The HIV epidemic is growing to be a huge global threat . In 2008 ,the number of people living with HIV worldwide continued to grow ,reaching an estimated 33.4 million (UNAIDS ,2009) , due to a contribution of new infection.
In South and South East Asia 2008 , there are about 3.8 million people living with HIV and about 280,000 new cases of HIV (UNAIDS ,2009) . Although the number people living HIV in 2008 reduce 200,000, compared with those in 2001 , (300,000) , the number of people living with AIDS is still high
According to Ministry of Health of Viet Nam, the number of people living with AIDS in Viet Nam now is 156,802 . Since the first case of HIV was found in December 1990 until June 31, there have been 44,050 people died of Aids .
Viet Nam is facing HIV concentrate epidemic , with most cases of HIV are on IDUs, FSWs ,MSM and all provinces of Viet Nam have people living with AIDS.
In Viet Nam, IDUs have the biggest proportion of PLWHIV in Viet Nam and have the highest HIV prevalence (28.4%) ( VAAC) . IDUs can be infected HIV through their risk behaviors such as not using condom when have sex or sharing needles with other when injecting drug. In addition, with active sexual behavior, IDUs would spread HIV to their non-injecting partner .
1.2)Problem justification:
Khanh Hoa province is located on the South Central Coast of Viet Nam and has about 1,200,000 people. As a one of tourism central of Viet Nam ,Khanh Hoa has a high proportion of commercial sex workers and IDUs ,and Khanh Hoa now is one of the provinces that have highest HIV prevalence in Viet Nam with the highest prevalence of HIV on IDUs and CSWs .
In addition, besides the risks of sharing injecting equipment, IDUs are also at risk of spreading HIV to non-injecting people via sexual transmission.
In Khanh Hoa, there have been some study about IDUs , but those study just focused on the KAB about HIV and HIV prevalence of IDUs , little studies learn about the risk factors of HIV infection of IDUs . Therefore, this study is needed in Khanh Hoa province, and it can provide more effective and practical support for HIV intervention program.
1.3)Research question:
What are the factors of HIV infection among IDUs in Khanh Hoa Province, Viet Nam?
1.4)Research objectives:
-Ultimate objective:
To help program administrators in reducing HIV infection among IDUs in Khanh Hoa province, Viet Nam
-Immediate objective :
Identify the factors of getting risk of HIV infection among IDUs in Khanh Hoa province, Viet Nam
II)LITERATURE REVIEW:
2.1) Theoretical Models:
This study applied "Health Belief Model" of Philip Banyard, published by Hodder & Stoughton 2002.
2.2) Previous study:
2.2.1) HIV infection among IDUs:
Injecting drug users have some of the highest HIV prevalence of any population in Asia . In Thailand, 30-50% of injecting drug users are believed to be infected HIV (National IDS Preventionand Alleviation Committee, 2008) . In Myanmar , more than one in three injecting drug users (37.5%) are HIV-infected . In China , HIV prevalence among injecting drug users was estimated from 6.7% to 13.4% (Wang et al.,2009) .
And in Viet Nam, HIV prevalence is highest among injecting drug users.( UNAIDS 2009) , about of 28.6% , compared with average HIV prevalence among FSWs is 4.4%. These figures differ from province to province.
2.2.2) Demographic characteristics of IDUs and HIV infection:
a) Sex of IDUs and HIV infection :
HIV infection of IDUs is difference between male and female IDUs . A study about IDUs in Baltimore said that female IDUs had significantly higher HIV infection compared with male IDUs (Steffanie et al 2001) , this research found that the rate ratio for HIV seroconversion among women vs men was 1.04 (95% CI, 0.8-1.4) .
Risk factors for HIV infection differed markedly by sex , predominant risks among men included needle sharing and homosexual activity; among women, factors consistent with high-risk heterosexual activity were more significant than drug-related risks . More over , human immunodeficiency virus interventions aimed at IDUs should be sex-specific and incorporate sexual risks.
