew about these topics only through
friends, but now [my] knowledge is more
scientific and concrete. (PE in Hanoi)
• Thanks to the course, I am more daring; I’m not
afraid of going to the establishments to talk
anymore. (PE in Hai Phong)
• [PEs] should be trained more to be more
experienced and knowledgeable to work. (PE in An
Giang)
13
Training & Skills
• >90% of PEs and HEs received pre-service
training, 95% received refresher training
• >95% of outreach workers had covered key
topics of HIV transmission, prevention through
safe sex/safe injection, demonstration of correct
condom use, negotiation & outreach skills
• 13% PEs and 26% HEs had not received
infection control training
• PEs mentioned wanting more training related to
antiretroviral therapy (ART)
14
Knowledge about HIV
Domain and level of knowledge
(score)
Transmission Knowledge (15 Qs)
15 correct
12 or more correct
8 or more correct
Prevention Knowledge (17 Qs)
16 or more correct
12 or more correct
8 or more correct
Treatment Knowledge (8 Qs)
8 correct
6 or more correct
4 or more correct
% PEs & HEs
62
98
100
45
97
99
13
71
82
15
PE/HE Knowledge Gaps
• 8% did not know that HIV can be transmitted
through breastfeeding
• Only 55% knew that withdrawal during sex is not an
effective method for preventing HIV infection
• 13% thought that not touching someone who is
HIV+ is an effective prevention method
• Nearly 20% did not know there is no cure for
HIV/AIDS
• 24% did not know that ART improves immune
functioning
• 60% did not know that the purpose of ART is to
treat HIV/AIDS.
16
Supplies
• Sometimes inadequate (PE, MARP)
• More safety items needed (PE)
• I’m not satisfied with the lack of some
aids…there should be alcohol, distilled water,
condoms, and it’s really good to have injection
syringes and needles. (PE in Hai Phong)
• Without access to sterile injection equipment
people like us can spread disease all over the
society. (CSW in Hanoi)
17
What type of support have you received?
100%
PEs
HEs
% reporting having received
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Any support
Verbal
encouragement
Training
opportunities
Career
development
opportunities
Financial bonus
18
Perceptions of Community Support
100%
Hanoi
Hai Phong
% reporting receiving support from
90%
HCMC
80%
An Giang
70%
60%
50%
40%
30%
20%
10%
0%
Any community
members
Family members
Establishment
managers
Police
19
Supervision and Support
• Now, we are still rushed by the police when
approaching gathering spots. Sometimes I am
even assaulted…We are even captured by the
police even though we wear uniform and
badges. (PE in Hai Phong)
• At present, the police are not quite clear about
our job. .. The police ask us to inform them
before approaching any particular places, but
we refuse as we have to keep our customers’
secret. (PE in HCMC)
20
Financial Support
• Some workers dissatisfied with salaries
(mean reported salaries: PEs = 900,000;
HEs = 2,300,000 VND/mo)
• …some outreach workers work at bars, massage
parlors, discotheques and at that time the fees are
especially high. At the moment we haven’t got the
financial support when approaching those areas.
(HE in Hanoi)
• If the workers here just thought of the salary, it’s
possible that nobody would do this job…Our salary
is quite poor… not enough to support our life.
(PE in Hai Phong)
21
Research Question 2:
How well do outreach workers
identify and communicate with
clients?
