Consistent condom use and correlates among men who have sex with men recruited by internet based sampling in hanoi

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HANOI MEDICAL UNIVERSITY

PHAM THU VAN

CONSISTENT CONDOM USE AND CORRELATES AMONG
MEN WHO HAVE SEX WITH MEN RECRUITED BY
INTERNET-BASED SAMPLING IN HANOI

THESIS OE GRADUATION MEDICAL DOCTOR
COURSE 2015-2021

HANOI - 2021

MINISTRY OF EDUCATION AND TRAINING .MINISTRY OF HEALTH

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HANOI MEDICAL UNIVERSITY
_____________

PHAM THU VAN

CONSISTENT CONDOM USE AND CORRELATES AMONG
MEN WHO HAVE SEX WITH MEN RECRUITED BY
INTERNET-BASED SAMPLING IN HANOI

Major

: Doctor of Preventive Medicine

Code

: D720302

THESIS OF GRADUATION MEDICAL DOCTOR
COURSE 2015-2021

Supervisor: MD. PhD. Hoang Thi Hai Van

HANOI-2021

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ACKNOWLEDGEMENT

To begin with. I would like to thank Preventive Medicine and Public Health Institute
Board of President and Global Health Department for giving me the opportunity to study and
complete this thesis
I would like to express my special thanks of my gratitude to my supervisor Mrs. Hoang
Thi Hai Van. MD. Ph D.. for Iter enthusiastic guidance, great patient, and strong support since
the beginning. 1 came to know about so many new things and I am really thankful to them.
1 am very grateful to all the study participants who agreed to spend their time
completing the questionnaire and all staff members at SUP clinic. Hanoi Medical University
who contributed. Their contribution plays a crucial role in the success of this thesis.
Besides, many thanks to Nguyen Thi Hoang Ha. Tran Thi Thao Allh. Nguyen Huy
Hoang. Tran Hoan. and all my classmates, who were always ready to share their knowledge

and skills, and helped me a lot throughout the process 1 would like to thank my close friends.
Trinh Thuv Duong. Bui Thu Hien. Quach Linh Giang, who always support me and give me a
hand whenever I need
Last but not least. I also would like to express my deepest gratitude towards my family,
who always stay by my side and encourage me to finalize this study
Hanoi, May 2021

Pham Thu Van

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DECLARATION

I declare that this thesis represents, my own work and has not been submitted for any
degree in any university previously. All the sources of information which have been used in the
thesis and external contributions are fully referenced and acknowledged.

Hanoi, May 2021

Pham Thu Van

CONTENT

ACKNOWLEDGEMENT.

i

DECLARATION
LIST OF ABBREVIATION
LIST OF FIGURES

.V

vi

INTRODUCTION.............................____..................
CHAPTER 1. LITERATURE REVIEW
1.1 Definitions
1.2. The situation of HIV/STls among MSM.............................................................................6
I 3. Researches on consistent condom use among MSM.......................................................7
1.4. Researches on factors associated with consistent condom use among MSM . 8
1.5. Researches on using the internet-based sampling to recruit MSM................................9
I 6. Information about MSM in Hanoi......................................................................................10

CHAPTER 2. METHODOLOGY.......... ....................................................................12
2 I Subjects

12

2.2. Location and time
2.3. Study Design....................................................................................................................13
2.4 Sampling............................................................................................................................13
2.5. Variables...........................................................................................................................13
2.6 Data collection

16

2 7. Statistical analysis........................................................................................................... 17
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2 8 Research ethics
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3.2.
condom use with different types of partners................................................ 26
3.1. Consistent
General3.information.........................................................................................................
CHAPTER
RESULTS............
18


3.3. Correlates of consistent condom use among MSM recruited by IBS in Hanoi
31

CHAPTER 4. DISCUSSION.................
4.1. General information
4 2. Consistent condom use with different types of partners

40

4.3. Correlates of consistent condom use

41

CONCLUSION.

