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

However, in Vietnam, the rate of consistent condom use among MSN remains low HIV Sentinel Surveillance Survey Plus HSS+ in 2011 indicated that only43.3% ofMSN used condoms consistently l

PIJAAl I III VAN

CONSISTENT CONDOM USE AND CORRELATES AMONG MEN WHO HAVE SEX WITH MEN RECRUITED BY

INTERNET-BASED SAMPLING IN HANOI

THESIS OF GRADUATION MEDICAL DOCTOR

COI RSE 2015-2021

HANOI -2021

PHAM Till VAN

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

Major : Doctor 01 Preventive Medicine Code : D720302

THESIS OF GRADUATION MEDICAL DOCTOR

COURSE 2015-2021

Supervisor MD PhD Holing I hi llai Van

HANOI - 2021

Tobegin with I would like to thank Preventive Medicine and Public Health

Institute Board of President and Global Health Department for giving me theopportunity to studyand complete this thesis

I would like to expressmy special (hanks ofmy gratitude to my supervisor

Mrs Hoang Thi Hat Van MD Ph D for her enthusiasticguidance,great patient, and

strong support sincethe beginning I came toknow about w manynew thingsand I Mil really thankful tothem

I am very grateful to all the studyparticipants whoagreed tospend their time completing the questionnaireand all staff members at SHP clinic Hanoi Medical

University whocontributed Their conuibution playsa crucial rolemthe success of

this thesis

Besides, many thankstoNguyen Thi Hoang Ha Tran 1hl Thao Anh Nguy enHuy Hoang Tran Hoan and allmy classmates, who were always readyto sharetheir

knowledge and skills, and helped me 3 lot throughout the process I would like to

thank my close friends Trinh Thuy Duong Bui Thu Hien Quach Luih Giang, who

always support me andgive mea hand whenever 1 need

Last but not least 1 also would like toexpress my deepest gratitude towaids

my family, who always Slayby my side andencourageme to finalizethis study

Hanoi May 2021

Pham Thu Van

I declarethat this thesis represents my ownwork and has notbeen submittedfor any detree in any university previously All the sources of information whichhave been used in the thesis and external contributions are fully referenced and

acknowledged

Hanoi, May 2021

Pham I hu Van

1.2 Thesituationof HIVTSTIs among MSN ••••■•••••••••••••••'••••••••■••(••••••a*«•••••••••••••••

13 Researches on consistentcondom use among MSM 7

14 Researches on factors associated with consistent condom use among MSM 81.5 Researches on usingthe internet-basedsampling to recruitMSM

1.6 Information about MSM in Hanoi

910

1313

3.3 Conchies of consistent condom use among MSM recruited byIBS in Hanoi 31

4.1 General information 37

4.2 Consistent condom use SSIth different typesof partners 40

4.3 Correlates of consistent condom use 41

CONCLUSION'^, -

. -RECOMMENDATION _

REFERENCES

APPENDIX _

47

LIST OF ABBREVIATION

CDC Centers forDisease Control and Presention

HS54 HIV Sentinel Surveillanceplusbehaviors

IBBS IntegratedBiologicaland BehavioralSurveillance

USAID United State Agency for International Development

VAI Unprotected analjnlCfcoursc

VAAC VietnamAuthority ofHIV/A1DS Control

LIST OF TABLES

Table 5 1 Socio-demographiccharacteristicsof participants 18

Table3.2 Self-reported HIV/STIs status 19

Table3.3 Drug use to enhance sexual performance 20

Table3 4.Having sexual intercourse with male partners metonline 23

Table3.5.Sexualbehaviors among MSMwith noncommercial male partner 25

Table3.6 Sexual behaviors among MSN with non-commercial female partner 26

Table 3.7 Consistent condom use with different types ofmale partners 26

Table3.8 Consistent condom use with different types of female partners 27

Table 3.9 Factors associated with consistent condom use among MSM in Hanoi reel tilt ed b\ IIỈS ■■ 31

Table 3.10 Factors associatedWith consistent condom use amongMSM recruitedby

LIST OF FIGURES

Figure 3 I Thepercentage of using the Internet to seekmale partners 21

Figure 3 2 Percentage of social apps andwebsites used to seek male partners 22

Figure 3.3 Distribution (>pes ofsexual partners during the last Ó months 24

male partners

Figure 3 4 Main reasonsfor not using condom when having sexual intercoursewith

Figure 3-5 Mainreasons for not using condom when havingse.xual in Iei course with female partners