•
•
•
•
Services provided by outreach workers
Approaches used by outreach workers
Perceived strengths of programs
Challenges encountered in providing
services
22
% of PE and HE who reported contact
with each client group in last month
Client group
CSW
IDU
MSM
Partners of at-risk groups
Clients of CSW
n=272 PE/HE
68%
63%
28%
18%
10%
23
PE/HE Contacts by Client Group
45
Mean number of contacts in previous month
40
# new clients
# repeat clients
35
30
25
20
15
10
5
0
Any client
IDUs
CSWs
MSM
Type of client
Clients of CSWs
Partners at-risk
24
Services Provided by
PEs and HEs
• Provincial variability in contacts per month
• Hai Phong: 50 total/12 new; An Giang: 25 total/8 new
• Rising trend in number of clients per month in the past 6
months: +81% in Hai Phong; +57% in HCMC
• 95% tell IDUs that sharing injection equipment is
unsafe
• 30% able to name unsafe sources
• 31% tell where to obtain bleach
• 93% provided VCT referrals in previous month
• 62% to STI clinics
• 36% for ART
• 33% to TB clinics
25
Conversations Reported by MARPs
Possible secondary benefit: Intervention MARPs had more
discussions about safe sex (98% v 45%) & safe injection
(69% v 27%) in previous 6 months
A. Discussions about safe sex
100%
Intervention
80%
% of MARP Group
% of MARP Group
100%
B. Discussions about safe injection
Control
60%
40%
20%
0%
Intervention
80%
Control
60%
40%
20%
0%
PEs
Friends
Sex
partners
HEs
Who has talked to you?
Other
PEs
Friends
Sex
partners
HEs
Who has talked to you?
Other
26
PEs/HEs use a variety of approaches
to reach clients
Develop maps or
strategies at team
meetings
9%
Obtain referrals
from other
acquaintances
11%
Obtain referrals
from prior clients
18%
Visit hot spots
regularly
22%
Visit known
establishments
regularly
20%
Visit new
establishments
regularly
20%
PEs/HEs that reach CSWs (n=161)
27
Approaches Used by
PEs and HEs
• Specific tactics: humor, scare tactics, friendly
and polite demeanor, emphasizing risks to family
members
• PEs/HEs said that approaching street CSWs
(SSWs) is much easier than establishment-based
CSWs (KSWs)
• For MSM, hot spots and introductions are key
• MARPs said best approaches are: making clients
feel comfortable, using personal connections,
being reliable
28
How PEs and HEs talk to clients
• It depends on each customer. For example, at the
railway, the ice-breaker is: Where did you buy the
“goods”? Is it good? Who did you buy it from?... I
show them that I’m in their circle. Then I step-bystep turn to some anecdotes [and] lead them to my
purpose, [which] is to talk about HIV. (PE in Hai Phong)
• We go to the women’s gathering places ourselves
to make friends … Sometimes I even bring my child
along. Sometimes I tell a lie that used to be a sex
worker. (PE in Hanoi)
• Continuous rain softens the hardest soil. We can’t
see it right away. They change their habits step by
step. (PE in Quang Ninh)
29
Perceived Program Strengths
• Intervention MARPs rated most services very or
mostly useful; >95% for:
• Information
• Demonstration of condom use, injection cleaning methods
• HIV transmission/prevention knowledge
• >95% said PEs/HEs are trustworthy
• 72% would “absolutely” urge friends to talk to
PEs/HEs
• About half of MARPs could not distinguish PEs v HEs
• Of those who could: HEs seen as more knowledgeable,
PEs as more practical, available, and able to help change
behavior
30
Perceived Program Strengths
• At first I was also shy as I didn’t know what they
were like, but when we were closer to each other,
I really liked talking to them. (CSW in Hanoi)
• …just like friends talking with each other. (MSM in
HCMC, on his relationship with a PE)
• [Talking with PEs is] beneficial as they bring us
information to prevent HIV…. (IDU in Hai Phong)
• I’ve met health educators and I find them really
enthusiastic. They all answered every question of
mine. … I see peers more often, so I like them
more…. I ask the health educators the questions
which peers can’t answer. (MSM in Hanoi)
31
Challenges in Providing Services
• 83% PEs/HEs reported difficulties in approaching
clients
• 53% had encountered violent clients
• Lack of client cooperation due to fear, police interference,
time conflicts
• MARPs: some PEs apathetic or too preachy:
• Most PEs working here are not enthusiastic. They just
work to receive salary. (MSM in HCMC)
• He [PE] communicates with me but sometimes talks so
much that it makes me feel a headache…. he keeps
preaching. Even on doing this and that for prevention;
such a headache….(IDU in Quang Ninh)
32
Challenges in Providing Services
• 3/4 of control MARPs had not heard of programs
• Of those who had, main reasons no contact: inconvenient
time, location, not sure how to contact, feel uncomfortable
• 1/4 expressed interest in talking to a PE
• Qualitative data highlight fears of MARPs and
potential need for more PEs:
•
I recommend an increase in the number of PE to
outreach drug users…If so, there will be a decrease in the
number of drug users. (IDU in Hai Phong)
• Outreach workers need to work better. To make the
unaware people go [to clinic] for examination; or they
should chat to those people. (CSW in An Giang)
33
Social Discrimination
• The biggest problem is the prejudices from the
community. Many people do not know anything
about MSM’s feelings, and they [think they] are sick
and debauched people.