RECOMMENDATION
46

•••••••••••••
47

REFERENCES
A ppcxiniv...................................................................................................
4» I J

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LIST OF ABBREVIATION

AIDS

Acquired Immunodeficiency Syndrome

CDC

Centers for Disease Control and Prevention

HIM

The Hanoi MSM Cohort Study

HIV

Human Immunodeficiency Virus

HSS+

HIV Sentinel Surveillance plus behaviors

IBBS

Integrated Biological and Behavioral Surveillance

IBS

Internet-based sampling

SUP

Sexual Health Promotion

STI

Sexually Transmitted Infection

USAID

United State Agency for International Development

UAI

Unprotected anal intercourse

VAAC

Vietnam Authority' of 11IV/A1DS Control

VND

Vietnamese Dong

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7

LIST OF TABLES

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8

LIST OF FIGURES

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ABSTRACT
Title: Consistent condom use and correlates among men who have sex. with men recruited by
Internet-based sampling in Hanoi.
Objective: This study was conducted to examine the consistent condom use (CCU) with
different types of partners and correlates among MSM recruited by internetbased sampling
(IBS) in Hanoi.
Methods: Data for this analysis were from a cohort study IÍIM-Ỉ lanoi conducted from 2017 IO
2019 in Hanoi. MSM aged from 16 years were recruited for the survey using IBS. Univariate
and multivariate logistic regression were used to assess the association of ecu with selected
socio-demographic characteristics and other factors.
Results: Among 802 MSN interviewed, ecu with non-commercial male partner, male client,
male sex worker, and female transgender was 39.8%. 41.5%. 40.0%. and 20.0% respectively.
Meanwhile, ecu with non-commcrcial female partner, female client and female sex worker was
43.1% 72.7% and 80.0%. respectively. Characteristics associated with increased odds for ecu
with noncommercial male partner were being aged from 25 years or older (OR: 1.27, 95%CI:
0.82 - I 96). having tertiary education level (OR: 1.63, 95%CI: 1.01 2.64). never getting married
(OR: 2.22. 95%C1: 1.01 - 4 88). and using the Internet to seek male partners (OR:
2.05,95%C1: 117 3.60). Factors associated with decreased odds of ecu w ith noncommercial
male partner was spending the night at hotel guesthouse frequently (OR: 0 49. 95%CI: 0 25 0.97). never being tested HIV (OR: 0.43. 95%CI 0 19-0 96). and using ATS to enhance sexual
performance (OR: 0.44. 95%CI: 0.21 - 0.90) Conclusion: ecu with different types of partners
among Hanoi MSM sun eyed remains low. HIV interventions for MSM should take associated
factors found in the study into consideration to increase ecu among MSM. thereby contributing
to the reduction of HIV and STI infections.
Keywords: Men who have sex with men. MSM. Consistent condom use. Sexual partners.
Internet-based sampling. Hanoi


10

TÓM TẢT

Tên đề tài'. Sử dung bao cao su thưởng xuyên vã các yều tồ liên quan ớ nhóm nam quan hệ
tinh dục đòng giới thu tháp bởi phương pháp chọn mầu trực tuyển tai Há Nội Mục liêu: Nghiên
cửu được thưc hiện nhím niuc tiêu xác đinh ti lệ sử dung bao cao su thưởng xuycn và cãc yếu
tố liên quan ơ nhóm MSM được thu thập bởi phương pháp chọn mầu trực tuyền tai Hà Nội
(IBS)
Phươngpháp: Nghiên cữu sư dụng số liệu tứ nghiên cứu IIIM-tlà Nội với đối tượng MSM tũ 16
tuỏi trớ lẽn được thu thập bảng phương pháp IBS Phương pháp phân tích hồi quy logistic
được dùng đề dành giá mói liên quan giừa việc sử dung bao cao su thưởng xuyên (CCƯ) với
các yếu tồ liên quan.
Kct quà: Trong số 802 MSM. ti lô CCƯ với ban tinh nam tư nguyện, bạn tinh nam khách hãng,
ban tinh nam bán dâm vã nừ chuyền giới lằn lưọt lã 39 8%. 41 5%. 40.0% và 20.0%. Ti lệ ecu
với bạn tinh nừ tự nguyện, ban lình nừ khách hàng vá bạn tinh nừ băn dâm lần lượt là 43.1%,
72.7% và 80.0%. Cãc vcu tơ lãm tăng khá năng ccu khi quan hộ tinh dục (QIITD) với ban tinh
nam tự nguyện gồm; tuồi tú 25 trở len (OR: 1.27.95%CI: 0 82 1.96). trinh độ hoe vần lữ đai hoe
trờ lẽn (OR: 1.63.95%CI: 1.01 - 2.64). chưa từng kềt hịn (OR: 2.22. 95%C1: 1.01

