current situation and factors affecting hiv infection and sexually transmitted diseases in male homosexual sex worker group in hanoi, 2009-2010”

1

NATIONAL INSTITUTE OF HYGIENE AND
EPIDEMIOLOGY
*


NGUYEN THI PHUONG HOA

CURRENT SITUATION AND FACTORS
AFFECTING HIV INFECTION AND
SEXUALLY TRANSMITTED INFECTIONS
MALE HOMOSEXUAL SEX WORKER GROUP
IN HANOI, 2009-2010


Specialization: Public health
Code : 62 72 03 01


THESIS SUMMARY



HA NOI - 2014

MINISTRY OF EDUCATION
AND TRAINING
MINISTRY OF
HEALTH
2

The thesis was completed in:
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY

Scientific supervisors:
1. Prof. Nguyen Tran Hien, MD, MPH, PhD
2. Assoc. Prof. Dao Thi Minh An, MD, PhD

Opponent 1:


Opponent 2:


Opponent 3:


The thesis will be defended at the Institute
‘
s PhD
Assessment committee at National Institute of Hygiene and
Epidemiology
Time: date: month 2014

The thesis can be found at:
- The National library
- The National Institute of Hygiene and Epidemiology
Library
3

PUBLICATIONS
1.

Nguyen Thi Phuong
Hoa, Le Minh Giang, Nguyen Tran
Hien and et al (2012), “Demographic characteristics and risk
behaviors for HIV/STIs of men having sex with men (MSM)
sex workers in Ha noi, 2009
-2010”, Journal of Preventive
Medicine
, Volume XXII, No 6(133), page. 39-46.
2.

Nguyen Thi Phuong Hoa, Le Minh Giang, Nguyen Tran
Hien and et al (2012), “Risk factors for HIV/STIs among
MSM sex workers in Ha noi, 2009-2010”, Journal of
Preventive Medicine, Volume XXII, No 6(133), page 47-54.

4

PREFACE
1. The thesis’s urgency
Male homosexual sex worker group is a branch of Men
who have sex with men (MSM) group. Epidemiological and
social researches of HIV infection and sexually transmitted
infections (STIs) among male homosexual sex worker/MSM
have shown that: Male homosexual sex worker group has
higher risk of HIV infection and STIs. Other researches also
pointed out the results of unsafe sexual intercourse with many
type of partners, numerous sex partners and using drugs.
Those researches have shown the importance of studying
male homosexual sex worker group in limiting HIV infection
and STIs. However, in Vietnam and particularly in Hanoi, there
are not much specific studies on male homosexual sex worker
group; therefore, we conducted this thesis in order to:
1. Describe sexual identity, knowledge about HIV/STIs,
sexual behaviors, use of addictions and use of medical
services among male homosexual sex worker in Hanoi,
2009-2010.
2. Identify current HIV infection and sexually transmitted
diseases rate in male homosexual sex worker group in
Hanoi, 2009-2010.
3. Analyze some factors affecting the risk of HIV infection
and sexually transmitted diseases in Hanoi, 2009-2010.