Methods: Data for this analysis were from acohort study IIIM-Hanor conducted from

2017 tô 2019 in Hanoi MSM aged from 16 jeais were recruited ÍỒI the survey using

IBS Univariate and multivariate logistic regression were used to assess theassociation of ecu with selected socio-detnographic characteristics and other

factors

Results: Among 802 MSM interviewed CCƯ with non-coinmctcial male partner,

maleclient, male sex worker, and femaletiansgenderwas39.8° Ô.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 inc I eased odds for ecu Willi non -cormnerc 1 al malepartner were being aged from 25 years ot older (OR: 1.27.95%CI: 0.82 - 1 96)

havingtertiary education level(OH 1.63.95%CI: 1.01 2 64) nevergetting married

(OR 2.22 95%CI: 101 -4 88) and using the Internet to seek male partner* (OR

2 OS.95*«CI: 117 3.60) Factors associated with decreased oddsof ecuwith non­

commercial malepartner was spending the night at hotel guesthouse frequently (OR

0 49 9$%CI:0 25 - 0 97) never being tested HIV (OR: 043 95%CI 0 19 -096)

and using ATS to enhance sexual performance (OR: 0.44.95%CI 0.21 0 90)

CớnchutMĩ ecu with different types of partners among Hanoi MSM surveyedremainslow HIV interventionsfor MSM should take associated factors found 111 thestudy into consideration to increase ecu among MSM therebv contnbuting tothe

reduction of HIV and STI infections

AcTM-wcfr Men who have sex with men MSM Consistent condom use Sexual

partners Internet-based sampling Hanoi

TÓM TÃT

Tên Jr toi: Sữdungbao cao su thướng xuyênvà các yểu to lien quan ợ nhóm nam quan lie tinh due đônggiới thu tliâp bởi pỉiưongpháp chọnmàu dire tư>én taiHá Nội

Mục tiêu:Nghiên cừuđược thưc hiệnnhảm muc tiêuxãc đinh ti lộ úr dụng hao cao

su thuõng xuyênvà cácyêu tồ hèn quan ợ nhóm MSM dưưc thu tháp ben phươngpháp chọn màutrựctuyển tai Hà NỘI (IBS >

Phmmgpháp:Nghiên cim sư dụng sò liêu tứ nghiêncứu HIM-Hả Nội với đôi tượngMSM tư 16 tuôi tre len đưọc thu tháp bảngphv«mg pháp IBS Phươngphápphân cich

hói quy logistic được dùng dếdãnỉi giA mói liên quan giữa việc sú dungbao cao su

Ihirớngxuyên (CCU) với cácyểu10 liên quan

quữ; Trong ũ» 802 MSM Il Ic ecu VỚI ban tinh nam tư nguyên, bạntinhnam khách lũng, ban tinh nam bân dủni vãnừ chuyêngiới lân luợt lã 398% 41 5% 40.0%

Và 20 0% Ti le ecu với bộn tình nừ tự nguyên, bạn tinh nừ khách hàng vả bạn linh

nùbândâm lãn lượt lá 43,1%, 72.7%vã 80.0% Cãcyều («>lãm ting khanăng ecu

khi quan hè tinh due (QIITDì VỚI ban tinh nam tự nguyên gồm: niỏi tù 25 trư len

(OR: 1.27.95%c 1:082 I 96>.tànhdộhộc vànlửdâihộClnũrlẻn(OK: 1.6.1.95%CI

1.01 - 2.64) chưa tưng két hôn (OR; 2.22 95%CI; 1.01 - 4.88) \a có sư dụng

Internet đê tim kiếm ban tinh nam (OR 2.05 95%CI; I 17 - 3 60) Các ycutô lãm giam kha nàngecu khi ỌIITD VỚI hạntinh nam tự nguyên gõ«n thường xuyên qua

đém t*ikhách san nhà nghi (OR 0.49 95%CI: 0 25 - 0.97) chưa (ưng xét nghiệm

HIV (OR 0.43 95%CI: 0.19 - 0.96), vã sử dung ATS de ling khoải cám tinh dục

(OR 44 9$%CI:021 -0901

A'Ố lu ủn; Ti lệ ecu với các loai bộn tinh khác nhau trong nhom MSN tai Há NỘI

càn iliẩp Các biện pháp can thiẽp dự phong HIV cần cliũ iTỌíig dén các yểutố liên quanđươc xãc dinh trong nghiên cứu đe làm t.ìng II lẽ CCƯ trong cõng đóng MSM

tudo gópphầngiâm lây nhicmHI V va cácbênh lây truycn qua đương tinhdue

TirfJjiia:Namquan hê linh due dóng giói MSM.sửdung bao cao ỈU thườngxuyên, ban tinh,chon mầu true tuyền Ha NỘI