4 88).

vả có sữ dung
Internet đê tim kiếm ban tinh nam (OR: 2.05. 95%CI: 1.17 - 3.60) Cãc yếu tố lãm giam kha
nàng ecu khi ỌHTD với ban tinh nam tư nguyên gôm thướng xuyên qua dẽm tai khách san
nhã nghi (OR 0.49. 95%CI: 0.25 0.97). chưa từng xét nghiêm HIV (OR 0.43. 95%CI: 0.19 0.96). vã sử dụng ATS đè tảng khoái cám tinh dục (OR: 0.44. 95%CI: 0.21 - 0.90)
Két luận: Ti lệ ecu với các loai ban tinh khác nhau trong nhõm MSM tạt Hã Nội còn thấp. Cãc
biện pháp can thiệp dư phóng HIV cần chủ trọng đèn các yếu tó liên quan được xác định trong
nghiên cứu để làm tâng ti lê ecu trong cơng đồng MSM. tử đõ góp phần giam lây nhiễm HIV và
các bênh lây truyền qua đường tinh due

Từ
Nam quan
hê ban

tinhtinh,
due đồng
MSM.tuyến.
sứ dung
bao
caokhỏa:
Nội
su thường
xuyên,
chongiói.
mầu trực
1 lã

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1

INTRODUCTION

The HIV epidemic in Vietnam is still a concentrated issue, with the highest prevalence
found among key populations including injecting drug users, female sex workers, and men who
have sex with men (MSM)1 In 2018, it is estimated that 230.000 people in Vietnam were living
with HIV. making up 0.3% of the population - While HIV prevalence among the general
population is low and shows no sign of increasing? the HIV infection rate Hl the MSM
population has been rising consistently, from 2.3% in 2012 to 6.7% in 2014, and to 7.4% in
2016.' The number of new infections among this population is predicted to continue increasing
significantly.4 .Although MSM represented only 0 68% of Vietnamese adult males aged 15 to

49? they accounted for 21% of all newly diagnosed HIV infections. 4 They arc identified as one
of the most at-risk populations for the national HIV pandemic

1

Condoms are one of the main tools for HIV prevention, with a high level of
effectiveness at preventing the transmission of HIV and STIs when used correctly and
consistently 6 Many studies also have shown that consistent condom use reduces the incidence
of STIs significantly in comparison with the non-use of condoms ' However, in Vietnam, the rate
of consistent condom use among MSM remains low HIV Sentinel Surveillance Survey Plus
(HSS-) in 2011 indicated that only 43.3% of MSN used condoms consistently last month and 71
3% of MSM reported using a condom with their male partners at their last anal intercourse In
Hanoi, although MSM who reported always using condoms in the past month with their male
partners (including both commercial and noil-commercial partners) rose remarkably during the
2005-2013 period, this figure remained low (below 45%)1

x
In the
recent
years.
Vietnam
has
witnessed
asignificant
tremendous
development
in
number
of
of

technology
Internet
that
users.
leads
Ituse
IS
tosocial
estimated
that
growth
about
sites,
65
accounting
million
Vietnamese
for
67%
of
people
the
population?
87%
networking
the
(98%)
MSM
population
use

at
least
have
one
smartphones
social
networking
and
almost
site
all
ofof
them

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2
This virtual environment creates a favorable condition for MSM to expand their social circles
Hence, more and more MSM have started to find then sexual partners via the Internet. In a
report of the Vietnam Administration of HIV/AIDS Control (VAAC), 74%of MSM users seek
partners through online websites by mobile phones

8

Hanoi saw a rapid increase in social

media use among the MSN community in the last decade, with more than 75%of MSM using

social media to find a male sexual partner compared to only 35% reported in 2008/' Although
Hanoi is the second-largest city in the MSM population with an estimate of 34 000 MSM”and
has high rates of MSM using the Internet,” little is known about the sexual behaviors of this
population Apart from this, many studies examined condom use among the MSN! population in
Hanoi.1*