5

2. New findings of the thesis
This is the first systematic research on demographic
characteristics, HIV infection and STIs rate, risk factors of HIV
infection and STIs in male homosexual sex worker group in Hanoi.
The thesis has identified current HIV infection and STIs
rate in male homosexual sex worker group in Hanoi as well as
has found some factors to forecast the risk of infected at least
one STI in this group.
The results have supported planning process to prevent
HIV infection and STIs among male homosexual sex worker
group in Hanoi.
3. Scientific and practical significance of the thesis`
Scientific significance: The thesis, which uses cross-
section descriptive research included quantitative and
qualitative research, trusted data collection methods and precise
analyzing methods, has concluded that male homosexual sex
worker group in Hanoi is the group with high risk of HIV
infection and STIs as well as identified some factors to forecast
the risk of infected at least one STI in male homosexual sex
worker group.
Practical significance: The results imitated some
solutions to prevent and control HIV infection and STIs in male
homosexual sex worker group.
The thesis also provided various practical data for
teaching purposes or reference for other researches.
Thesis arrangement: The thesis was presented on over
102 pages (excluded references, table of contents) and divided
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into; Preface: 2 pages; Chapter 1-Introduction: 30 pages;
Chapter 2-Research subjects and methodology: 15 pages
Chapter 3-The thesis’s findings: 32 pages; Chapter 4-
Discussion: 20 pages; Conclusion: 2 page; Recommendations:
1 page. Thesis consists of 17 tables, 13 charts, 1 image, and 1
diagram. The appendix includes 77 references (16 Vietnamese,
61 English), list of sampling sites, the deep interview
questionnaire guidance, adventure screening, agreed to
participate in research, questionnaires, and card for promissory
test results.
CHAPTER 1: INTRODUCTION
1.1. Introduction and basic concepts
1.1.1. Sex and gender
1.1.1.1. Sex: is the concept which implies biological
characteristics of male and female body.
1.1.1.2. Gender: is social concept of role, behaviors, activities and
other features which are considered suitable for male or female.
1.1.2. Sex and related concepts
1.1.2.1. Sexual orientation: Imply a long-term sexual or
emotional attraction by a same gender, different gender or both.
Therefore, there are 3 general sexual orientations: heterosexual,
homosexual and bisexual.
1.1.2.2. Concepts of Transgender, Transsexual, Intersex, Gay,
Men who have sex with men, Male homosexual sex worker
1.1.2.3. Transgender: the situation in which a person with
normal body characteristics about sex but believe that he/she
belong to other sex and live as he/she thought.
7

1.1.2.4. Transsexual: The use of surgery or hormone

treatment… to change biological sex from man to woman or
vice versa.
1.1.2.5. Intersex: A person has extraordinary strange about sex
differentiation, body and genital organs because of unusual
genes, endocrine… The person would have biological
characteristics of both male and female or unidentified sex.
1.1.2.6. Gay: A male individual is attracted or has sexual desire
with another male individual. Gay infer to homosexual
orientation of a male individual.
1.1.2.7. MSM: the term infer to sexual intercourse of a male
with another in any situation regardless sexual orientation,
sexual identity.
1.1.2.8. Male homosexual sex worker: Prostitution is the coitus
behaviors of a person with another in order to exchange money
or other benefits. Male homosexual sex worker is defined as a
male has sexual intercourse with another man to get money or
benefits (accommodation, foods, drugs…).
1.1.2.9. Other terms, concept (Gay, straight men), Pê – đê.
1.1.3. Concept of sexually transmitted infections
Infections due to bacteria, virus, monocle, fungus,
parasitic and can be transmitted between people through sexual
intercourse.
1.2. Demographic characteristics of MSM/Male
homosexual sex worker group worldwide and in Vietnam
1.2.1. Population size
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The proportion of male homosexual sex worker in
MSM group fluctuates between 20.0% and 74.0%, depending
on each country. In Vietnam, this proportion is about 22.0% to

52.4%, depending on each province.
1.2.2. Socio-Demographic characteristics, sexual identity
and gender identity
Worldwide and Vietnamese studies have shown that male
homosexual sex worker group does not uniform, they diverse as
ages but popular in young men, educational background,
nationalities, and jobs…Most male homosexual sex worker are
immigrations from other areas. Male homosexual sex worker
group consists of gay, intersex and heterogeneous.
1.3. Current situation of HIV infection and STIs rate in
male homosexual sex worker group
Until now, there is not any international organization
introduce statistics data on level of HIV infection and STIs rate
in male homosexual sex worker group worldwide. This ratio
fluctuate proximately between 2.1% - 33.3%, and the ratio of
infected at least one STI is about 2.0% - 60.0%.
1.4. Sexual behaviors and the use of addictions
1.4.1. Sexual behaviors
There were a number of studies on risks of infecting HIV
and STIs in male homosexual sex worker group which depend on
the number of sex partners as well as their diversity. The male
homosexual sex worker member not only has sexual intercourse
with male but also with female. In other words, inter-gender sex
among male homosexual sex worker group is quite popular in
recent years which increases the risk of infecting.
9