(HE in Hanoi)
• The police even beat us if they catch us delivering
condoms outside the street. I have been beaten by
a club. They don’t even want to know what we do,
just chase us. (PE in Hai Phong)
• The obstacles are from the [establishment] owners;
they don’t welcome us. They deny that they have
prostitutes inside…if the local government and
other unions support us a bit in our job, the
program will be more effective. (PE in An Giang) 34
Research Question 3:
How effective is the behavior
change communication?
• Knowledge, attitudes, and beliefs
• Risk behaviors
• Referral service usage and perceived
risk
• Qualitative information on program
strengths and weaknesses
35
Effectiveness of BCC:
MARP Knowledge
Domain and level of knowledge
(score)
Transmission (16 Qs)
15 or more correct
12 or more correct
8 or more correct
Prevention (17 Qs)
16 or more correct
12 or more correct
8 or more correct
Treatment (8 Qs)
8 correct
6 or more correct
4 or more correct
Intervention (%)
Control (%)
62
96
100
44
88
98
18
86
99
14
81
96
4
32
51
1
16
28
36
Knowledge Gaps Among MARPs
• Transmission
• 28% (24% Int, 32% Con) did not know that HIV can be
transmitted through breastfeeding
• Prevention
• 65% (both Int/Con) said that withdrawal during sex is an
effective method of HIV prevention
• 27% (24% Int, 30% Con) said that not touching someone
who is HIV+ is an effective prevention method
• Treatment – main area of knowledge weakness
• 25% (both Int/Con) did not know there is no cure for HIV
• 66% (56% Int, 76% Con) did not know that ART improves
immune functioning
• 60% did not know that the purpose of ART is to treat HIV37
Changes in MARPs’ Beliefs
• Changes in beliefs about what was risky behavior
and the seriousness of risk
• Better understanding of modes of HIV transmission
• New attitudes toward people living with HIV
• Stronger feelings of personal security and selfefficacy
• I changed a lot of my beliefs…I used to underestimate [the
risk] and not use condoms, but since talking with him, I know
the benefits. (MSM in Hanoi)
38
IDUs and Injection Behaviors
• IDU MARPs (n=703) - reported low-risk injection
behaviors
• 97% Intervention / 95% Controls could obtain new needles/syringes
when needed
• 14% in both groups had recently shared needles/syringes
• In IDIs, noted barriers to access sterile equipment
• No single guaranteed source
• Inconvenience in bad weather, late at night
• Fear of discovery with equipment by police, family
• Intervention IDUs - more likely to start or increase
cleaning of injection equipment
• 71% intervention vs 61% controls
39
IDUs and Injection Behaviors
•Before meeting [outreach workers], I thought
nothing about problems concerning sharing
syringes and needles. Now I no longer share
syringes or needles with others. (IDU in Hanoi)
•We used to share syringes and needles in groups
of 4, 5 users. Now we no longer share them as
I’ve witnessed many deaths. (IDU in An Giang)
•I’ve changed a lot, I’ve thought of it a lot…After
listening to him, I don’t [share]. I used to use the
kits again…Now I wash them with boiling water
twice or three times according to the formula.