The HIVepidemic 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)? Ill 2018 It IS estimated that

230.000 people in Vietnam were liv ingw ith HIV.making up0.3%of thepopulation •’While IIIV prevalence among the general population is lowand shows no Sign of

increasing.' the HIV infection rate in the MSM population Ims been risingconsistently, from2.3% in 2012 to6.7% in 2014 and to7.4% in 2016? The number

of new infections among this population IS predicted to continue increasing significantly? Although MSM represented only 0.68% of Vietnamese adult males

aged 15 to 49? they accounted for21 % ofall newly diagnosed HIV infections? They arc identified as one ofthe most 11’11 sk populations forthe national HIV pandemic ;

Condoms arcone 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 Manystudies also base shown that consistent condom use reduces

the iacidcnce of STIs significantly in companion with the lion-use of condoms However, in Vietnam, the rate of consistent condom use among MSN remains low

HIV Sentinel Surveillance Survey Plus (HSS+) in 2011 indicated that only43.3% ofMSN used condoms consistently last month and 713°«of MSM reported using a condom with their male partners at their last anal intercourse In Hanoi, althoughM$M whoreported always using condoms in the pastmonth w 1ththeir malepartners

(including both commercial and non-coininercial partners) rose lematkably during the 2005-2013 period, this figure remained low (below 45%)1

In recent years Vietnam has witnessed a tremendous development of

teclindogỊ that leads IO significant growth in the number of Internet asm Il IS estimated that about 65 million Vietnamese people use social networking sites,

accounting for 67% of the population? 87% of the MSM population havesmartphones and almost all ofthem (98%) use at least one social networking site?

This MiTualenvironment creates 1 favorable condition forMSM toexpandtheirsocial Circles Hence moreandmore MSM hast stalled to find their sexual partners via thelinemet Ina report of the Vietnam Administration of HIV AIDS Control (VAAC)

74%of MSM users seek partnersthrough online websites bymobile phones * Hanoisaw a rapid increase in social media use amongthe MSM community in the lastdecade, with ntoie than 75%ofMSM usingsocial media tofind amalesexual partner

compared to only 35% reported in 2008“Although Hanot is the second-largestcity

in the MSM populationwith an estimate of34 000 MSM ' andhas highrates ofMSM

using the Internet.11 little is known about the sexual behaviors of tills population

Apart from this, many studiesexamined condom useamongthe MSM populationin Hanoi.'* " but the study thatexamined indicators of consistentcondom use amongthis population was limited Hence It IS importantto understandthe factors inorder

to inform effective HIV prevention interventions targeted towards MSM in Hanoi

To till this gap we have conducted a study title “Consistent condom use and correlates among men who have sex with men recruited by internet-basedsampling in Hanoi'*Willithe aim:

I To describe consistent condomuse w ith different types of partners amongmen

whohave sex with incn recruited by internet-based sampling in Hanoi

2 To describe correlates of consistent condom use among men who have sexwith men recruitedby mlemet-based sampling 111 Hanoi

CHAPTER 1 LITERATI RE REMEW

1.1 Definitions

1.1.1 I erms related to men who have sex with men

• Sex; The term "sex** refersto biologically determined differencesthat arc used

to label individuals as males or females I he bases for this classification are reproductive organs and functions.14

• Gender: The term ■ gender" refers to the social aitlibuies and opportunities associated with being male and female and the relationships between women

and men and girlsand bos s a&well as the relationsbetween womenand thosebetween men Gender determines what is expected aliassed, and salued in a

woman ora man in a given context14

- Gender identity; Gender identity has been defined as a person’s internal,deeply fell sense of being male or female orsomething other, or in between 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 01'any sex 14 Terms includehomosexual, heterosexual, bisexual, etc Sexual orientation does not equalsexual behaviour10

♦ Heterosexual Tile term heterosexual is used to refer10 peoplewhohave sexwith and/or are attracted to people of the opposite sex.14

♦ Homosexual People who have sex w ith andor sexual attraction topeople

of the same sex This should not be confused with the Latin word homo, meaning a man 14