Although oral sex is very popular in male homosexual sex
worker/MSM group, the proportion of using condoms is seldom.
Besides, anal sex is the main reason for infecting HIV and STIs in

male homosexual sex worker group. Many specific researches on
male homosexual sex worker have concluded that the proportion
of anal sex with out protection is pretty high, from 13.0% to 78.5%,
much higher than that of non male homosexual sex worker group
(22.4% compared with 4.6%).
1.4.2. The use of addictions
The use of addictions among male homosexual sex
worker is quite popular. Studies have shown that there are vast
addiction types used, included: alcohol, tobaco, marijuana, cocain,
heroin, benzodiazepines, pain retriever, ecstasy….In the world,
research in Kenya in 2008 showed the relationship between alcohol
and unprotected-anal sex (OR=1.63; 95%CI=1.05-2.54). Among
male homosexual sex worker group, the number of IDUs
fluctuates between 1.5% - 11.1%.Vu Ngoc Bao’s research in 2009
also proved the relationship between prostitution and using drugs-
particularly injecting heroin.
1.5. Factors affecting the risk of HIV infection and STIs
Those factors can be classified into 3 categories: individual
factor, socio-environmental factors and the specific situation of
prostitution.
1.6. Medical services
In Vietnam, medical services assessibility of male
homosexual sex worker group has not been concerned, some
studies have shown this limitation. Among male homosexual sex
10

worker group, self-admitted HIV tested ratio of group prostitution
only is about 12.5%, much lower than average ratio (19.5%).
Besides, only 39.0% was received condoms, in which, the ratio of
group prostitution only is lowest (22.2%).

CHAPTER 2: METHODOLOGY
2.1. The thesis object
The study objects are men who have homosexual
prostitution in Hanoi, from 16 to 35 years old and admitted
having anal sex or oral sex with another man in the last
previous month.
2.2. Time and location of the thesis
2.2.1. Time: from 01/2009 to 12/2010.
2.2.2. Location
Places are gathering points of male homosexual sex
worker group in Hanoi, which are chose through qualitative
social research, included: Hoan Kiem lake, Thien Quang lake,
Water resources university park, massage street Quan Thanh-
Nguyen Truong To, steam room Quan Tho-Kham Thien street,
Hale club in Nguyen Du street, Bar GC-Bao Khanh.
2.3. Structure of the thesis
Cross-section research combines with qualitative
research (social research) and quantitative research.
2.4. Sample size and sampling methods
n =
2
)2/1(


Z
DE
d
pp



2
)1(

Which include:p is current rate of HIV infection and
sexually transmitted infection rate in male homosexual sex
worker group in Hà Nội, 2006 (p= 0,088), Z
1-α/2
= 1,96, d =
0,044, DE=1,5
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Countable sample size was rounded to 250 observation.
Sample was chose through time-location method
2.5. Variations and index: Based on the research purposes.
2.6. Means of the thesis
Deep interview questionnaire guidance, interviewees
screening sheets, study enrollment’s agreement, interview
questionnaire; blood, or pharyngeal, genitals and fundament tests.
2.7. Data collecting methods
2.7.1. Qualitative social research
Using observation method combine with daily field
records, deeply interview 12 male homosexual sex worker
objects and 7 objects who have relationship, knowledge of male
homosexual sex worker group and inspected locations in order
to collect data on the location which male homosexual sex
worker appear frequently (characteristics of location and types
of objects), collect information on male homosexual sex worker
group (approaching methods, estimated number according to
time periods and dates, types of sexual intercourse, risky
behaviors, health problems…) and design suitable

questionnaire for targeted subjects of the research.
2.7.2. Quantitative Cross-section research
Aim to select appropriate objects in inspected locations.
When a qualified object is read and signed agreement to
participate the research, the object would be asked to answer
the designed questionnaire, and took 3 ml blood,
oropharyngeal, genitals and fundament to test.

