International Journal of Public Health

, Volume 59, Issue 5, pp 833–840 | Cite as

Stigma related to sex work among men who engage in transactional sex with men in Ho Chi Minh City, Vietnam

  • Catherine E. Oldenburg
  • Katie B. Biello
  • Donn Colby
  • Elizabeth F. Closson
  • Thi Mai
  • Thi Nguyen
  • Ngoc A. Nguyen
  • Matthew J. MimiagaEmail author
Original Article



Male sex workers (MSW) in Vietnam face high levels of stigma related to sex work, which may be associated with depression and increased vulnerability to HIV.


In 2010, 300 MSW completed a behavioral and psychosocial survey. Multivariable models assessed factors associated with sex work-related stigma and the association between stigma and depression.


Factors associated with increased stigma included having disclosed sexual orientation to healthcare workers (b 1.75, 95 % CI 0.69–2.80), meeting clients in the street/park (b 1.42, 95 % CI 0.32–2.52), and having been forced to have sex without a condom (b 2.36, 95 % CI 1.27–3.45). Factors associated with decreased stigma included meeting clients via the telephone or internet (b −1.26, 95 % CI −2.39 to −0.12) and receiving financial support from family or friends (b −1.31, 95 % CI −2.46 to −0.17). Stigma was significantly associated with increased odds of depression (AOR 1.07, 95 % CI 1.01–1.15).


Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs’ needs, and may result in decreased HIV spread.


HIV Sex workers Male sex workers Vietnam Depression Stigma 



This study was conducted with the support of a pilot grant from Harvard Catalyst—The Harvard Clinical and Translational Science Center (PIs: Colby and Mimiaga). CEO is supported by NIAID T32AI007535 (PI: Seage).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All study procedures complied with current laws of the country in which they were performed. This study conformed to the tenets of the Declaration of Helsinki.