♦ Bisexual: A bisexual person IS defined as aperson whoIS attractedto and/or

has sex with both men and women, and whoidentifies with thisasacultural

identity The terms men whohave sex with both menandwomen or women

who have sex with both women and men should be used unless individuals

orgroups self-identiK as bisexualw

4 Asexual: Person wholacks (or laiely)having 1 sexual attraction 10 others

or lack interest in sex .An asexual may or may not have an emotional

attractiontopeople of the same opposite'bothgenders 6

- Condom less sexA'nprvtected sex: the sex act IS not protected by male orfemale condoms Previously knownas unprotected sex.this isnow increasingly

referred to as condomless XX 4

• Insertise anal sex: the sex act which inserting the penis into the anus, alsoknown as topping

• Receptive anal sex: the sex act which receiving the penis intothe anus, also known as bottoming ’

1.1,2.Definition of men who havesex with men

According to VNAIDSTerminology Guidelines 2015 the lean"menwho have

sex with men" (MSM> describes mates who have sex with males, regardless ofwhether Of not theyalso have sex with women or have a personal or social gay OI

bisexual identity.14

4 Gay- The termgay can refer to same-sex sexualattraction, same-sexsexual behavior, and same-sex cultural identity Unless individualsor groups self­identify as gay the expression ofmen who have sex with men should beused

+ Transgender - Iransgcndei IS an umbrella termto describe people whosegender identity and expression do not conform to the norms andexpectations traditionallyassociated with their sex at birth Someone whodresses or/and acts as and wishes to be (or 1$) recognized as a member of the opposite sex fromwhich theywereborn

+ Bóng kín hidden gay/shadow)- A man who is discreet about his sexualidentity.who maintain amasculine gender performance.and w ho publicallypiesent as heterosexual

♦ Bóng lộ (conspicuous shadow) - A man who IS open about his sexual

identity Bông lộ refers to MSM whose presentationIS moreeffeminate, andwho do not hidetheir sexual preference formen*

1,13.Definition ofsexualpartners

Inthis study, w e mentioned 7 ty pes of partners;

♦ Non-commercialmale partners• Males whothey havesex with but there wasno exchange of money or goods

♦ Malesex workers - Males arc those they have sex with and pay money

♦ Maleclients whothey pay' for sexincludes pay ment by moneyor goods

♦ Non-commercial female partners - Females with who they have sex but therewas noexchange of money orgoods

♦ F emale transgender* a transgender person who wasa male al birth but

whosecurrent gendet identity is a female

♦ Female clients - Females who pay for sex include payment by money or goods

♦ Female sex workers - Females are those they have sex with and paymoney

1.1.3 Definition of consistent condom use

Consistent condom use definition was variedin previous studies It depended

on the scales theyused 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 lime*, and always’ Inconsistentcondom usewas defined as neverusecondoms*

or rarely use condoins’, while consistent condom use was defined as 'always use

condoms■and usecondomsmost ofthe time ** Ilow ever.according to another study

conducted in lluzhou, China, consistentcondom users arc MSM who reported using

a condom every time withboth stable andcasual partners,while inconsistentcondomusers did not?1

In this study, condom use frequency was recorded as •always*',

“occasionally* and “never" Consistent condom use was defined as “always use

condom” andinconsistent condom usewas defined as“occasionallx" “never" or “do not remember"

1.2 The situation ofHIV/STIs among MSM

1.2.1 I he situationof HIV7STB among MSM in the world

Analysis of dataavailable ofUNAIDS suggested that gay men and othermen who base sex with men accounted fol an estimated 17% of new HIV infections

globally 11» 2018*' MSM had the highest new infections among key populations in

most continents Especially, in Asm and the Pacific and L3tinAmerica MSM made

up up to 30%and40% of new HIV infectionsrespectively21

/Mong with HIV STIs prevalence wasalsohigh amongthe MSM population

In report ofthe I S CDC the incidence OÍ many S I Is in gay bisexual, and other

men who have sex with men (MSM>—including primary and secondary syphilis and

antimicrobial-resistant gonorrhea—is greater than thatreported in women and men

who have sexwith women only." MSM accounted for nearly two-tlurds (64.3%) of

reported syphilis cases among women or men with information about sex ofsex

partners in 2018." Among menexclusively MSM accounted for 77.6%ofreported

eases with mfonnahon on sexof sex partners." Researchconducted 111 Amsterdamalso indicated that the infection rate of rectal gonoirhea and early syphilis increased amonghomosexual menwhen compared withbisexual male?'