12

Sampling procedures preservation and transportation
were carried out legally and directly sent to experimental lab by
officers in that day.
2.8. Testing techniques
HIV, HBV, HCV và syphilis tests were conducted in
Microbian faculty of Bạch Mai hospital.
Contraband, Chlamydia and HPV tests were conducted in
Laboratory of the Hospital of Hanoi Medical University.
All these technical tests were carried out under the
guidance of the Ministry of Health.
2.9. Processing and analyzing data
2.9.1. Qualitative data
Depth interviews records were decode and saved into
computer through word documents. Other information noted in
STIs and Depth interviews were encoded thematically. All is
analyzed through Nvio8 software.
2.9.2. Quantitative data
The data was cleaned before putted in Epi Data 6.04
software, analyzed by SPSS 16.0. The test used


2
test and
Logistics regression model.
2.10. Research ethics
The thesis was proved by ethics council of Hanoi Medical
University.
13

CHAPTER 3: RESULT OF RESEARCH
3.1. Demographic characteristics of male homosexual sex
worker group in Hanoi
According to research’s result, the mass of the participants
are in young age between 20-24 (52.0%), Most objects are still
single (94.4%). 87.2% have high school qualification or above,
the majority of them are immigrants (78.0%), and main income
from 2-5 million VND (53.6%).
3.2. Sexual identity, knowledge about HIV/STIs, sexual
behaviors, using addictions and using medical services of
the study group
3.2.1. Sexual identity
Most participants declared to be male (68.8%); only 5.2%
participants declared to be female and 5.2% participants
declared to be transgenders; prefer having sex with female
(56.0%), over 1/3 of objects likes have sex with male and
12.4% likes to have sex with both male and female.
3.2.2. Knowledge about HIV/STIs
The research results showed that the proportion of objects
with results correctly answer questions of knowledge about
HIV/STIs high. Still a small percentage of object wrong answer
questions about HIV transmission through mosquito bites and

sharing a cup of HIV infected persons.
3.2.3. Sexual behavior and use addictions
3.2.3.1. Sexual behavior
- The objects have sex with male, female partners and
male client, not only sex selling but also sex purchasing.
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Table 3.6. Forms of sexual intercourse and condom use with
sexual partners in the first time
Featuring
Condom use
Number Rate (%)
Female sex partners
Oral sex (n=159) 133 83.6
Vaginal sex (n=209) 96 45.9
Anal intercourse (n=41) 21 51.2
With male sex partners not only exchange

Oral sex (n=81) 10 12.3
Anal intercouse (n=77) 32 41.6
- Table 3.6 showed: the proportion of condom use differ
between forms of sex and between sexual partners.


Chart 3.2. Condom use during sexual intercourse with the
most recent with Vietnamese and foreign clients.
- Chart 3.2 shows: The percentage of condom use objects
in the forms sex is low.
- On average, objects had 9.5 and 11.7 times that they
have sex with their clients in the last 30 days.

15

- The everage number of clients who oral sex is 9.2; The
everage number of clients who give anal sex is 3.5 and to
receive anal sex is 3.9
Characteristics of selling sex: Most (52.8%) selling sex
male objects take part in this activity at the first time in age
from 20-24 (average at 20 years old), the majority of
participants have experience from 1 to nearly 5 years (54.0%),
and the reason is for money (86.8%); In the last 30 days,
research objects often meet male clients at various locations.
Most of their first time and latest clients are Vietnamese (95.2%
and 77, 6 % in counterpart). Nonetheless, More than 70.0% of
Vietnamese buyers is older than the subjects (5 years or more).
3.2.3.2. Use addictions
- 52.0% of objects had used at least one drug, up to
42.2% of objects have ever use synthetic drugs. 8.4% users
injecting drug and only 0.4% (1 person) is declared multiple
shared needles in the past 90 days. Most of the study objects
used wine/beer (97.6%).
3.2.4. Use of medical services
The majority of objects had used health services
(80.4%); However, only 1/4 (20.8%) talk to the medical staff
about MSM; Percentage of objects vaccinated with hepatitis B
vaccine relatively low (25.6%); Percentage of HIV tested object
is not high (47.8%); Percentage examination and treatment of
STIs is low (6,8%); Percentage examination and treatment of
HIV is low ( 9,6%).
16

3.3. Prevalence of HIV infection and STIs in male homosexual
sex worker in Hanoi.
2.0
14.0
5.2
1.6
19.2
12.0
12.8
4.0
0.4
1.6
0
20
40
60
80
100
%
Testing Seft report

Chart 3.7. Prevalence of HIV infection and STIs through test
results and self report
Graph 3.7 showed that: Prevalence of HIV infection and
STIs through some test of the study are much higher than
declaration questionnaire (48.8% compared with 7.6%).
Chart 3.8. The prevalence of STIs by organs tested
17

