Pilot Study 1
Shifting Paradigms in Social Science Research on HIV/AIDS
The first study will use behavioral-science research to build a foundation for a theory-based HIV prevention intervention for men who have sex with men (MSM).
Drs. Patrick Wilson and Dao Thi Minh An
The goal of this pilot is to draw upon critical consciousness theory (CCT) and to build the foundation for adapting a critical consciousness intervention, tailoring it to meet the needs of MSM in Vietnam. Critical consciousness is a way to unveil the variety of historical, political, social, and cultural factors that serve to promote oppression and reduce positive self-concept and self-esteem. The intervention focuses on the critical analysis of media (music, videos, books, print media, television) and the stereotypes of Vietnamese MSM that are promoted by such media.
Background and Significance
CCT intervention has the potential to serve as a way for men to deconstruct the harmful messages propagated by the media and give them skills to engage in personal and collective actions that challenge these health-damaging societal norms around sexuality. The pilot will hopefully enhance feelings of empowerment among MSM and reduce their engagement in risky behaviors, fostering positive psychosocial development and physical health.
The methods used in the study will be categorized into three phases. The first phase, months 1-8, will be the initial intervention development activities that involve a review of prior studies, an expert panel, a CAB meeting, and a community ethnography. Phase 2, months 9-12, will consist of three focus groups. The final phase, months 13-18, will utilize data analysis, CAB meeting, and an expert panel. All of these phases will help shape the final intervention manual and the training for intervention piloting and efficacy testing.
The future work of pilot study 1 will enlist the local research community’s support in the creation and testing of the intervention. Multiple-day workshops will be held to train researchers on how to explore the feasibility, acceptability, and potential efficacy of implementing a critical consciousness intervention. The workshop will help prepare researchers to evaluate the critical consciousness intervention developed as part of the STAR partnership.
Pilot Study 2
Bedside to Community: Understanding How to Engage HIV-Infected IDUs in Care
Drs. Helen-Maria Lekas and Ho Thi Hien
This health services research project focuses on explaining disengagement or engagement of drug-using HIV-infected inpatients with HIV outpatient care. The goal is to bring social science into implementation science by understanding factors that hinder drug treatment and health care for HIV-infected IDUs in Vietnam. The pilot project will use Cockerham’s Model of Health Lifestyles as a theoretical framework, and will examine both individual- and structural-level barriers to engaging in drug treatment (including harm reduction and detention centers) and health care (e.g., accessing free care at health stations, self-medicating symptoms with heroin).
Background and Significance
This pilot will use the hospital as a novel setting for HIV research. It will shed light on the challenges Vietnam is encountering in scaling up harm reduction, methadone maintenance treatment (MMT) and HIV health care programs from the perspective of the consumers.
The pilot will use qualitative interviews with a sample size of 40 HIV-infected IDU inpatients in three hospitals in the Hanoi vicinity. Inpatients must be diagnosed with HIV but not received any related HIV health care or drug treatment services in the last 6 months. 10 of the inpatients selected will be female, and all participants will answer a screener and structured questionnaire.
Some of the next steps in this collaboration will involve redesigning the data collection instruments, holding a multiple-day workshop on bilateral training on recruitment, and further refining Cockerham’s model of health habitus, practices, and lifestyles. The study will prepare researchers to translate public health theories from one country to another and explore the possibility of a B2C-based intervention.
Pilot Study 3
Scale-Up, Sustainability, and Country Ownership: The Social and Structural Determinants of the Next Phase of HIV/AIDS Policy in Vietnam
This policy research study focuses on the process of scale-up, sustainability over time, and country ownership of the Vietnamese response to HIV. It will use critical case study methodology to examine both scale up and sustainability of HIV/AIDS as social and political processes involving diverse sectors, including government agencies, NGOs, CBOs, and grassroots movements of people living with HIV as social actors engaged in constructing collective responses to the epidemic at the intersection of global, national and local forces and interests.
Background and Significance
HIV/AIDS policy in Vietnam has shifted rapidly, moving from a focus punishing those who have HIV risk behaviors by labeling them as “social evils” to a focus on limiting public harms brought about by these behaviors. International donors have played a major role in the shift in policy and have supported scale-up of significant programs. Recent developments have been bankrolled primarily by donors such as PEPFAR, which has invested more than 800 million dollars since 2004. Investment from the national government has increased almost threefold during this period, but government spending per capita still accounts for less than one third of the total expenditure on AIDS. In such a context, the planned phasing out of PEPFAR is expected to have significant impacts on the Vietnamese responses to HIV/AIDS, at both policy and implementation levels. The development of HIV/AIDS policy responses in Vietnam offers a unique opportunity to further our understandings of both the processes of formulation and implementation of HIV policy in many developing countries.
We will carry out research by analyzing existing documents to identify and conduct interviews with 20 key players in 4 areas (total interviewees = 80) of the Vietnamese responses to HIV/AIDS. The 4 areas include national and provincial government AIDS agencies, non-governmental organizations (NGOs) with HIV-related activities, men who have sex with men and injection drug user community-based organizations, and networks of people living with HIV/AIDS. Research participants will be asked to describe the history of HIV/AIDS programs and policy drawing on their institutional or network point of view. These interviews will be used to construct four case studies on PEPFAR-focused provinces in Vietnam with very different populations and disease patterns: Hanoi (the capital city) and the Dien Bien Phu province.
Our findings will provide significant insights into how inequalities and vulnerabilities related to HIV/AIDS are influenced by the ways policies and programs are strategized, carried out and sustained. The pilot hopes to describe the response to HIV/AIDS of various sectors in Vietnam over the past two decades, examine the tensions within and between different local, national and international actors that have been part and parcel of Vietnamese responses to HIV/AIDS, and that have continued to develop as the actors are developing strategies to cope with the new situation where donors are shifting the emphasis from country stewardship to country ownership of donor-supported programs. The study also will explore the social and structural determinants of HIV and public health policies in developing countries, and how shifting policy formulation and implementation expose inequalities, vulnerabilities, and policy challenges at both global and national levels.
The study will build capacity for Vietnamese mid-level researchers to apply case study methodology in studying health policies and other health domains, and to collect preliminary data, prepare appropriate publications in peer-review journal and build foundation for future grant application.