(IDU in Quang Ninh)
40
Sexual Behaviors: Condom Use
• Sexually active MARPs
(n=1623) reported on
condom use:
•
•
•
•
37% always use condoms
34% usually use condoms
29% never/occasionally use
CLEARLY substantial room
for improvement
41
Sexual Behaviors
• Higher condom use reported by intervention
MARPs
IDU
MSM
KSW
SSW
Always carry condoms Always use condoms
Int
Control
Int
Control
32%
22 **
28
18 **
37%
28 *
41
34
52%
44 *
42
34 *
65%
54 **
43
38
**p<.01, *p<.05
• …but lots of room for change
42
Sexual Behaviors
• I changed a lot of my beliefs…I used to
underestimate [the risk] and not use condoms,
but since talking with him, I know the benefits.
(MSM in Hanoi)
• After talking, I know how to protect myself. When
I have sexual relations, I use condoms even with
my lover. I’ve taught my boyfriend to use
[condoms]. (CSW in Hai Phong)
• She convinced [me] so I understand that when I
am in a hard situation earning money as a
prostitute, I have to use condoms, have blood
test….I also learned how to use condoms in the
right way. (CSW in HCMC)
43
Referral Service Usage
& Perceived Risk
• Intervention group more likely than controls to
seek HIV testing
• 76% of intervention group vs. 46% of controls were
tested
• 78% vs. 33% sought pre-test counseling
• Among tested, 81% vs. 61% sought post-test
counseling
• MARPs reported low perceived risk of infection
• Less than 1/4 see high risk
• Reasons: always use condom, never use drugs
44
Referral Service Usage
& Perceived Risk
• In IDIs, MARPs described mixed experiences with
referrals:
• Positive: provided for free, make them feel more
secure, friendly staff, short wait times
• Negative: unkind/unfriendly staff, unhelpful counseling
• Illustrative statements by IDI respondents:
• The way they greeted us really offended us. [The
receptionist’s] manner was very hierarchical, and she
shouted and scolded us. (CSW in Hanoi)
• It’s a waste of medicine to treat an addict like him. (PE in
Hai Phong retelling what a doctor told him, while motioning toward an IDU)
45
Key Informants on Program
Strengths
• Why are programs effective?
• Proven ability of PEs/HEs to reach clients who
need services
• Rise in number of people accessing VCT and
other services
• Improvement in knowledge/awareness of
MARPs
• Reduction in risky behaviors of MARPs
• Reduction in HIV incidence
• Careful management of programs
46
Key Informants on Program
Strengths
• Additional strengths:
• Comprehensive in scope, with broad
support
• Tight/strict management, stable budgets
• Well-trained staff
47
Key Informants on Program
Weaknesses
• Challenges:
•
•
•
•
Policy conflicts
Inability to distribute sterile needles/syringes
Turnover, mediocre PE performance, low salaries
Geographic coverage
• Little coordination between PEPFAR-funded and
other outreach programs
• But views varied on whether this is a major issue
 These views generally shared by PEs/HEs and MARPs
48
Summary
1. Outreach workers generally well prepared
 But some areas need improvement.
2. Outreach workers use many effective strategies
to identify and communicate with MARPs
 Yet social stigma still makes it difficult to access
clients.