11

but the study that examined indicators of consistent condom use among this

population was limited Hence, It is important to understand the factors in order to inform
effective HIV prevention interventions targeted towards M$M in Hanoi To fill this gap. we have
conducted a study title “Consistent condom use and correlates among men who have sex with
men recruited by internet-based sampling in Hanoi” with the aim:
1. To describe consistent condom use with different types of partners among men who
have sex with men recruited by internet-based sampling in Hanoi

To
describe
of consistent
condom use among
men
whoHanoi.
in
have sexcorrelates
with men recruited
by internet-based
sampling

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CHAPTER 1. LITERATI RE REVIEW

1.1. Definitions
1.1.1.

Terms related to men who have sex with men

• Sex: The term “sex” refers to biologically determined differences that are used to label
individuals as males or females. The bases for this classification are reproductive
organs and functions.1*
- Gender: The term “gender” refers to (he social attributes and opportunities associated
with being male and female and the relationships between women and men and girls
and boys, as well as the relations between women and those between men. Gender
determines what is expected, allowed, and valued in a woman or a man in a given
context 14
- Gender identity: Gender identity has been defined as a person’s internal, deeply felt
sense of being male or female or something other, or in betw een. A person’s gender
identity may or may not correspond with their biological sex (Human Right Council.
2011)”
- Sexual orientation: The term sexual orientation refers to each person's capacity for
profound emotional, affectional, and sexual attraction to (and intimate and sexual
relations with) individuals of any sex

14

Terms include homosexual, heterosexual,

bisexual, etc. Sexual orientation does not equal sexual behaviour.10
+ Heterosexual The term heterosexual is used to refer to people who have sex with
and/or are attracted to people of the opposite sex. 14
+ Homosexual People who have sex with and or sexual attraction to people of the same
sex. This should not be confused with the Latin word homo, meaning a man

14

+ Bisexual:
IS
attracted
Ato
bisexual
and/or
person
has
sex
IS
with
defined
both
asidentity
men
aand
person
who
terms

and
who
men
identifies
who
have
withwith
sex
this
both
as
amen
cultural
and women
orwomen,
women
The

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14
4
who have sex with both women and men should be used unless individuals or
groups self-identify as bisexual

14

+ Asexual: Person who lacks (or rarely) having a sexual attraction to others or lack
interest in sex. An asexual may or may not have an emotional attraction to people of
the same'oppositcAroth genders “
- Condomless sexA'nprotceted sex: the sex act is not protected by male or female
condoms. Previously known, as unprotected sex. this is now increasingly referred to as
condom less sex.14
- Insertive anal sex: the sex act which inserting the penis into the anus, also known as
topping. '
- Receptive anal sex: the sex act which receiving the penis into the anus, also known as
bottoming 17

1.1.2.

Definition of men who have sex with men

According to UNAIDS Terminology Guidelines 2015. the term “men who have sex with
men" (MSM) describes males who have sex with males, regardless of whether or not they also
have sex with women or have a personal or social gay or bisexual identity.14
+ Gay - The term gay can refer to same-sex sexual attraction, same-sex sexual
behavior, and same-sex cultural identity. Unless individuals or groups sclf- ldentify
as gay. the expression of men w ho have sex w ith men should be used
+ Transgender - Transgender is an umbrella term to describe people whose gender
identity and expression do not conform to the norms and expectations traditionally
associated with their sex at birth. Someone who dresses or/and acts as. and wishes
to be (or is) recognized as a member of the opposite sex from which they were born.
+ Bóng kin (hidden gay/shadow) - A man who is discreet about his sexual identity, who
maintain a masculine gender performance. and who publically present as
heterosexual18.
+ Bóng lộ (conspicuous shadow) - A man who IS open about his sexual identity Bóng lộ
refers to MSM whose presentation is more effeminate, and who do not hide their

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sexual preference for men18.

1.1.3.

Definition of sexual partners

In this study, we mentioned 7 ty pes of partners:
+ Non-commercial male partners - Males who they have sex with but there was no
exchange of money or goods.
+ Male sex workers - Males arc those they have sex with and pay money.
♦ Male clients - who they pay for sex includes payment by money or goods.
+ Non-commercial female partners - Females with who they have sex but there was Ito
exchange of money or goods.
+ Female transgenders - a trans-gender person who was a male at birth but whose
cunent gender identity is a female.
+ Female clients - Females who pay for sex include pay ment by money or goods.
+ Female sex workers - Females are (hose they have sex with and pay money.