  1. Berry MC, Go VF, Quan VM et al (2013) Social environment and HIV risk among MSM in Hanoi and Thai Nguyen. AIDS Care 25:38–42. doi: 10.1080/09540121.2012.687808 PubMedCrossRefGoogle Scholar
  2. Biello KB, Colby D, Closson E, Mimiaga MJ (2013) The syndemic condition of psychosocial problems and HIV risk among male sex workers in Ho Chi Minh City, Vietnam. AIDS Behav. doi: 10.1007/s10461-013-0632-8 Google Scholar
  3. Blanc M-E (2005) Social construction of male homosexualities in Vietnam. Some keys to understanding discrimination and implications for HIV prevention strategy. Int Soc Sci J 57:661–673CrossRefGoogle Scholar
  4. Clatts MC, Gian LM, Goldsamt LA, Yi H (2007) Male sex work and HIV risk among young heroin users in Hanoi, Vietnam. Sex Health 4:261–267PubMedCrossRefPubMedCentralGoogle Scholar
  5. Colby D, Cao NH (2004) Men who have sex with men and HIV in Vietnam: a review. AIDS Educ Prev 16:45–54PubMedCrossRefGoogle Scholar
  6. Diaz RM, Ayala G, Bein E et al (2001) The Impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health 91:927–932PubMedCrossRefPubMedCentralGoogle Scholar
  7. Emlet CA (2007) An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work 31:299–308CrossRefGoogle Scholar
  8. Floyd FJ, Widaman KF (1995) Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess 7:286–299CrossRefGoogle Scholar
  9. Garcia MC, Meyer SB, Ward P (2012) Elevated HIV prevalence and risk behaviours among men who have sex with men (MSM) in Vietnam: a systematic review. BMJ Open 2:e001511–e001511. doi: 10.1136/bmjopen-2012-001511 PubMedCrossRefPubMedCentralGoogle Scholar
  10. Herek GM (2007) Confronting sexual stigma and prejudice: theory and practice. J Soc Issues 63:905–925CrossRefGoogle Scholar
  11. Hoang TV, Tuan NA, Mills SJ et al (2006) Results from the HIV/STI integrated biological and behavioral surveillance (IBBS) in Vietnam: 2005–2006. Ministry of Health, VietnamGoogle Scholar
  12. Hoang TV, Tuan NA, Mills SJ et al (2009) Results from the HIV/STI integrated biological and behavioral surveillance (IBBS) in Vietnam—round II 2009. Ministry of Health, VietnamGoogle Scholar
  13. King EJ, Maman S, Bowling JM et al (2013) The influence of stigma and discrimination on female sex workers’ access to HIV services in St. Petersburg, Russia. AIDS Behav 17:2597–2603. doi: 10.1007/s10461-013-0447-7 PubMedCrossRefGoogle Scholar
  14. Kingori C, Reece M, Obeng S et al (2012) Impact of internalized stigma on HIV prevention behaviors among HIV-infected individuals seeking HIV care in Kenya. AIDS Patient Care STDs 26:761–768. doi: 10.1089/apc.2012.0258 PubMedCrossRefGoogle Scholar
  15. Lau JTF, Cai W-D, Tsui HY et al (2009) Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in Shenzhen, Mainland China who serve cross-border Hong Kong male clients. AIDS Behav 13:939–948. doi: 10.1007/s10461-009-9591-5 PubMedCrossRefGoogle Scholar
  16. Li L, Lee S-J, Thammawijaya P et al (2009) Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care 21:1007–1013. doi: 10.1080/09540120802614358 PubMedCrossRefPubMedCentralGoogle Scholar
  17. Logie CH, Newman PA, Chakrapani V, Shunmugam M (2012) Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Soc Sci Med 74:1261–1268. doi: 10.1016/j.socscimed.2012.01.008 PubMedCrossRefGoogle Scholar
  18. Logie C, James L, Tharao W, Loutfy M (2013) Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black Women in Ontario, Canada. AIDS Patient Care STDs 27:114–122. doi: 10.1089/apc.2012.0296 PubMedCrossRefGoogle Scholar
  19. Luong HV (2006) Structure, practice, and history: contemporary anthropological research on Vietnam. J Vietnam Stud 1:371–409CrossRefGoogle Scholar
  20. Ma W, Raymond HF, Wilson EC et al (2012) Participation of HIV prevention programs among men who have sex with men in two cities of China—a mixed method study. BMC Public Health 12:1–13. doi: 10.1186/1471-2458-12-847 CrossRefGoogle Scholar
  21. Mimiaga MJ, Reisner SL, Closson EF et al (2013) Self-perceived HIV risk and the use of risk reduction strategies among men who engage in transactional sex with other men in Ho Chi Minh City, Vietnam. AIDS Care 25:1039–1044. doi: 10.1080/09540121.2012.748873
  22. Ngo DA, Ross MW, Phan H et al (2009) Male homosexual identities, relationships, and practices among young men who have sex with men in Vietnam: implications for HIV prevention. AIDS Educ Prev 21:251–265PubMedCrossRefPubMedCentralGoogle Scholar
  23. Nguyen TA, Nguyen HT, Le GT, Detels R (2007) Prevalence and risk factors associated with HIV infection among men having sex with men in Ho Chi Minh City, Vietnam. AIDS Behav 12:476–482. doi: 10.1007/s10461-007-9267-y PubMedCrossRefPubMedCentralGoogle Scholar
  24. Rao PJ, Mboi N, Phoolchaoren W, Sarkar S (2010) AIDS in Asia amid competing priorities: a review of national responses to HIV. AIDS 24:S41–S48PubMedCrossRefGoogle Scholar
  25. Rhodes T (2009) Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy 20:193–201PubMedCrossRefGoogle Scholar
  26. Risher K, Adams D, Sithole B et al (2013) Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland. J Int AIDS Soc. doi: 10.7448/IAS.16.3.18715 PubMedPubMedCentralGoogle Scholar
  27. Setia MS, Sivasubramanian M, Anand V et al (2010) Married men who have sex with men: the bridge to HIV prevention in Mumbai, India. Int J Public Health 55:687–691. doi: 10.1007/s00038-010-0173-0 PubMedCrossRefGoogle Scholar
  28. Simbayi LC, Kalichman S, Strebel A et al (2007) Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med 64:1823–1831. doi: 10.1016/j.socscimed.2007.01.006 PubMedCrossRefGoogle Scholar
  29. Thanh DC, Moland KM, Fylkesnes K (2012) Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam. BMC Health Serv Res 12:428. doi: 10.1186/1472-6963-12-428 PubMedCrossRefPubMedCentralGoogle Scholar
  30. Thi MDA, Brickley DB, Vinh DTN et al (2008) A qualitative study of stigma and discrimination against people living with HIV in Ho Chi Minh City. Vietnam. AIDS Behav 12:63–70. doi: 10.1007/s10461-008-9374-4 CrossRefGoogle Scholar
  31. Thomas B, Mimiaga MJ, Mayer KH et al (2012) The influence of stigma on HIV risk behavior among men who have sex with men in Chennai, India. AIDS Care 24:1401–1406. doi: 10.1080/09540121.2012.672717 PubMedCrossRefPubMedCentralGoogle Scholar
  32. Tran TN, Detels R, Long HT, Lan HP (2005) Drug use among female sex workers in Hanoi, Vietnam. Addiction 100:619–625. doi: 10.1111/j.1360-0443.2005.01055.x PubMedCrossRefGoogle Scholar
  33. Wohl AR, Galvan FH, Carlos J-A et al (2012) A comparison of MSM stigma HIV stigma. and depression in HIV-positive Latino and African American men who have sex with men (MSM). AIDS Behav. doi: 10.1007/s10461-012-0385-9 PubMedGoogle Scholar
  34. Wu DY, Munoz M, Espiritu B et al (2008) Burden of depression among impoverished HIV-positive women in Peru. J Acquir Immune Defic Syndr 48:500–504PubMedCrossRefGoogle Scholar
  35. Zhang W, O’Brien N, Forrest JI et al (2012) Validating a Shortened Depression Scale (10 Item CES-D) among HIV-positive people in British Columbia, Canada. PLoS One 7:e40793. doi: 10.1371/journal.pone.0040793.t004 PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Catherine E. Oldenburg
    • 1
  • Katie B. Biello
    • 1
    • 2
  • Donn Colby
    • 3
    • 4
  • Elizabeth F. Closson
    • 2
  • Thi Mai
    • 3
  • Thi Nguyen
    • 3
  • Ngoc A. Nguyen
    • 3
  • Matthew J. Mimiaga
    • 1
    • 2
    • 5
    Email author
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.The Fenway InstituteFenway Community Health BostonBostonUSA
  3. 3.Harvard Medical School AIDS Initiative in VietnamHo Chi Minh CityVietnam
  4. 4.Center for Applied Research on Men and HealthHo Chi Minh CityVietnam
  5. 5.Department of PsychiatryHarvard Medical School/Massachusetts General HospitalBostonUSA

Personalised recommendations