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High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City, Vietnam

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Abstract

In Vietnam’s concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a ‘bridge’ of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam’s largest cities, in 2013–2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0–27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2–47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across ‘bridging’ categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87–7.56), current opioid use (OR 2.55; 95% CI 1.02–6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46–19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These results indicate high HIV prevalence among male clients of FSWs, particularly among those with a history of drug use. Programs to expand HIV testing, drug-use harm reduction, and HIV treatment for HIV-infected male clients of FSWs should be considered as key interventions for controlling the HIV epidemic in Vietnam.

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Acknowledgements

The authors would like to thank the Vietnam Provincial HIV/AIDS Committees (PACs) of Hanoi and Ho Chi Minh City who contributed to the completion of this study. We would also like to sincerely thank Dr. Sheryl Lyss, the Vietnam CDC Associate Director for Science, for her technical review and suggested edits to the manuscript.

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The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Funding

This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention under the terms of contract 200-2011-M-42018.

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Correspondence to Patrick Nadol.

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Nadol, P., Hoang, T.V., Le, LV. et al. High HIV Prevalence and Risk Among Male Clients of Female Sex Workers in Hanoi and Ho Chi Minh City, Vietnam. AIDS Behav 21, 2381–2393 (2017). https://doi.org/10.1007/s10461-017-1751-4

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