HIV-STI infection status, some related factors and effectiveness of preventive intervention among Dao ethnic group in 3 communes of Yen Bai province, 2006-2012

The percentage of participants with correct and complete knowledge about HIV/AIDS was 45.8%, of which the 15-24 age group was 46.1% [63].

In a study on the 15-49 year old group in Phong Dien, Can Tho, the rate of knowing the three transmission routes of HIV/AIDS was 39.2%. 36.7% knew that mosquitoes do not transmit HIV/AIDS and 94.7% knew that eating and drinking with an HIV-infected person does not transmit HIV [48].

In Long An, in a cross-sectional survey in 2012 on the 15-49 age group, the proportion of participants with correct knowledge about the three routes of HIV transmission was 74.4% [34]. A study on HIV/AIDS knowledge of students at a pedagogical college in Yen Bai in 2012 also had higher results: the majority of 97.2% of students had general knowledge about HIV/AIDS prevention; 97% knew all three routes of HIV transmission [58].

Attitudes towards people with HIV/AIDS are always an important issue in improving the effectiveness of HIV/STI prevention activities, especially among ethnic minorities. The results of this study showed that attitudes towards people with HIV/AIDS among the study subjects increased significantly after 6 years of intervention, with 661% having the correct attitude towards people with HIV/AIDS and 265% having the correct views towards people with HIV/AIDS. However, this result is still lower than the target of 60% of people not discriminating against people with HIV by 2015 in the national strategy for HIV/AIDS prevention to 2020 and vision to 2030 [75]. In the study assessing knowledge, attitudes, behaviors and effectiveness of interventions to reduce the risk of HIV infection among some ethnic minority groups aged 15-49 in Vietnam in 2012 by the HIV/AIDS Prevention Project in Vietnam, the proportion of participants with correct attitudes towards people with HIV/AIDS increased from 10.9% in 2006 to 22.2% in 2012. This proportion was highest in the study subjects in Thanh Hoa, Son La and Lang Son [31]. In the study in Dak Lak in 2012, only 24% of participants had positive attitudes towards people with HIV [62]. In the study in three communes of Buon Don district, Dak Lak in 2011, 39.5% had correct attitudes towards people with HIV/AIDS [52].

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In the general population aged 15-49, a survey of the 15-49 age group in Da Nang showed that the proportion of participants with positive attitudes towards people infected with HIV/AIDS was 21.1%, while the 15-24 age group was 19.3% [63]. In Phong Dien, Can Tho, 92.9% agreed that children infected with HIV should go to school and 87.8% responded that it was necessary to create conditions for people infected with HIV/AIDS to integrate into the community [48]. In Long An, the proportion of study participants with attitudes towards people infected with HIV was 68.9% towards teachers and 65.2% towards vendors [34].

Changing perceptions of HIV risk is also important to evaluate the effectiveness of the intervention. After 6 years of intervention, the proportion of ethnic minorities who could distinguish whether they were at risk of HIV infection increased by 175%; 16% and the proportion of participants who did not know whether they were at risk of HIV infection decreased by 36% from 39.9% in 2006 to 25.4% in 2012.

4.2.2.2. Changes in HIV/STI risk behaviors

Condom use behaviors when having sex with different types of partners have also changed positively among the ethnic minority groups participating in the study. However, when compared with the target of 90% of people aged 15-49 using condoms the last time they had sex with more than one partner in a year [75], the results in 2012 were still much lower. Therefore, local preventive intervention activities still need to be maintained and improved in quality to achieve the goals of the national strategy for HIV/AIDS prevention and control to 2020 and vision to 2030.

The results of condom use behavior of Dao ethnic people after intervention were better than the results of some studies in the same period of 2011-2012. In the study of IDU couples in two mountainous districts of Thanh Hoa province, up to 28.5% of wives did not use condoms during their most recent sexual intercourse with their husbands and up to 61.5% of wives did not use condoms during sexual intercourse with their husbands in the past 12 months. In the group of wives whose husbands were infected with HIV, only 81.7% of wives used condoms during their most recent sexual intercourse with their husbands and 40.4% of wives regularly used condoms during sexual intercourse with their husbands. In the group of wives who knew their husbands' risk of HIV infection, only 79.3% of wives used condoms during their most recent sexual intercourse.

Most women use condoms with their husbands and 41.4% of wives regularly use condoms when having sex with their husbands [78]. In a study on ethnic minorities in Dak Lak in 2012, up to 86.6% of participants responded that they did not use condoms during sex [62].