Result of the 3.8 diagram shows: own review in three parts

of infiltration sex ban, 20.4% of objects infected at least one STI at
anal, 15.6% at oropharynx and 12.8% in the genitals.
Analysing the rate of objects who infected at least one
STI according to demographic characteristics has shown that:
in the group of candidates from 25 years old, more than a half
of them has at least one STI, illiterate or low knowledge
background group hold the highest proportion, about 68.8%.
Although, candidates who have already had wife or a lover
account for the lowest proportion in research objects (4.4%),
the rate among this group is very high (72.7%). The proportion
of male homosexual sex worker who originally was born in Ha
Noi has infected at least one STI is relatively high (54.5%).
3.4. Some risk factors of HIV infection and STIs in Hanoi.
3.4.1. Factors related to behavior of anal sex without condom
for the last time
Research results showed that: factors associated with anal
intercourse sex no condom use is adulterers, those who have the
tendency of homosexuality and have incomes ≤ 2 million VND
in the last month.
3.4.2.Risk factors of HIV infection and STIs
To analyze the factors related to susceptibility to at least
one STI, researchers used logistic regression analysis in which
the dependent variable is infected with at least one STI and
independent variables are the variables after univariate analysis
with at least 1 STI, have statistically significant (p <0.05).
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Table 3:16. Logistic regression model
The dependent variable for at least one STI; parity coefficient: -
1.7; Significance level: 0.006, R2 = 0.1

Independent variable
Regression
coefficients

Significance
level
OR

95%
Education
level
Less primary 1
0.007
2.5 1.3-4.8

From junior
high or more
1
The Average
number of male
clients in the
last 30 days
≥ 10 clients 1,1
0.025
2.6 1.5-3.9

<10 clients 1
After logistic regression analysis, from primary or less
education levels and the average number of male clients from
10 guests or more in the last 30 days the variables related to

infection with at least one STI.
CHAPTER 04: DISUSSION
4.1. Demographic characteristics
The results of demographical characteristic of research
objects in our study are quity similar to other studies conducted
by Hanoi Medical University and LIFE center. In comparison
with IBBS in 2009, male homosexual sex worker group in
Hanoi are younger, higher level of education and income than
their counterparts in Can Tho, Hai Phong and Ho Chi Minh
city. These findings are also similar with other studies
conducted in China, Russia, Indonesia, Pakistan and India.
Studies in other countries and in Vietnam show that a large
number of gay sex workers come from other areas. In our
19

study, a lot of male homosexual sex worker come from
neibouring provinces and they do not have a fixed house to
sleep over night. The results reflect the difficulties this group of
person are facing with while they live in Hanoi and a lot of
them operate at public areas.
4.2. Sexual identity, knowledge about HIV/STIs, sexual
behaviors, using addictions and using medical services of
the study group
4.2.1. Sexual identity
Majority of male homosexual sex worker group in
Hanoi are male (68.8%) and be attracted to have sex with
female (56%). The sexual attractiveness can be different among
research objects. Although they may have sexual attractiveness
with male or female both, they still have sex with other male
partner due to economic purpose. In addition, the results reveal

that diversified population of male individuals are participating
in gay sex working activity.
4.2.2. Knowledge about HIV/STIs
The results show that there are a large number of male
homosexual sex worker have not understood correctly and
sufficiently about ways of tranmission and risk-factors of HIV
and STIs.
4.2.3. Sexual behavior and drug use
Having sex with both male and female partners
Male homosexual sex worker group in our study not only
have sex with male, but also with female including female sex
partners and female sex worker, not only sex selling but also
20

sex purchasing. Number of clients and frequency of sex selling
of research objects are reflected through their risk factors. In
average, each have 9.5 clients over the last 30 days, number of
sex buyers is correspond to the number of sex intercourse. The
average number of sexual intercourse with male clients over the
last 30 days is 11.7. Therefore, diversity of sex partner, the
average number of sex partner, the average number of sexual
intercourse over the last 30 days in our study reveal that they
have high risk of being infected with HIV and STIs.
Forms of sexual intercourse and condom use
The forms of sexual intercourse of sex worker for gay in our
study are quite diversified: oral sex, anal sex and intercourse. 1/3 of
research objects have been experienced with oral sex and anal sex
with male sex partner not due to exchange purpose.
Oral sex is quite popular among research objects. HIV
can still be infected to receiver through oral sex without using