1.1.3.

Definition of consistent condom use

Consistent condom use definition was varied in previous studies It depended on the
scales they used to examine the frequency of condom use. In a study conducted in Tokyo.
Japan, condom use frequency was recorded as ‘never*, ‘rarely’, most of the time’, and ‘always’
Inconsistent condom use was defined as ‘never use condoms’ or ‘rarely use condoms', while
consistent condom use was defined as ‘always use condoms’ and use condoms most of the
time.19 However, according to another study conducted in lluzhou. China, consistent condom
users are MSM who reported using a condom every time with both stable and casual partners,
while inconsistent condom users did not?"
In this study, condom use frequency was recorded as '‘always”, “occasionally”, and
“never”. Consistent condom use was defined as “always use condom" and inconsistent condom
use was defined as "occasionally", “never” or “do not remember"

1.2. The situation of HIV/STIs among MSN

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16
6
1.2.1.

The situation of HIV/STIs among VISM in the world

Analysis of data available of UNAIDS suggested that gay men and other men who have
sex With men accounted for an estimated 17% of new HIV infections globally in 2018." MSM
had the highest new infections among key populations in most continents. Especially, in Asia

and the Pacific and Latin America, MSM made up lip to 30% and 40% of new HIV infections
respectively.21
Along with HIV. STIs prevalence was also high among the MSM population In a report
of the US CDC. the incidence of many STIs in gay. bisexual, and other men who have sex with
men (MSM)—including primary and secondary syphilis and antimicrobial-resistant gonorrhea—
is greater than that reported in women and men who have sex with women only." MSM
accounted for nearly two-thirds (64.3%) of reported syphilis cases among women or men with
information about sex of sex partners in 2018." Among men exclusively. MSM accounted for
77.6% of reported cases with information on sex of sex partners. 22 Research conducted in
Amsterdam also indicated that the infection rate of rectal gonorrhea and early syphilis
increased among homosexual men when compared with bisexual male.2'
1.2.2.

The situation of HIV/STIs among MSM in Vietnam

24
In Vietnam.
increasing,
HIVfrom
from
prevalence
2.3%
in in
2012
among
to6.7%in
MSM7.36%
tends
2014.
to2016.

and
be 7.4%
in I
2016.'
among
MSN
HSS+
rose
in
2016
also
5.1%
showed
2015
that
to
the
HIV
in
prevalence
The
BBS
2013

also reported that the HIV prevalence among MSM was high in big cities such as Ho Chi Minh
city (12 1%), Hanoi (4%). and Hai Phong (5.4%).12
In addition, the STIs were also a concentrated problem among the MSM population in
Vietnam. STI infection among MSM was high in three of the four IBBS provinces, namely
Hanoi. Ho Chi Minh city and Can Tho in 2009. 2' In Ho Chi Minh city, every five people has a
person infected with Rectal Chlamydia. Genital Chlamydia. Neisseria Gonorrhea and other

STIs.25 The STIs prevalence among MSM in Can Tho and llai Phong was 17.3%and 15.$%
respectively.2'

1.3. Researches on consistent condom use among MSM
1.3.1.

In the world

Condoms are one of the main tools for HIV prevention, with a high level of
effectiveness at preventing the transmission of HIV and SI Is when used correctly and

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7

consistently.6 Many studies have shown that consistent condom use reduced the incidence of
STIs significantly when compared with the non-use of condoms. 7 However, the prevalence of
using condoms when having sex still remains high, especially in unprotected anal intercourse.
Hence, unprotected anal intercourse is considered as the highest risk in 1IIV and STIs
transmission in the MSM population

26

A study conducted in Tamil Nadu. India shows that among 1618 MSM interview ed,
consistent condom use during anal sex with regular, paying, and a casual male partner was 45

3% 50 8% and 57 9% respectively. Consistent condom use with all three types of partners
combined was 52.6%.27
Another study conducted in Nigeria showed similar results, approximately more than
half (53%) of participants reported always using condoms with male partners in the past 6
months and 43% reported always using condoms with female partners in the past 6 months. 28
A cross-sectional study used survey data from 1,230 MSM in Beijing. China reported
that nearly half of the participants engaged in unprotected anal intercourse with at least one of
up to three partners in the past 6 months.2*
1.3.2.

