Vietnam is in the midst of an expanding HIV epidemic, primarily driven by an increase in injection drug use in young people. This study was conducted to understand the patterns and initiation of drug use, and the sexual risk behavior among youth in three provinces in southern Vietnam. A cross-sectional survey was conducted among male and female drug users under age 25 recruited from drug treatment centers (N = 560) and the community (N = 240) in Ho Chi Minh City, Dong Nai and Ba Ria-Vung Tau. The majority of those surveyed (82%) began by smoking heroin; after a year, 57% were injecting heroin and/or opium. Initiation of drug use frequently occurred in entertainment venues. Among injectors, 23% shared needles; 71% of all users were sexually active of whom 77% had unprotected sex. More than half of those recruited from treatment centers had previously been in drug treatment. Public health programs to prevent and treat the dual epidemics of HIV and drug abuse must be able to access and respond to the needs of youth, many of whom are unemployed and exposed to drug traffic.

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In Ho Chi Minh City, the locus of the HIV epidemic in Vietnam, efforts have been under way for several years to implement prevention efforts for migrant worker populations. The main activity has been volunteer health communicators (HCs) visiting workplaces and conducting HIV education activities. These efforts have reached only a small number of the intended audience, and the impact is unclear. Local authorities want to scale up their efforts but need information on the most effective and least costly activities, and their potential for scale up. The Horizons Program, the Population Council/Vietnam, and partners compared two programs for highly mobile construction workers: the existing HC workplace program, where social work students deliver HIV-prevention education, and a new peer-education program. Concerns exist about the turnover of health communicators in the HC program and whether social work students, about half of whom are female, are the most effective HIV-prevention educators for a largely male construction worker population. The new program uses construction worker peer educators to promote HIV risk reduction. Findings noted in this report indicate that the peer-educator program reached a higher proportion of workers than the health-communicator program.

As HIV prevalence in Vietnam increases, promoting prevention behavior among vulnerable populations, such as migrant workers, becomes more critical. In Ho Chi Minh City, efforts by the local government have been in place for several years to focus prevention activities on migrant workers. The principal activity uses volunteer health communicators to conduct HIV education activities at workplaces. Yet these prevention efforts have reached only a minority of migrant workers, and the effectiveness of the approach remains unclear. Local authorities want to expand their efforts but need more information about which activities are the most effective and least costly, as well as their potential for scale-up. The Horizons Program, the Population Council/Vietnam, and partners compared the existing workplace HIV-prevention program for highly mobile construction workers with a new peer-education (PE) program. As stated in this brief, while both the PE and HC programs had a positive impact on workers, the PE program has a number of advantages over the HC program for this type of work environment.