condom and the risk of HIV will be increased if having sperm
in mouth and wounded throat/mouth. For other STIs, oral sex
without condom will have very high rate of infection while
directly touching with sexual fluid even having not scratch.
Around one third of research objects in our study used
condoms when having anal sex with Vietnamese and foreign
customers. Having anal sex with foreigner, especially when
being done without condom, will increase HIV infection; it is
because of that HIV transmission is mainly due to gay men in
the developed countries.
21

The above data also show that risk of HIV and STIs
infection of research objects are very complicated and reflected
through the role of male homosexual sex worker group being
the bridge of HIV infection and STIs among different groups in
our community not only in MSMs.
Features of gay sex working activity.
In our study, majority of male homosexual sex worker are
for money, and other reasons such as presents or
food Diversity of exchange form in terms of male sex
working activity is also criteria of research subject selection in
our study.
Use additions
There are not many male homosexual sex worker group
being drug users (8.4%). However, use one of drug at least and
mixed drug can be frequently witnessed in our research object.
There is no relation between drug use with sexual intercourse
without condom being found in our study.
4.2.4. Using medical services

Nowadays in Vietnam, we have none comprehensive
national guidelines about HIV and STIs intervention among
male homosexual sex worker/MSM group. In spite of effective
services, accessing to those services remains limited. Because
of discrimination and stigma, barely male homosexual sex
worker/MSM dare to seek and use national medical services.
Several studies among male homosexual sex worker/MSM
group have also shown limitations of this groups in accessing
VCT services. Moreover, the proportion of those have been
22

tested for HIV among group who admitted selling sex only is
relatively low, about 3.0%-45.1%. However, our study has
shown a higher proportion, about 47.8%. Even though the
treatment is important in responding to the epidemic, accessing
to HIV and STIs diagnostic and treatment services among
MSM group is still restricted.
4.3. Prevalence of HIV infection and STIs in male homosexual
sex worker group in Hanoi.
Prevalence of HIV infection.
Our study shows the low prevalence of HIV infection in
our research objects in comparison with other studies due to
Shared cylin cannot be found in our drug users (only one
subject revealed that he had been shared his xilan over the last 90
days). Therefore, HIV transmission in our study is mainly due to
sexual transmission. However, the percentage of anal sex users
without condom is still low compared with other studies.
In addition, there are supposedly some related factors that
decreased the risk factors of HIV transmission such as our
research objects are very young (age median is 22); short time of

risk factor exposure, dominant number of them have sexual
attractiveness with female, young person coming from other
provinces (same sex acts are due to money purpose, they will
come back homeland to get married, therefore, the percentage of
anal sex with male customers is lower than that of other studies).
Other STIs,
It is, however, a low prevalence of HIV infection. 19.2%
of research objects got positive results while examing HPV
23

(positive result if one of three body parts being throat, anal,
penis expoused to positive). However, in order to give the
validiy of the database, our study needs to be supplemented
with clinical check-up for all research objects because not all
positive result having cases lead to diseaes. They are almost
self-limitted.
The percentage of objects having positive testing with HPV
in our study is 12.8% higher than that of other studies. Of which,
throat HPV is 8.0%, penis HPV is 3.6% and anal HPV is 2.8%.
HPV disease is a reliable indicator because almost HPV infected
people are due to sexual intercourse. We also found that there were
12.0% of research objects having positive testing with Chlamaydia
and Chalmydia is also mainly infected through sexual intercourse.
Self-reported objects infected with STIs are lower than the
examination results. Not early detection and late treatment of
STIs increased the effect risk of disease to research individuals
and increase secondary infection to their sexual partners and
community. Generally speaking, The rate of being at least
infected with one STIs in our study is higher than that of other
studies because our study is the first one to get the disease

sample located at three body parts throat, anal and penis.
4.4. Some risk factors of HIV infection and STIs
4.4.1. Factors related to anal sex without condom for the last time
Factors such as living in neighboring provinces, same
sex trend, having income less than 2 million VND are related
to anal sex without condom for the last time.
24