3. Tension between “peers” and being a role
model
4. Job satisfaction high, but there are issues:
 Inadequate supplies
 Weak community support
 Low compensation
49
Summary
5. Possible “ripple effect” seems to be important
benefit of the outreach programs
6. Data on contacts/worker raise questions about
data quality and possible market saturation in
some areas
7. Programs appear to have increased knowledge
among MARPs, but knowledge on treatment is
low, among both MARPs and outreach workers
8. Program impact is suggested by differences in
intervention v control: condom use, HIV testing
50
Summary
9. Little reported needle sharing, but intervention
group more likely to start or increase cleaning
of injection equipment
10. Although there are differences between PEs
and HEs, a combination of both PEs and HEs
appears most effective for service provision
• PE and HE model appears to work well
11. There is a need for greater coordination
between PEPFAR-funded programs and other
programs
51
Recommendations:
Related to BCC Programs
• Strengthen training of PEs/HEs
 Specifically aspects of HIV prevention and treatment
• Share lessons learned related to training and
contact strategies for MARP groups
 May help improve access to un-reached MARPs
• Ensure adequate and uninterrupted supplies
 In all programs and all provinces
 Hold discussions with clients about distributing supplies
that are most suitable
52
Recommendations
• Strengthen staffing
 Consider increasing salaries and/or expense
allowances
 Consider offering drug cessation programs to longserving PEs
• Revise contact targets
 Consider using targets as goals, not requirement
linked to salaries
• Develop and utilize new approaches for MSM
 Seek direct input from MSM to ensure effectiveness of
approaches
53
Recommendations
• Expand existing programs into new areas
Optimize coverage in existing districts not yet
fully saturated
Rural areas in current program provinces
• Expand programs to include other MARP
groups
Young CSWs
Sexual partners of IDUs
54
Recommendations
• Develop targeted quality improvement
approaches to overcoming fear among clients
 Hold group discussions with outreach workers and
MARPs to explore challenges, discuss solutions
• Improve coordination among programs
 National workshop where partners share experiences,
prioritize problems, discuss solutions
 Regional or provincial workshops to engage local plan
program managers, implementers, and health
authorities to plan collaboratively across donor
supported and ministry programs.
55
Recommendations: Areas for Attention
Beyond Outreach Programs
• Enhance community education and sensitization about
outreach workers to improve environment for outreach
activities
 Need to improve collaboration between public security forces and
BCC in most provinces
• Consider environmental and societal factors (i.e.
alcoholism, unemployment, domestic violence), that
contribute to the vulnerability of various risk groups
• Improve coordination with other public health and social
welfare programs
 Need to better communicate/coordinate with government and nongovernmental agencies (non-PEPFAR)
56
Thank you for your attention!
57
Secondary Research Questions
PE demonstrating needle cleaning
1. Are there differences
between types of
workers (PEs vs.
HEs)?
2. How well do services
harmonize with those
provided by other
donors and
organizations?
58
Overview of
Evaluation Design
•
•
Qualitative and quantitative methods
Components
1. Review of program information
2. Qualitative (all 6 provinces)
Structured in-depth interviews with 223*
respondents:
• Outreach workers (n = 78)
• MARP informants (n = 103)
• Other key informants (n = 42)
*Number of respondents excludes Can Tho (data collection ongoing)
59
Overview of
Evaluation Design (2)
3. Quantitative:
• Cross-sectional survey of MARPs
(n = 2,222) including 1,101 intervention
MARPS and 1,121 control MARPs
•
•
•
Control group = no contact with outreach
worker in past 6 months
PEs/HEs (n = 272)
Snowball recruitment approach in 4
provinces: Hanoi, Hai Phong, HCMC,
An Giang
60
Sites of data collection
Quantitative/qualitative:
• Hanoi
• Hai Phong
• Ho Chi Minh City
• An Giang
Qualitative only:
• Quang Ninh
• Can Tho
61
Overview of Community
Outreach Programs
• Harm reduction activities that aim to:
• Distribute information about HIV
transmission, prevention, and care
• Reduce risky behaviors, increase safe
behaviors (drug use, sexual practices)
• Promote use of VCT, STI, and other
available support services
Goal: to reduce risk of HIV transmission and STI
prevalence among most at-risk populations
62

Overview of Community
Outreach Programs
• PEPFAR-funded programs – explicitly included
• CARE International (CARE)
• CDC/LIFEGAP (CDC/LG) and HCMC/Provincial AIDS
Committee
• Family Health International (FHI)
• Médecins du Monde (MDM) France
• Other HIV prevention programs - also referenced
• DfID
• World Bank
• Global Fund
63
Overview: PEPFAR-funded
Community Outreach Programs
Peer Educators (PEs):
• Current or former IDUs, CSWs, MSM who:
• reach peers with HIV prevention messages
• promote VCT and referral
• Potential advantages:
• relatively fast and inexpensive recruitment
• easy to scale up
• natural access to social networks
64
Overview: PEPFAR-funded
Community Outreach Programs
Health Educators (HEs):
• Young, university educated staff who:
• reach MARPs with HIV prevention messages
• promote VCT and referral to services
• Support and often supervise PEs
• Potential advantages:
• Relatively more informed
• More consistent schedules
65
Community Outreach Programs
CDC/LIFEGAP
• All 6 focus provinces
• PE approach: teams of 4, supervised by a leader
• Target groups (in order of % of PE who reported meeting with this
population in last mo.)