1.2.2 The situation of HIV/SThamong MS.M in Vietnam

In Vietnam HIV prevalence among MSM lends to be increasing, from 2.3%

in 2012 to 6.7%in 2014.and7.4%in2016.' HSS + in2016 also showed thattheHIV prevalence among MSM rosefrom 5.1% in 2015to 7.36%in 2016?' TheI BBS 2013

also reported that theHIV prevalence among MSM washigh in big cities such as Ho

Chi Minh city (12.1%), Hanoi (4%) and Hai Phong (5.4%) :

In addition, the STIs were also a concentrated problem among the MSMpopulation inVietnam STI infection among MSM was high in three of rhe four I BBS

ptOMnees,namely Hanoi,Ho Chi Minh cityand Can Tho in 2009iS In IIo Chi Minh

city, every five people has a person infected with Rectal Chlamydia, GenitalChlamydia NeisseriaGonorrhea and other STIs.25The STIs prevalence among MSM

in Can Tho and llai Phongwas 17.3%and 15.8%respectively

13 Researches on consistentcondom use among MSM

However the prevalence of using condoms when having sex still remains high,

especially in unprotected anal intcrcouise Hence, unprotected anal intercourse IS considered as the highest riskin HIV and STIstransmission in the MSM population 6

A study conducted in Tamil Nadu India shows that among 1618 MSNinterviewed, consistent condom use during anal sex withregular,paying, and a casualmale pan net was 453% 50 8°« and 57 9% respectively Consistent condom use

with all threety pesof partner* combined was 52.6%.27

Another study conducted 111 Nigeria showed similar results, approximately more than half (53%) of participants reported always using condoms with male

partner,mthe past 6 months and 43% reported always using condoms with femalepartners in the past6 months/*

A cross-sectional study used survey data from 1.230 MSM in Beijing Chinareported that nearlyhalfof the participants engaged in unprotected anal intercourse

with at least one of up tothree partners in the past 6 months.2*

1.3,2 In Vietnam

In Vietnam previous studiesshowed that MSM had low levels of condom use

In 2011 USS 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 he specific, consistent condom use with non­commercial malepartnersin 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 100% '•

Another stud) conducted U1 An Giang showed (tut condom use wasconsiderably low in both heterosexual and homosexual sex The overall rate of consistent condom usewasonly 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 examined the assocation between consistent

condom use and factors A study conducted in Tamil Nadu India with 1618 MSMrecruited by time-location cluster sampling examined factors associated with

consistent condom use with thiee types of male partners including regular, payingand casual male partners This study revealed rival factors associated with increasedoddsfor ecu with MSM having all three types of partners combined were frequentreceptive anal sex acts with regular partners, fewer number of casual partners,and being a member in a community-based organization, meanwhile, factors associated

with decreased odds of ecu were using alcohol and using drug m the past month In

terms of ecu with paying male partners MSM who perceived higher risk of

acquiring HIV were more likely to use condom consistency Besides, those who

accessing to any HIV prevention interventionwas associated with increased odds of

ecu with casual male partners?’

A cross-sectional studs in lluzbou China using the Internet-based sampling

to rccruitc 410 MSMshowed that factors associatedwith consistentcondomuse wasliasing a comprehensive know ledge ofHI V using alcohol before sex andev erlias Illgsex with male sex workers?

1.4.2 In Vietnam

In Vietnam little IS known about factors associated with consistent condom

useamong MSM Only a cross-sectional study conducted by Garcia et al in 2011

using Internet-based survey examined the factors associated with inconsistent

condom useduring anal sex intercourse with male partners.This siudv revealed that

MSM who consumed alcohol before or during sex m the last 6 months were more

likely touse condom inconsistently In addition, those who reportedhaving received free lubricants in the last 12months and those who perceivedthemselvesas being atmedium or high risk of HIV infection were more likely to engage in inconsistent

condom useWith male partners?1

1.5 Researches on using the internet-based sampling torecruit MSM

recruit persons who accessed MSM-relaied websitesteg Gay coin Manhunt net

Dlist>nnd social networking websites <c.g MySpace and Friends ter)from 2003 to

2005 and total 7.978 were eligible for participation13 Manystudies alsosucceeded

in using social media to recruit a large numberof MSM?1 *Therefore, the Internet

providesỈI perfect channel to access sensitive informationand recruit a large number

of participants

1.5.2 In V ietnam

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

implemented 1112011 Bengtsson el at used 20 seeds torecruit panic Ipants onlinefor

a study using web-basedRDSsampling Thisstuds recruited 676 Vietnamese MSM

in two months (Fcbruaix to April 2011).’' Another internet-based cross-sectionalsurvey among Vietnamese MSM Has conducted by Garcia el al from August to