b) Age of IDUs and HIV infection:
A study on IDUs in Thailand showed that age had relationship to HIV infection ,young injectors were found at greater risk for HIV infection (Pajongsil et al 2003) , most of the HIV-positive IDUs belong to the age group 15-24(Pia Kivela et al 2006) .Another study about IDUs in Baltimore reported that injection drug users who were younger than 30 years at enrollment were more than twice as likely to experience HIV infection (Steffanie et al 2001) . Compared with older drug users, younger IDUs tend to have initiated injection more recently; specific factors related to initiation into injection (eg, number of "trainers" who teach new initiates how to inject) may be associated with elevated HIV transmission risks. There are several reports indicate that younger IDUs are more likely to engage in needle-sharing and other behaviors that place them at higher risk of acquiring HIV (Steffanie et al 2001) . Because of lack of injecting skills may push them to hang out, inject, and share needles/syringes with older, 'skillful experienced' IDU friends who might have already be HIV-infected, not be aware of their own HIV status, and appear health (Pajongsil et al 2003).
c) Marital status of IDUs and HIV infection:
A study about IDUs in the border of Viet Nam and China said that being married or living as married was related to HIV negativity(Theodore M. Hammett 2005) . Another study found that , male IDUs who reported not having a heterosexual partner were more likely to acquire HIV infection . Maybe lack of heterosexual partnership may also be a marker for more severe drug dependence and high-risk injection practices are more common in the absence of a partner who can provide social support (Steffanie et al 2001).
d) HIV knowledge of IDUs and HIV infection:
Study about IDUs in the border of Viet Nam and China also reported that higher levels of HIV knowledge were predictably related to HIV risk reduction behavior (ie, obtaining needles in ''safe'' places, reducing or discontinuing the sharing of injection equipment). (Theodore M. Hammett 2005).
In Vietnam, 98% of HIV-positive IDUs reported taking some steps to reduce their risk of acquiring or transmitting HIV since hearing about HIV, whereas 62% of HIV-positive IDUs in China reported taking some risk reduction measures (Theodore M. Hammett 2005).
2.2.3) Sexual characteristics of IDUs and HIV infection:
a) Number of sexual partner of IDUs and HIV infection:
Study about IDUs in the border of Viet Nam and China found that we recently found that men were more likely to overreport heterosexual activity to an interviewer, which could explain the inverse association we observed between HIV seroconversion and number of heterosexual partners(Steffanie et al 2001) . And the more sexual partners they have,the more risk of infecting HIV they get.
b) Consistent condom use with regular partner of IDUs and HIV infection:
A study about condom use on IDUs in Nothern Thailand reported that using condoms with regular sexual partners (adjusted RR 0.2; 95% CI 0.02-1.2) were independent predictors of HIV infection, although the last risk factor was of marginal statistical significance (Myat Htoo Razak et al 2003) .
Another study reported that condom use was significantly associated with an increased risk of HIV seroconversion, which is not surprising because condom use is highly correlated with high-risk sexual behaviors (eg, sex trade) (Steffanie et al 2001).
c) Consistent condom use with irregular sexual partner of IDUs and HIV infection
Irregular sexual partner includes commercial sex partners and other irregular sexual partner . Irregular sexual partner of IDUs play a important role as a bridge to transmit HIV between IDUs and non-injecting population (Steffanie et al 2001) . Commercial sex workers also have high prevalence of HIV, IDUs can be infected HIV from CSWs when having sex.
Consistent condom use with irregular sexual partner of IDUs has negative relationship with HIV infection of IDUs.
2.2.4) Injecting characteristics of IDUs and HIV infection:
a) Duration of injecting of IDUs and HIV infection:
A study about IDUs in Pakistan reported that duration of injecting drug were positive associated with HIV infection (Arshad Altaf et al 2009). If the duration of injecting drug were long , IDUs would get more risk of infecting HIV. (Pia Kivela et al 2006).
b) Frequency of injecting of IDUs and HIV infection:
A study in Aborigina reported that there were a strong association between frequent speedball injection and HIV infection among both the Aboriginal men and women appears to be a new finding and is of grave concern.
c) Sharing needles behavior of IDUs and HIV infection:
A study about IDUs in Baltimore reported that high risk of HIV infection associated with injection-related behaviors that are associated with needle-sharing behaviors(Steffanie et al 2001). Another study said that IDU had almost twice the odds of being HIV positive if they had injected with used needles and syringes in the 4 weeks before the interview (Tim Rhodes et al 2002)
2.3) Conceptual framework:
Demographic characteristic:
-Sex
-Age
-Marital status
-AIDS knowledge
Drug injecting characteristics:
-Duration of injecting drug
-Frequency of injecting drug
-Sharing needle
HIV status
-Sexual characteristics:
-Number of sex partner
- Consistent condom use when having sex with regular partner
- Consistent condom use when having sex with irregular partner
-Consistent condom use
2.4) Research hypotheses :
- There are some demograpic characteristics ( age, sex, marital status, employment status, HIV knowledge) affect HIV infection among IDUs in Khanh Hoa province, Viet Nam.
