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Building a Public-Private Partnership to provide health services to MSM in Viet Nam

Center for Applied Research on Men and Health

Harvard Medical School AIDS Initiative in Vietnam

Donn Colby, MD, MPH

HIV Prevention, Care, and Treatment for MSM and TG: A Review of Evidence-based

Findings and Best Practices August 28-30, 2012 Bangkok, Thailand

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Background Ho Chi Minh City has a large population of MSM: 50,000

to 150,000 • Increasing number and variety of entertainment

venues

Rapidly rising HIV prevalence rates: • 5.4% in 2006 to 14.8% in 2009

Access to services reported as very low by the HCMC health department: • 14-19% report HIV testing in the previous 12 months • Only 1,000 to 1,500 accessing HIV testing at public

sites per year (2010-2011)

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Question:

How can we sustainably provide high-quality HIV prevention and clinical services, including HIV testing, that will attract and

retain MSM?

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Baseline Needs Assessment

Qualitative methods • 3 focus group discussions divided by age

groups with 31 MSM • 19 individual interviews

Quantitative methods

• survey that was conducted online with recruitment through websites that target Vietnamese MSM (n=1,166 in HCMC)

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Qualitative Research Results

• Many MSM know that they should have regular HIV testing, but there is less knowledge on the need for other health services such as STI screening and hepatitis vaccination.

• Very few ever revealed their sexual orientation to a health care worker.

• Many men prefer MSM-specific services, where they can feel comfortable disclosing their sexual orientation.

• Most MSM would pay for health services, including HIV testing, if it were seen to be of good quality, confidential, non-judgmental, and provided with good customer service

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MSMs accessing healthcare

Freq. Percent No 288 25% Depends 761 65% Yes 113 10% Total 1,162 100

Are you comfortable talking to health care professionals about your sexual activity or orientation?

5.41

94.59

Do you know an MSM-Friendly Clinic in HCMC?

YesNoClinic Freq.

Bau Troi Xanh 18 Chan Troi Moi 22 B.V. Da Lieu 9 B.V. Binh Dan 1 Vien Pasteur 3 Other 1

Name three MSM-friendly clinics in HCMC that you know.

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Discussing one’s sexual history/orientation with health care professionals.

0

10

20

30

40

50

60

Very Poorly Poorly Normally Well Very Well

How do you think health care professionals would treat you upon learning your sexual history/orientation? (%, 317 respondents)

11.95

88.05

Have you ever revealed your sexual orientation or history to a health professional? (%, 318

respondents)

Yes

No

62.16

37.84

If YES, then why did you reveal your sexual history/orientation? (%, 37 respondents)

Because I was askedabout it.

I wasn't asked, but Ivolunteered itanyway. 90.32

9.68

If NO, then why didn't you reveal your sexual orientation or history? (%, 279 respondents)

Because I wasn'tasked.

I was asked, but Ididn't reveal it.

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HIV testing

295

532

0

100

200

300

400

500

600

Yes No

Num

ber o

f Res

pond

ents

Do you know anywhere in HCMC providing HIV tests?

21.11

78.89

Have you ever been tested for HIV? (%, 829 respondents)

Yes

No

90.75

4.62 4.62

What was the result of your most recent HIV test? (%, 173 respondents)

Negative

Positive

Don't Know

0

10

20

30

40

50

60

<3 months ago 3-6 months ago 6-12 months ago > 12 months ago

Num

ber o

f Res

pond

ents

When was your most recent HIV test?

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HIV testing (continued)

45.66

54.34

Were you counseled before your most recent HIV check? (%, 173 respondents)

Yes

No

36.05

63.95

Were you counseled after your most recent HIV check? (%)

Yes No

0

10

20

30

40

50

60

70

1 2 3 4 5

Num

ber o

r Res

pond

ents

Rating of Service Quality (1 is lowest, 5 is highest)

How would rate the quality of service when given the HIV test?

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HIV testing (continued) If you’ve never been tested for HIV testing before, then why? (Multiple responses allowed)

0.00 20.00 40.00 60.00 80.00

I believe I'm at low risk.

I'm afraid of discrimination if I test positive.

I don't know where to go to get tested.

I don't trust that the results would be keptprivate.

I don't want to be seen by others at the testingsite.

The costs are too high.

Other reason.

Percentage of Those Who Answered Question (652 respondents)

Reas

on

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PEP (Post-Exposure Prophylaxis)

3.77

96.23

Do you know any health care provider in HCMC that provides medication that helps prevent HIV infection

after unsafe sex?

Yes

No

0.52

99.48

Have you ever used PEP?

YesNo

527

82 160

0

100

200

300

400

500

600

Yes No Not Sure

Freq

uenc

y

If there was medication that when taken after unsafe sex could help prevent HIV

infection, would you take it? 6.72

69.76

23.52

There is a pill that taken after unsafe sex may help to prevent HIV transmission.

YesNoDon't Know

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Public-Private Partnership Model

• Provide health services within an existing general medical clinic:

• HIV testing and treatment • STI screening and treatment • Hepatitis screening, vaccination, and treatment. • Vaccination: HPV • General Medical exams

• Partner with local MSM NGOs to: • provide counseling for HIV testing and risk reduction • liaison with the community

• peer educator projects • online promotion • “offline events”

•

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Men’s Health Clinic

Objectives • Increase the number of MSM accessing basic

health services: • HIV testing and counseling • HIV treatment • Hepatitis screening and vaccination • HPV vaccination • PEP

• Increase awareness of health issues among MSM s

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Men’s Health Service

• Service established within Viet My Polyclinic • 2 rooms for counseling and examination • Open Tuesday-Friday 1pm-7pm, Saturday 9am-

5pm • Intake and counseling providing by staff from MSM

NGO (G-link) • Medical Services provided by clinic staff

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Advantages • MSM-friendly service • Confidential • Sustainably supported by user fees

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Challenges Few models for public-private partnerships in providing health

services in Vietnam Difficulty in obtaining a license to perform HIV testing on site

• Samples sent to outside lab, which makes rapid HIV testing not feasible

Separate license needed to provide vaccination Service not yet promoted or advertised in the community

pending ability to provide rapid HIV testing

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Next Steps Free HIV testing and counseling started 1 August

with support of the HCMC AIDS Committee • Free HIV testing Tuesdays & Thursdays • Other days HIV tests for 90,000 VNĐ (US$4.50)

Free PEP (post-exposure prophylaxis) donated by Mylan will start in September

Pending approval for on-site HIV testing: • Provide rapid HIV testing (results in 30 minutes) • Launching event • Community-wide promotion

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THANK YOU VERY MUCH!

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EXTRA SLIDES

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