In Vietnam

In Vietnam, previous studies showed that MSM had low levels of condom use In 2011.
IISS+ reported that 73.3%of MSM using condom use during anal sex with male partners in the
last time, and only 43.3% of MSM using condoms consistently during the last month. IBBS
2013 gave more information about using condoms with different types of partners. To be
specific, consistent condom use with noncommercial male partners in the last month ranged
from 40% to 78.6% among MSM in four surveyed cities Consistent condom use with male
clients among male sex workers ranged from 55 8% to IOƠ%.,:
Another study conducted 111 An (hang showed that condom use was considerably low
in both heterosexual and homosexual sex. The overall rate of consistent condom use was only
24.7%?'

1.4. Researches on factors associated with consistent condom use among MSM
1.4.1.

In the world

In the
world,

many
studies
and
factors.
examined
Awho
the
study
assocation
conducted
between
in
Tamil
cluster
Nadu.
sampling
India
examined
with
L618
factors
MSM
recruited
associated
by
time-location
with
consistent
including
regular,

condom
use
paying
with
and
three
casual
types
male
of
male
partners.
partners
This
study
for
ecu
revealed
with
MSM
that
having
factors
all
associated
three
types
with
of
partners

increased
odds
combined
regular
partners,
were
frequent
fewer
receptive
number
of
anal
casual
sex
partners,
acts
with
and
being
meanwhile,
a
member
factors
111
a
associated
community-based
with
decreased
organization,

odds
of
ecu
were
terms
using
of
ecu
alcohol
with
paving
and
using
drug
partners.
in
the
MSM
past
who
month
perceived
In
higher
condom
risk
consistently.
of
acquiring
Besides,

HIV
were
those
more
likely
accessing
to
use
to
any
odds
HIV
prevention
of
ecu
w
ith
intervention
casual
male
was
partners?'
associated
with
increased

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18
8
A cross-sectional study in lluzhou. China using the Internet-based sampling to recruite
410 MSM showed that factors associated with consistent condom use was having a
comprehensive know ledge of Hl V. using alcohol before sex and ever having sex with male sex
workers?
1.4.2.

In Vietnam

In Vietnam, little is known about factors associated with consistent condom use among
MSM. Only a cross-sectional study conducted by Garcia Ct al. in 2011 using Internet-based
survey examined the factors associated with inconsistent condom use during anal sex
intercourse with male partners This study revealed that MSM who consumed alcohol before or
during sex in the last 6 months were more likely to use condom inconsistently. In addition,
those who reported having received free lubricants in the last 12 months and those who
perceived themselves as being at medium or high risk of HIV infection were more likely to
engage in inconsistent condom use with male partners.3*

1.5. Researches on using the internet-based sampling to recruit MSM
1.5.1.

In the world

With the increasing number of MSM who are connected through web-based social
media and phone-based social apps. MSM have more opportunities to expand their social
relationships and seek partners. The advances in technology provide a potential platform to
identify and recruit at-risk MSM for HIV/ST1 interventions. Thanks to that, many researchers in
the world used this method to reach hidden MSM population A study conducted in 2007 ill the

USA used banner advertisements to recruit persons who accessed MSM-related websites (e
g . Gay.com. Manhunt.net. Dlist) and social networking websites (c.g., MySpace and
Fnendster) from 2003 to 2005. and total 7.978 were eligible for participation 32. Many studies
also succeeded in using social media to recruit a large number of

MSM.W-M Therefore, the

Internet provides a perfect channel to access sensitive information and recruit a large number
of participants.
1.5.2.

In Vietnam

In Vietnam, the first internet-based sampling (IBS) study among MSN was implemented

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1
9

in 2011. Bengtsson el al. used 20 seeds to recruit participants online for a study using webbased RDS sampling This study recruited 676 Vietnamese MSM in two months (February to
April 20ll).r Another internet-based cross-sectional survey among Vietnamese MSM was
conducted by Garcia et al from August to October 2011 using multiple websites. This study
posted advertisements and questionnaires in the 12 most popular and highly visited MSM
commercial and social networking websites. Ill two months, this study attracted 5.128 individual
responses, among those 2.077 were eligible Three websites with the highest participants were

listed (Tao Xanh (17.0%). Tinh Yeu Trai Viet (15.7%), and Vietboy.net (14 6%)). This study also
reported that 10.2% of eligible participants are from Hanoi.*
1.6. Information about MSM in Hanoi
1.6.1.