• IDUs – 70%
• CSWs – 50%
• MSM – < 5%
66
Community Outreach Programs
FHI
• Works in all 6 focus provinces
• Uses PE and HE approach
• Target groups (in order of % of outreach workers who
reported meeting with this population in last mo.)
• CSWs – 60%
• MSM – 40%
• IDUs – 25%
67
Community Outreach Programs
MdM
• Hanoi and HCMC
• Integrated
• Uses PE and HE approach (Hanoi), and PE only
(HCMC), mobile teams
• Target groups (in order of % of outreach workers who
reported meeting with this population in last mo.)
• IDUs – 80%
• CSWs – 60%
• MSM – 20%
68
Community Outreach Programs
CARE (in partnership with 11 NGOs)
•
•
•
•
Hanoi, Quang Ninh, Can Tho, An Giang, HCMC
Integrated “STRONGER 3”
PE and HE approach
Target groups in Hanoi for PEs
CSWs – 80%
• IDUs – 70%
• MSM – 70%
•
69
Qualitative Sample*
• 223 respondents including:
• 103 MARPs
• 78 PEs/HEs
• 42 Key informants
• Completed in:
•
•
•
•
•
43 Hà Noi
42 Hai Phòng
53 HCMC
42 An Giang
43 Quang Ninh
* Interviews in Can Tho have not been completed.
70
Quantitative Sample
• 2222 MARPs including:
• 1101 intervention, 1121 control
• 1212 CSWs, 605 IDUs, 408 MSM
• 810 Hà Noi, 802 HCMC, 310 Hai Phòng, 300
An Giang
• 272 outreach workers including:
• 241 peer educators, 31 health educators
• 86 Hà Noi, 49 HCMC, 115 Hai Phòng, 22 An
Giang
71
MARP Demographics
Significant differences, interventioncontrol
Intervention
Control
Age in yrs
29.6
28.5***
Ever tested for
HIV & rec’d +
result
21.8
15.5**
***significant at p<0.001
**significant at p<0.01
72
Characteristic
Intervention
group
1,101
Control group
7.1%
19.8%
24.1%
3.5%***
20.4%
14.6%***
MARPs:
Risk
Profile,
All respondents(n)
1,121
Ever had sex
Intervention vs.13.1%
Control5.6%***
with someone infected with HIV
1
with someone who had hepatitis
with a man who has sex with men
with someone who injects drugs
Injecting drug users (n)
Ever admitted to an 06 center (drug rehabilitation center)
Ever had trouble with police due to drug using behavior?
Used non-injectable drugs for non-medical purposes in
last 6 months
Ever injected drugs: 2
with someone infected with HIV
Commercial sex workers (n)
Ever admitted to an 05 center (re-education center)
Ever had trouble with police because of commercial sex
work
Men who have sex with men (n)
Ever used injectable drugs for non-medical purposes
Ever gave someone money, drugs, or goods for sex in
last 6 months
Ever received money, drugs, or goods for sex
298
40.9%
52.7%
307
34.2%
44.0%**
23.5%
20.9%
26.9%
603
16.1%
20.5%**
609
7.6%***
41.6%
200
8.0%
14.0%
28.1%***
208
9.1%
23.1%**
30.5%
40.1%**
*Significant at p<0.05, **significant at p<0.01, ***significant at p<0.001
73