October 2011 using multiple websites This study posted advertisements and

questionnaires in the 12 most popular and highly visited MSMcommercial and social

networking websites In twomonths, this studyattracted 5.128individualresponses, among those 2,077 were eligible Illite websites with the highestparticipants werelisted (Tao Xanh (17.0%) Tinh Ycu Trai Viet (15.7%) and Victboynet (14.6%))

Thisstudy alsoreported that 10 2% of eligible participantsarc from Hanoi *

1.6 Information aboutMSM in Hanoi

1.6.1 The numberofMSM in Hanoi

According tothe lepoit "Estimates and projections of HIV/AIDS III Vietnam

2OƠ7 - 2012" the high estimate isused to estimatethe size ofthe populationgroup,

assuming 3% of men over 15 years old in Hanoi A specific number IS estimated at 35.436people

1.6.2 The HIV/STIs prevalence among MSM in Hanoi

In terms of HIV prevalence, lirereport IBBSI II Ill in 2005 2009.and2013

showed that tile HIV prevalence among MSM in Hanoi was 9.4% 14% and 4% respectively In theIBBS 2009.for MSM whohad sold sex the IIIVprevalencewas 14% lot those whohad not sold sex.theprevalence was 20% 11» 2009 ”

When It conies to STIs prevalence, (he proponion of Rectal Chlamydia infection and Rectal Neisseria Gonorrhea in Hanoi was the highest among surveyed provinces, at 10% and 3.4%respectively?*Genital Chlamydiaprevalence was 4.4% among MSM in Hanoi UI 2013.M III a 2017 study conducted by Hanoi Medical

University among MSM in Hanoi, neatly 10% of participants tested positive for syphilis.4

1.6.3 The situationof condom use among MSM in Hanoi

The BBS 2013 used respondent-driven sampling to examine the consistent condom use rate with 6 types of partners m the last month in four cities To be

specific, lire consistent condom use rate among MSN 111 Hanoi with non-com mere I al nude partners, male clients, and male sex workers in the past month was 59.1%, 76.4% and98.7%, respectively, meanwhile, all participantsreported using condom

consistently with their female partners including non-commercial female pinners,

female clients, and female sex workers in the past month Although trends in consistent condom use with male partners in the past month among MSN 111 Hanoiincreased in the 2005-2013period, thefigure remained low atroughly40% ;

CHAPTER 2 METHODOLOGY

2.1 Subjects

MSM aged 16vearsandabove, living in Hanoi for at least3 months, having

no planto move in thenext24 months, and willing (O provide consentto participate

in the study

• Inclusion criteria:

♦ Vietnamesenational

♦ Male at bifth

♦ At least 16 yearsofage

♦ Living in Hanoi continuously for the past 3months and not having an immediateplantomove in thenext two years

♦ Havehadoral oranal sex with another manor transgender woman in thepast 12 months

♦ Willing and ableto provide written informed consent

- I’xcluSioncriteria

♦ Foreignnational

♦ Female at birth

♦ Not residing in Hanoi

♦ Younger than 16 years of age

♦ Neitheroral nor anal sex with another man or a transgender woman inthe past 12 months

♦ Not ableorwillingto piovide wlitten informed consent

2.2 Location and lime

This studs-was conducted U1 Hanoi

- Participantswere identified and recruited fromJuly 2017 to September 2019

- Studentsaccessed d3taand analyze II from March 2021 toMay 2021

23 Study Design

This IS a cross-sectional study using datafrom the baseline survey ofthe

"HIV incidence andthe d> nanniesofbehavioral change Jinong men who have sex with men in Hanoi Vietnam the Hanoi MSMcohort study**(HỈM-lỉanoi)

2.4 Sampling

2.4.1 Sample size

A total of 802eligible participants were recruitedby internet-ba^ed sampling

methodin the baseline survey 0Í the HIM-Hanoi

2.4.2 Samplingtechnique

Convenience sampling Using mtemet-based sampling method to recruit

participants from websites and social apps which were used b> MSM III Hanoi

Income Salary permonth, including

support from then family

Unifl million Vietnam Dong

In the last 30 days, where

have youslept (spent the

night) most frequently

In the past, havethey ever

been diagnosedwith STIs at

Lists of social appsdial

participants used to findmale sex partners

Qualitative

Having sexual

intercourse withmale partners met online

The frequency of hax ing sexual intercourse withmale partners metthrough wcbsilcs/social apps