4.4.2. Risk factors of HIV infection and STIs The results show
that, level of education being primary and under primary is
related to risk factor of STIs. It can be explained that the being
educated at higher level, they will have better job than their
counterparts so that they have favourable conditions and
knowledge to performe safe sex behaviours.
For activity of male homosexual sex worker, objects
having more than 10 male clients will be estimated to be risked
with at least one STI. It is quite reasonable because for each sex
buyer and each sex intercourse, the object will be risked to get
infected with HIV and other STIs.
Therefore, objects having more sex clients or having
more sexual intercourse will have higher risk of being infected
with HIV and STIs. It should be strongly mentioned in the
intervention programme so that objects having more sex clients
or having more sexual intercourse will be paide more attention
in terms of behaviour of sexual act. Other risk factors are not
found to be related to HIV and STIs infection among male
homosexual sex worker group.

25

CONCLUSION
1. Demographic characteristics of male homosexual sex
worker group in Hanoi
Majority of research group are young males (78.4% is
under 25 years), immigrants (78.0%) and have educational
background (87.2% have high school qualification or above).
Most subjects are still single (94.4%).
2. Sexual identity, knowledge about HIV/STIs, sexual
behaviors, using addictions and using medical services of
the study group
About sexual identity: There is also high proportion of
self-affirmation interested in sexual intercourse with women
and men (56.0% and 31.6%).
Knowledge about HIV/STIs: The percentage of objects
misunderstanding of HIV transmission is relatively high
(20.8%). The percentage of subjects knows how to use
lubricating oil during intercourse to reduce risks of HIV
infection is relatively low (25.2%).
About sexual behaviors: The proportion of objects
using condom during having anal sex with male clients in the
most recent times is relatively low (30.0%). Also the average
number of male clients in the last 30 days is quite high: about
9.5 male clients. Moreover the average frequency of having sex

with male customers within 30 days is 11.7 times.
About the characteristics of prostitution activities:
There is a relatively high rate of first time prostitute occurs in
the age of 20 to 24 (52.8%) and have experience in prostitution
26

from 1 to under 5 years (54.0%). The percentage of objects the
money motivated male prostitutes is very high (86.8%). Male
clients are not only Vietnamese but also foreigners.
About drug use: This proportion for drinking alcohol is
very high (97.6%). The high percentage of using at least one
type of drugs (52.0%) and use synthetic drugs (42.4%).
However, heroin injecting rate is low (8.4%).
About using medical services: The use of medical
services and accessing to intervention programs on HIV/AIDS
are at the average level (less than 50.0%).
3. STIs and HIV prevalence
The proportion of the studied subjects infected with at
least one STIs is very high (48.8%), which include HIV 2.0%,
14.0% HBV, HCV 5.2%, 19.2% HPV, gonorrhoea 12.8%,
Chlamydia 12.0% and 1.6% for syphilis. However, the
percentage of objects reported HIV infection and STI are low
(7.6%). Infection with the STIs infections pathogens can occur
in some organs where they have sex: genital (12.8%),
oropharynx (15.6%) and anal (20.4%).
4. Some factors related to STIs/HIV infection
Predictive risk factors for at least one STIs disease is
educational background from primary level or below (OR =
2.5, 95% CI = 1.3 to 4.8) and the average number of male
clients of 10 clients and above clients in the past 30 days (OR =

2.6, 95% CI = 1.5 to 3.9).


27

RECOMMENDATIONS
To reduce the risk of HIV infection and sexually
transmitted diseases in male homosexual sex worker group in
Hanoi, should take the following interventions:
1 . Communication activities on STIs , infections, preventive
methods, information about the treatment facilities and information
about the types of synthetic drugs and harms in locations where
male homosexual sex worker group meet their clients and via the
internet network.
2 . Communication to raise awareness for the young male
homosexual sex worker group about safe sex, especially those
with low educational backgrounds and their regular clients.
3 . Establishing an appropriate model for STIs testing,
counselling and treatment STIs to male homosexual sex worker
group in order to improving the young male homosexual sex
worker group access services.
4 . Strengthening the HIV/AIDS harm reduction intervention
programs in male homosexual sex worker group such as
providing condoms, lubricant.