In the study assessing knowledge, attitudes, behaviors and effectiveness of interventions to reduce the risk of HIV infection among some ethnic minority groups aged 15-49 in Vietnam in 2012 of the HIV/AIDS Prevention Project in Vietnam funded by WB & DFID, in Lai Chau, 4.4% of the Hmong ethnic group had sex with a partner outside of marriage and the rate of condom use in the last sexual intercourse in this group was 25.8% [31]. In addition, some other provinces in the study had a lower rate of ethnic minority people having sex with a partner outside of marriage or with female sex workers than the results in this study.

In a study on knowledge, attitudes and practices of HIV/AIDS prevention among the population aged 15-49 in Da Nang in 2011-2012, 57.4% of the study subjects responded that they never used condoms and only 29.8% used them during their most recent sexual intercourse with a regular partner. The rates of reporting condom use with casual partners in the past 12 months and with female sex workers in the past 1 month were 88.8% and 83.3%, respectively [63]. In a study in Long An, 12.1% of the study subjects had sexual intercourse with casual partners or female sex workers and among them, the rate of condom use was 58.1%.

The rate of drug use among ethnic minorities in the study area remained low in both survey rounds (1.6% and 1.4%).

The results on HIV/STI risk behaviors of Dao ethnic people in 2012 after 6 years of intervention were consistent with the results of intervention activities that people had access to and consistent with improving knowledge of HIV/STI prevention in the research group.

4.2.2.3. Changes in HIV/STI prevalence

The rate of syphilis infection among the Dao ethnic group aged 15-49 in the study area continued to increase and was at a high level in 2012. The cause of HIV infection was determined mainly through two behaviors: drug injection and sexual intercourse. The research results showed that the Dao ethnic group only used drugs

Through smoking as a habit of the people, HIV epidemic has not penetrated the Dao community through drug injection. Regarding sexual behavior, the Dao ethnic group is liberal in sexual relations and according to research results, the rate of condom use during sexual relations of the Dao ethnic group is also very low. However, a notable characteristic of the Dao people is that they are only liberal in sexual relations within the Dao community and have little interaction with people of other ethnic groups. These reasons explain why there has not been a source of HIV infection in the Dao community, so no cases of HIV infection have been detected in the study area, although the rate of syphilis infection in this group is high. In addition to subjective factors in the characteristics of the Dao ethnic group, the results of implementing intervention programs have increased awareness of people in the study area and contributed to limiting the occurrence of sources of HIV infection.

Although no HIV-positive cases were detected in the study area in both survey rounds, the rate of syphilis infection remained high, so the risk of HIV infection among the Dao ethnic group was still very high. This result also showed the limitations of the intervention program implemented in the study area in covering all target groups. The implemented intervention activities were only effective among adolescents, who had better access to communication and support information than other groups. Combining STI examination and treatment activities with other activities was ineffective, as the main content of the intervention activities was communication and testing counseling. Another reason was that the STI examination and management activities developed in this study were carried out by the District Health Center, with the main content being examination, treatment counseling and prevention, without treatment for people diagnosed with syphilis. Meanwhile, the unit responsible for treating STIs at the district level, the district hospital, did not participate in the study. In addition, shortcomings in monitoring and following up on intervention activities were also the reason for the prevalence results not reaching the target.

Among Dao ethnic adolescents, the rate of syphilis infection has decreased compared to 2006. This result can be explained by some activities focused on adolescents such as condom programs and STI screening because this group is likely to have more sexual partners than other age groups. This is also the reason why this group has a strong increase in condom use after 6 years of intervention (103%). In addition, with the ability to access communication information as well as high support services, the rate of having correct knowledge in HIV/STI infection prevention also increased after the intervention.

The proportion of Dao people in the study areas who self-reported having STI infections in the 12 months prior to the interview was lower than in 2006. These results can be explained by the effectiveness of HIV/STI prevention interventions in the study areas, which helped Dao people here to be aware of and correctly assess their risk of STI infections.

With the rate of syphilis infection still increasing after 6 years of intervention, this rate among the Dao ethnic group is much higher than that of other ethnic minority groups. In the study assessing knowledge, attitudes, behaviors and effectiveness of interventions to reduce the risk of HIV infection among some ethnic minority groups aged 15-49 in Vietnam in 2012 of the HIV/AIDS Prevention Project in Vietnam, the rate of syphilis infection among the Thai ethnic group in Son La was 1.4%. The remaining provinces in this study all had low syphilis infection rates of less than 1% [31]. The rate of ethnic minorities self-reporting symptoms of STI infections in the past 12 months was higher than the results in this study. The provinces with the highest self-reported rates were Khanh Hoa (9.2%), Kien Giang (6.0%), Thai Nguyen (4.7%), Lang Son (4.4%), Nghe An, Dong Nai (4.1%) and Bac Giang (3.8%) [31].