- There are some sexual characteristics (number of sexual partners , consistent condom use with regular sexual partner , consistent condom use with irregular sexual partner ) affect HIV infection among IDUs in Khanh Hoa province, Viet Nam
-There are some injecting characteristics ( duration of injecting , frequency of injecting , sharing needle ) affect HIV infection among IDUs in Khanh Hoa province, Viet Nam
III)RESEARCH METHODOLOGY:
3.1) Source of data:
This study use data from KAB survey :" Describe knowledge , attitude and behavior about HIV/AIDS Prevention among high risk group in Khanh Hoa Province , Viet Nam" ,carried out by Khanh Hoa department of health from July to December ,2008.
The survey was conducted in Khanh Hoa province, in south central of Viet Nam
3.2) Sample design and sample size:
Data in this study were obtained from a crossectional survey which was conducted from July to December ,2008.
IDUs is a hard to reach population ,they are hardly to recruited by random sampling. Therefore, RDS method was used to recruited 350 IDUs in 7 districts of Khanh Hoa Province.
3.3) Measurements and Questionnaire design:
Respondents were interviewed face to face to get information about socialdemographic and behavioral characteristic by structured questionaire based on National guideline.
3.4) Operational definition of variables:
- Dependent variable :
HIV status: HIV status of IDUs after IDUs got a blood HIV test . Results of HIV status are negative and positive.
-Independent variables :
There are 3 groups of independent variables: demographic variables with 4 independent variables ( age, sex, marital status, HIV knowledge ), sexual variables with 3 independent variables ( number of sexual partners, consistent condom use when having sex with regular sexual partner, consistent condom use when having sex with irregular sexual partner ), injecting variables with 3 independent variables ( duration of injecting, frequency of injecting, sharing needles when injecting )
Variables
Categories
Measurement
Independent variables
Age (year)
Age of IDUs at time of survey .Age is used as a continuos variable
Interval
Marital status
Marital at time of survey
0= married or cohabiting
1= single or divorced or separate
Nominal
Knowledge of HIV
Knowledge of IDUs at time of survey . Completely correct answer of total 5
questions is defined as having good
knowledge , if not, poor knowledge
0=poor knowledge
1=good knowledge
Nominal
Injecting duration
Number of year that an IDU has been
injected drug ,from the first injection up
to the time of survey
Interval
Injecting frequency
Number of time of injecting of an IDU
per day/week
1=at least 2 times/ day
2= 1-7 times /week
3= less than 1 time/week
Ordinal
Sharing needle
Sharing needles with injecting partner
behavior of IDUs when injecting
0= never sharing needles with partners
1= ever sharing needled with partners
Nominal
Number of sexual partner
Total number of sexual partners of IDUs during last 12 months, including
spouse/lover ; CSWs ; casual partner
Ratio
Consistent condom use with regular partner
Condom use of IDU when having sex with regular sexual partner
0= not always use condom when having
sex with regular sexual partner
1=always use condom when having sex
with regular sexual partner
Nominal
Consistent condom use with irregular partner
Condom use of IDU when having sex with irregular sexual partner
0= not always use condom when having
sex with irregular sexual partner
1=always use condom when having sex
with irregular sexual partner
Nominal
Dependent variables
HIV status
HIV serostatus of IDUs at time of survey
0= negative
1= positive
Nominal
3.5)Data analysis:
Frequencies and crosstab tabulation were used to decribe personal , sexual , injecting characteristics and HIV status of IDUs
Binary logistic regression was used to examine the net effect of risk factors on HIV infection.
3.6) Limitation of study:
-This study get data from a cross-sectional survey so that it cannot draw definitive causal inferences
-IDUs is hard -to-reach population ,therefore it is hard to select a random sample of drug injectors , the results may not be generalized to IDUs who do not yet perceive a need to seek drug treatment
-This data are based on self-reported responses; data may possibly be over-or under-reported, and may suffer from recall bias.
