Community-led outreach in Vietnam reduces HIV risk and increases testing
The most comprehensive study to date of peer outreach in Vietnam finds it significantly increases HIV knowledge and testing and reduces risky behaviour.
Although data from the study, newly published in BMC Public Health, is from 2007 and 2008, no other research has assessed the impact of community-based outreach programmes on a national level in Vietnam. The study among people who inject drugs, men who have sex with men and sex workers shows that trained peers are effective in reducing high-risk sexual behaviour and increasing both HIV knowledge and testing.
The research focuses on programmes supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest international donor in Vietnam. These programmes recruited, trained, and deployed cadres of men who have sex with men and people with a history of injection drug use or sex work as outreach workers. Each outreach worker supported their peers to access HIV-prevention information, skills, and supplies (such as condoms) and link them to HIV testing, treatment and other services. Operating alongside peer outreach workers were health educators – college graduates trained in health education.
The newly published research is based on a survey of around 2,200 people from the three population groups living in six provinces. Roughly half of survey participants had been in contact with a peer outreach worker in the past six months and half had not. The survey results were accompanied by 125 in-depth interviews with people from each population group.
Participants had a mean age of 29 and were evenly divided between men and women. One-third of all participants reported sex work as their main daily activity. Those who had come into contact with a peer outreach worker in the past six months (the intervention group) were slightly older than comparison participants and more likely to have tested positive for HIV (22% vs. 15%).
Researchers found 48% of participants who interacted with peer and health educators could demonstrate good knowledge of HIV transmission, prevention and treatment, compared to 35% of those who had not. Having an enhanced level of HIV knowledge due to peer interaction was true across all population groups. The majority of interview participants also described how outreach workers helped increase their knowledge of HIV, which was associated with behaviour change, new attitudes about living with HIV and reduced fear.
Peer outreach workers also had a significant impact on HIV testing, with 76% of intervention participants having tested for HIV compared to 47% in the comparison group. Intervention participants were also more likely to have received pre-test (78% vs. 33%) and post-test counselling (80% vs. 60%).
Overall, researchers found the majority of participants who were sexually active reported high-risk sexual behaviours, with only 37% always using a condom and 17% occasionally using one in the past six months. Around 38% of female sex workers reported always using condoms, the highest consistent condom rate across the three population groups, while people who inject drugs reported the lowest consistent condom use at 31%.
Regardless of population group, a significantly higher proportion of those in the intervention category reported more frequent condom use, and this was true regardless of whether sex had been with a primary or casual partner or with a client.
The differences in consistent condom use between intervention and comparison participants were greatest with client sex partners for both female sex workers (70% v. 58%) and people who inject drugs (61% v. 46%). Among men who have sex with men, the difference between intervention and comparison group was highest for sex with casual partners (42% v. 32%).
In relation to injection drug use, researchers found low levels of risk-behaviours and little evidence of programme impact on such behaviours. Among survey participants who reported injecting drugs in the previous six months, only 14% reported sharing equipment. Of these people, 36% reported re-using a needle/syringe at last injection. Few differences between intervention and comparison groups emerged.
However, when asked about measures taken to reduce infection risk, 75% of intervention participants said that they had stopped sharing injection equipment, compared to 68% of comparison participants. Similarly, 62% of intervention participants reported starting to clean injecting equipment, or increasing the frequency of cleaning, compared to 52% of comparison participants.
Although more than a decade old, the results of this study still have major relevance for Vietnam’s HIV response. As the Vietnamese government is due to fund 75% of HIV programming by 2020, and international donors continue to withdraw, it provides useful insights into how resources will be best spent to ensure those most affected by HIV can be supported to protect their health and the health of others.