4.3. LIMITATIONS OF THE STUDY

Although important activities in HIV/STI prevention have been developed and implemented and certain results have been achieved, there are still problems in the research such as the selection and training of collaborators and colleagues.

There are still many limitations in the membership, leading to communication activities and free condom distribution not being as effective as expected.

Implementing intervention activities in the community of ethnic minorities is a difficult task, which must be done well, from mobilizing the support of authorities from the district to the commune level and prestigious people in the locality such as village elders and village chiefs to organizing and mobilizing target subjects to participate in intervention activities.

Intervention activities still face difficulties such as limited capacity of collaborators and peer educators, difficult terrain conditions, frequent fluctuations, so the effectiveness of the intervention program is not high. Stigma and discrimination against HIV/AIDS has improved, but is still severe. Many families still hide and do not agree to participate when they know it is a research on HIV/AIDS.

The effective form of communication in mountainous areas, remote areas, and ethnic minority areas is community-based communication, however, the capacity and skills of collaborators/propagandists, commune/village health workers are still weak, training and coaching for this network is a persistent process. Communication materials such as leaflets or pictures for the Dao people have also been tested in the community to select the most suitable version, however, the visual images still have some shortcomings.

The research area is a mountainous area with complex terrain, difficult transportation and economy, sparse population, low education, many ethnic groups, many backward customs, border exchanges always occur and social evils easily arise. Most Dao families in the research area are poor or near-poor. Therefore, because they are busy working in the fields to earn a living every day, their access to HIV/STI prevention interventions as well as health services is limited. This is also a major difficulty in the process of intervention and provision of HIV/STI prevention services.

Regarding the STI screening and management program, combining STI screening and counseling activities with communication and mobile testing counseling programs is not effective, when the main content of the intervention activities is:

The intervention is about communication and testing consultation. Meanwhile, the examination and consultation of fixed STI infections at the District Health Center only focuses on high-risk clients such as the group of female sex workers in the district. In addition, the examination and management of STI infections built in this study is carried out by the District Health Center with the main content being only examination, treatment consultation and prevention without treatment for people diagnosed with STI infections. Meanwhile, the unit responsible for treating STI infections at the district level, the district hospital, did not participate in the study.

In addition, the research design does not have appropriate tools to collect and evaluate changes in economic, cultural, social factors, as well as people's living standards and their aspirations for health programs in general and HIV/AIDS prevention in particular for ethnic minority areas.

CHAPTER 5 CONCLUSION

5.1. CURRENT SITUATION OF HIV/STI INFECTION AND RELATED FACTORS IN DAO ETHNIC PEOPLE AGE 15-49 IN 2006

- The prevalence of syphilis among the Dao ethnic group in 2006 was quite high (3.4%), although the rate of self-reported STI infections and symptoms of STI infections was lower. No cases of HIV infection were detected.

- The Dao ethnic group has very low knowledge of HIV/STI prevention (18.7%). The problem of stigma and discrimination against people infected with HIV/AIDS in the study area is still quite common with a very low rate of Dao people having the right attitude towards people infected with HIV/AIDS (6.7%). The cause of this problem may be that in the study area, in 2006, there were almost no HIV/AIDS prevention activities implemented and some of the prepared activities were mainly focused on IDU and FSW groups. In addition, in remote areas, difficult travel and language differences are barriers for Dao people to access information about HIV/AIDS.

- The rate of always using condoms when having sex with all types of partners among the Dao people is very low (3.5%), the reason may be due to very low knowledge of HIV/STI prevention along with a lack of HIV/AIDS prevention activities such as communication or condom distribution programs.

- The rate of reported drug use is very low (1.6%).

5.2. EVALUATION OF THE EFFECTIVENESS OF HIV/STI PREVENTION INTERVENTION IN DAO ETHNIC PEOPLE AGE 15-49 IN THE PERIOD 2006-2012

Interventions reduced the risk of HIV/STIs through the following indicators:

- Knowledge and attitude of Dao people in HIV/STI infection prevention have also improved significantly (CSHQ: 168%, p<0.001 and CSHQ: 661%, p<0.001).

HIV-STI infection status, some related factors and effectiveness of preventive intervention among Dao ethnic group in 3 communes of Yen Bai province, 2006-2012 - 18

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