The number of MSM in Hanoi

According to the report ’’Estimates and projections of HIV/AỈDS 111 Vietnam 2007 2012”. the high estimate is used to estimate the size of the population group, assuming 3% of
men over 15 years old in Hanoi. A specific number is estimated at 35.436 people.
1.6.2.

rhe HIV/STls prevalence among MSM in Hanoi

In terms of HIV prevalence, the report IBBS I. II. Ill 111 2005. 2009. and 2013 showed
that the HIV prevalence among MSM in Hanoi was 9.4%. 14%. and 4% respectively

1237

•’* In

the IBBS 2009. for MSM who had sold sex. the HIV prevalence was 14%. For those who had
not sold sex. the prevalence was 20% in 2009
When It comes to STIs prevalence, the proportion of Rectal Chlamydia infection and
Rectal Neisseria Gonorrhea in Hanoi was the highest among sun eyed provinces, at 10% and
3.4% respectively.'* Genital Chlamydia prevalence was 4.4% among MSN in Hanoi in 2013.'* In
a 2017 study conducted by Hanoi Medical University among MSM in Hanoi, nearly 19% of
participants tested positive for syphilis?
1.6.3.

The situation of condom use among MSM in Hanoi

12
The workers
I MSM
BBS
2013
used
respondent-driven
sampling
to
examine
the
consistent
last
month
condom
in
four
use
cities.
rate
with
To
be
676.4%
specific,
types
ofperiod,
partners
rhe

in
male
partners,
rate
among
male
MSM
clients,
in
Hanoi
with
male
sex
workers
respectively;
in
the
meanwhile,
past
month
all
was
participants
59.1%,
reported
and
98.7%.
using
condom
noncommercial

consistently
female
with
partners,
their
female
partners,
clients,
and
including
female
sex
consistent
condom
in
the
use
past
with
month
male
.Although
partners
trends
in
the
in
past
month
figure

among
remained
in
Hanoi
low
increased
at
roughly
in
40%.
the
2005-2013
the

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CHAPTER 2. METHODOLOGY

2.1. Subjects
MSM aged 16 years and above, living in Hanoi for at least 3 months, having no plan to
move in the next 24 months, and willing to provide consent to participate in the study.
-

*
Inclusion criteria:
+ Vietnamese national.
+ Male at birth.
+ At least 16 years of age.

+ Living in Hanoi continuously for the past 3 months and not having an immediate plan
to move in the next two years.
+ Have had oral or anal sex with another man or transgender woman in the past 12
months.
+ Willing and able to provide written informed consent.

-

Exclusion criteria
+ Foreign national
+ Female at birth
+ Not residing in Hanoi
+ Younger than 16 years of age
+ Neither oral nor anal sex with another man or a transgender wo-man in the past 12
months
+ Not able or willing to provide written informed consent

2.2. Location

and time

This study was conducted in Hanoi.
• Participants were identified and recruited from July 2017 to September 2019.
-

Students accessed data and analyze it from March 2021 to May 2021.

2.3. Study Design

This is a cross-sectional study, using data from the baseline survey of the "HIV incidence
and the dynamics of behavioral change among men who have sex with men in Hanoi. Vietnam:
the Hanoi MSM cohort study” (HLM-Hanoi).

2.4. Sampling
2.4.1.

Sample size

A total of 802 eligible participants were recruited by internet-based sampling method ill
the baseline survey of the HIM-Hanoi.
2.4.2.