Qualitative

Types of partners

inthelast 6months

- Non-commercial male

partners

- Male sex workers

Qualitative

• Mnlc clients

- Non-commerciâl femalepartners

- Female sex workers

Female transgenders

Number ofsexual partners

Number ofsexual partners duringthe last month

Quantitative

Sexual role Sexual role when having

anal sex duringthe last 6

intercoursewiththeir

- Condom usereduces the pleasure

- Condom is not available

- My partneis look healthy

• Condoms ate too expensive

- My partner didn't wantto

- trust my partners

- 1 feel embarrassedto buycondoms

Qualitative

• 1 was in a homed

- Other (specify)

2.6 Datacollection

2.6.1 Data collection tool

The self-answered questionnaire included 3 pans: (I) Socio-demographic

characteristics(2) Internet usage and other factors (3) Sexual history with different

types of panneis

2.6.2 Data collection process

- Step 1 Recruiting pcHemiaỉparticipants through the Internet.

Studypromotion materialsandstudy contacts were posted on commercial and

community -operated websites*'Facebook pages used by MSM in Hanoi such asxomcauiong gtown loveboyhanoi and social apps such US Zalo Jack’d, and

Blue’d Promotional materials had SHP clinic contact information (telephone and street address) so that interested participants might contad SHP Staff if they wereinterested in the study Those who were interested in the study would be asked to

contact study staff(viaemail, phone,other social media means, orshow up at Slip

clinic) for screening

- Step 2: Screeningandrm natron

Once outreach workers or field researchers made contact With potential participants, they used the Field Scree 1KI to establish eligibility of the participantsthrough an internet-based questionnaire Those who were eligible were briefed on

surveyobjectivesandgiven imitation coupons with information abouttheaddress ofthe survey center where the data were collected, and the appointment date Each recruitment method was screened by study staff Then the individual came to the

clinic for the first visit, the study would be further described and informed consent

obtained Ifthe selected indisidual did notvisit the survey center within four weeks

after the Appointmentdate, another selection was madeuntilthe required samplesize

wasmet

•Step 3; Data colfarfon

Data collection took place at the Sexual Health Promotion (SUP) Clinic

located on the campus ofHanoi Medical University The eligible participants self­

answered 111 the form of computer-administered structured questionnaire A

research assistant trained in interviewing with MSM assisted participants in completing the self-interviewing process

2.7 Statistical analysis

Analysistests used

- Desen pine statistics Mean and standard deviation were used IO describequantitative variables Frequency and percentage were used to describe qualitative variables

• Univariateandmultivariatelogistic regression model were used to determine

the association between consistentcondom use and participants* socio-dcinograpluccharacter sties and other related factors

Stataversion 14.0 was used for dataanalysis

c hapter3 RESULTS3.1 Generalinformation

\ enueswhere they spent thenight mostfrequently

The averageage of the subjects was 24 8 X 6.1 years withmore than half of participants (63.5%)at the age of 16to 24 years old.23.3% of participants from 25

to 29 years old and 13 2%over 30 The age rangedfront 1610morethan 55 tearsold In

terms of education 19 4% of survey edpeople just finished gradeunder 12 34.7% were

studying in vocational training,college ưuVUSItv and nearly a lialf completed tertiaryeducation(45.9%) While die majority OỈ respondents never gotnamed 10women,only 7.4% of participants reported thatthey used to marry to afemale

Nearly all of the respondents had a occupation to support their life (93.9%)

and lud anincome of more than 3 million permonth (84 4%)

Venues, where MSM spent the night most frequently, were their Own home

(78.8%) and their fanily/rclative's home (11.7?®) Besides 6.1% of participants

usually spent the night at hotel guest house/other temporary room and just a small proportion of participants (I 9%)overnighted at their sex partner's home

Alarge percentageof MSM U1 this study self-identified as beingattiactedto men (51.6%) However, the percentage ofMSM am acted to bothmen and women Wils alsohigh, accounted for 47 9% Very few MSM wereattracted to women only (0 4%)

3.1.2 Self-reported HIV/S I Is status

Table Ỉ.Ỉ Seự-reparted HJÌ'/STỈ\ stains

(□>

Percentage(%)HIVstatus (Self-report)