Sampling technique

Convenience sampling: Using internet-based sampling method to recruit participants
from websites and social apps which were used by MSM ill Hanoi.
2.5. Variables

2.5.1. General information variables
Variable

Variable

Definition

subgroup
Socio-

Types of

variables

Age

Age according to the

demographic

Western calendar.

characteristics

Calculating by years
Education

Marital status

The highest level of education

Have been married to a

Quantitative

Quantitative

Qualitative

woman
Have never been married
to a woman

Employment

Have a job to support their life

Qualitative


Income

Salary per month, including

Quantitative

support from their family.
Unit: million Vietnam Dong
The venue where

In the last 30 days, where

they spent the

have you slept (spent the

night most

night) most frequently

Qualitative

frequently

Sexual orientation

Types of people that

Qualitative

participants are sexually
attracted to
Correlated

Self-reported HIV

- Positive

factors (referred

status

- Negative

from previous

- Unknown/unidentify

studies)2’ ■”

- Never tested
Ever diagnosed

In the past, have they ever

STIs

been diagnosed with STIs at a

Qualitative

Qualitative

health clinic
Drag use

Ever used drug to enhance

Qualitative

sexual performance
Using the

Lists of social apps that

Internet to find

participants used to find male

male sex partners

sex partners.

Having sexual

The frequency of having

intercourse with

sexual intercourse with male

male partners met

partners met through

online

wcbsites/social apps

Types of partners

-

partners

in the last 6
months

Non-commercial male

-

Male sex workers

Qualitative

Qualitative

Qualitative


-

Male clients

-

Non-commercial female

partners
-

Female sex workers

Female transgenders
Number of sexual

Number of sexual partners

partners

during the last month

Sexual role

Sexual role when having anal

Quantitative

Qualitative

sex during the last 6 months

2.5.2.
Consistent condom use with different types of partner
variables
Variable

Variable

- Definition

group

Types of
variables

Consistent

Consistent condom

Consistent condom use was

condom use

use

defined as "always’' using

with di tierent

condom during sexual

types of partner

intercourse with their partners)

Qualitative


Main reasons for
not using condom
consistently

-

Condom use reduces
the

Qualitative

pleasure
-

Condom is not available

-

My partners look healthy

-

Condoms are too
expensive

• My partner didn’t want to
-

1 trust my partners

-

I feel embarrassed to
buy

-

1 was in a hurried

-

Other (specify)

2.6. Data collection

2.6.1.

Data collection tool

The self-answered questionnaire included 3 parts: (I) Socio-dcmographic characteristics
(2) Internet usage and other factors (3) Sexual history with different types of partners.
2.6.2.
-

Data collection process

Step 1: Recruiting potential participants through the Internet.
St udy promotion materials and study contacts were posted on commercial and

community-operated websites/Facebook pages used by MSM in Hanoi such as xomcauvong.
gtown. lovcboyhanoi.. and social apps such as Zalo. Jack’d, and Blue d Promotional materials
had SHP clinic contact information (telephone and street address) so that interested participants
might contact SHP staff if they were interested in the study. Those who were interested in the
study would be asked to contact study staff (via email, phone, other social media means, or
show up at SUP clinic) for screening
-

Step 2: Screening and invitation

Once
outreach
workers
or
field
researchers

made
contact
to
establish
potential
eligibility
participants,
of
the
they
participants
used
the
Field
through
Scrccner
an
internet-based
briefed
onIf
survey
questionnaire.
objectives
and
Those
given
who
invitation
were
eligible

coupons
were
with
where
information
the
data
were
about
collected,
address
and
of
the
appointment
survey
center
date.
Each
the
individual
recruitment
came
method
to
the
was
clinic
screened
for

by
the
study
first
staff
visit,
Then
the
study
obtained.
would
be
the
further
selected
described
individual
and
informed
did
not
visit
consent
the
survey
center
witlun
four
weeks

after the appointment date, another selection was made until the required sample size was met.


- Step 3: Dam collection
Data collection took place at the Sexual Health Promotion (SUP) Clinic located on the
campus of Hanoi Medical University. The eligible participants selfanswered in the form of a
computer-administered structured questionnaire. A research assistant trained in interviewing
with MSM assisted participants in completing the self-interviewing process.

2.7. Statistical analysis
Analysis tests used
- Descriptive statistics: Mean and standard deviation were used to describe quantitative
variables. Frequency and percentage were used to describe qualitative variables.
• Univariate and multivariate logistic regression model were used to determine the
association between consistent condom use and participants’ socio-demographic characteristics
and other related factors.
Stata version 14.0 was used for data analysis.

2.8. Research ethics
This study is a part of the prospective cohort study HIM was approved by Hanoi Medical
University' Ethics Committee.
All subjects participated voluntarily and all information provided was kept confidential.