Among 802 MSM surveyed 28? participants never tested HIV before Ofthose who joined the survey 37 (4 0%) participants self-reported HIV positive,and

455 (56.7%) participants reported lhe HIV-negative result Besides, there were 23(29%) participants stated thattheydid not know the resultsof theirHIV test Besides

577 respondents reported the) were diagnosed with at least one Sĩ I at a health clinic,

accountedfor72%of the sample

3.1.3 Drug use

Table I)ruf{ me to enhance se.vualperformance

(")

Percentage(%)Ever used drug (ATS) to enhance sexual performance

The table aboveshows the result of using drug (ATS) amongM$M toenhance their sexual performance 6.5%of MSM interviewed reported they had ever useddrug to help them boost their sexual performance

3.1.4 Internet usage to seek partners

■ Yes No

HịỊure 5.1, rhe percentage uf listnp the Inter net III seek male partners

A majority ofmen surveyed stated seeking male partners online, accounted

for 88.7% Meanwhile,only 11.3% of participants did not find the information ordid

not have smartphonetoaccess theInternet

i'U ran IS

w I 1

OtHn I 0 a

Figure 3.2 Percentage of social apps anti websites used to secb male partners

Of those who used the Internet toseeksexual male partners, the percentage 0Í

using Blue!) was the highest figure, at 64.4% Facebook and Zalo accounted for 613% and 48 1%.respectively II is followedbyJack’dand Chindr with 30.$% and

21.9% of MSX1 using to find their partners, respectively Just n fraction of MSM

surveyed used other social apps

Table 14 / 'laving sexual intercourse with mule partners met online

in the I ait 6 months

Everhad sex with male partner through

social apps (N“8O2)

MoreIlian halfof MSM surveyed reported theyhadeverhad sexual act withmale partner met through social apps 1 his proponion was more than fourth filliesas

higher as theproportion of MSM whoreported everhasing sex withmale partnerntet

through websites (51.5%compared to12 3%)

3.1.5 Sexualbehaviors

Female transgender 0.7

Mon -commercial female partner

Female client I :<

female sex worker

Figure 3.3 Distribution types of sexual partners during the last 6 months

Among 7 types of sex partners, non-commercial male partner held the vast

majority of MSM's sexual partners The percentageof MSM reported has Illg sexual encounter with non-commercial male partners during the last 6 months seasapproximately 13 times higher than that of those having sexual intercourse With thesecond popular sex partners - non-commcrcial female partners <98.7% compared to

77%) Just a fraction of MSM surveyedhaving sexual intercourse with other types

of partners in the last 6 months period

Table ỉ Ĩ Sexual behaviors among MSM with non-commercial male partner

Sexual role when having anal sex during

thelast 6 months (»743)

Approximately 80% of MSM having non-commcrcial male partner engaged

in sexual intercourse and 38 1% had more than two partners in the last month

Among 743 MSM havingsex with non-commercial male partner III the last 6 months,

one-fifth of respondents engaged in insert! VC anal sex 63 5*0 reported engaged in both insertive and receptivesexualencounter, and 15.4% engaged in receptive analsex

TaMc 3.6 Sexual behaviors antottg WSM with nou-commercial female partner

Characteristics

frequency

(■)

Percentage(%)Numberof sexualpartners during the last

Among those who had non-commcrcial female partner all of them engagedin

sexual encounter in the last month period and most respondentsreported had sexwith

only one partner <81 0%) However a participant stated having sexual intercourse

withup to 14 noncommercial female partners ina month

3.2 Consistent condom use withdifferent types (ifpnrtncrs

Table 3.7 Consistent condum use with different typer tif mate partners

during the last 6 months

Consistentcondom use

The table above show* the percentage ofconsistent condom use during sex

practices with different types of male partners doling the last 6 months Thepeicentage of consistent condomuse with female transgenders was lowestamong all

types ofpartners at only 20° o 41.5%of participants who having anal intercourse

with non-commcrcral male partner used condom consistently during the last 6

months.Althoughthere were a large number ofMSM having non-commercial malepartner, only 39.8% reported always using condom at everysex practice 12 out of

30 partKpants(40%) reported using consistently with male sexworker

Table 3.8 Consistent condom use with different types of female partners

during the fast 6 months

When examining rhe condom use during sexual encounter with female

partners 72.7%and 80% of MSMusing condomconsistently during hax ing sex with

female clients and female sex workers,respectively Meanwhile, only 43.1%of MSM

reported using condom consistently when having sexual intercourse with non­commercial female partner

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