Injection drug use (IDU) and HIV infection are important public health problems in Vietnam. The IDU population increased 70% from 2000 to 2004 and is disproportionately affected by HIV and AIDS--the country's second leading cause of death. Hepatitis B virus (HBV) and hepatitis C virus (HCV) share transmission routes with HIV and cause serious medical consequences. This study aimed to determine risk factors for acquisition of HIV, HBV, and HCV infections among IDUs in a northern province. We conducted a matched case-control study among active IDUs aged 18-45 who participated in a community-based survey (30-minute interview and serologic testing). Each HIVinfected IDU (case) was matched with one HIV-uninfected IDU (control) by age, sex (males only), and study site (128 pairs). Similar procedures were used for HBV infection (50 pairs) and HCV infection (65 pairs). Conditional logistic regression models were fit to identify risk factors for each infection. Among 309 surveyed IDUs, the HIV, HBV, and HCV prevalence was 42.4%, 80.9%, and 74.1%, respectively. Only 11.0% reported having been vaccinated against hepatitis B. While 13.3% of the IDUs reported sharing needles (past 6 months), 63.8% engaged in indirect sharing practices (past 6 months), including sharing drug solutions, containers, rinse water, and frontloading drugs. In multivariable models, sharing drugs through frontloading was significantly associated with HIV infection (odds ratio [OR] = 2.8), HBV infection (OR = 3.8), and HCV infection (OR = 4.6). We report an unrecognized association between sharing drugs through frontloading and higher rates of HIV, HBV and HCV infections among male IDUs in Vietnam. This finding may have important implications for bloodborne viral prevention for IDUs in Vietnam.

High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.

No abstract

In a community-based cross-sectional survey among out-of-treatment male opiate injecting drug users (IDU) aged 18-45, data on non-fatal overdose were collected using a semi-structured questionnaire. From August to September 2003, 299 IDU were recruited in two districts of Bac Ninh, a semi-urban province in North Vietnam. Prevalence of lifetime and recent non-fatal overdose were 43.5 and 83.1%, respectively. Logistic regression analyses showed associations between non-fatal overdose and younger age, unemployment, residence in the provincial township, frequency of injecting, injecting heroin mixed with valium, and history of drug treatment. While recognizing the limitations of this study, it is the first in Southeast Asia to report on prevalence of drug use-related overdose. Future research is recommended on occurrence of fatal overdose in this population.

The HIV epidemic in Vietnam is concentrated primarily in injecting drug users (IDUs). To prevent HIV-1 super-infection and to develop effective HIV prevention programs, data are needed to understand the characteristics of high risk HIV-positive IDUs. In 2003, we conducted a community-based cross-sectional study among predominately male, out-of-treatment IDUs, aged 18–45, in Bac Ninh Province, Vietnam. Among 299 male participants, 42.8% were HIV-positive and among those, 96.9% did not know their status prior to the study. Thirty-two percent were HIV-positive and had high HIV behavioral risk (having unprotected sex or having shared injecting equipment in the past 6 months). Injecting for ≥ 3 years, younger age, and pooling money to buy drugs were independently associated with being at high risk for transmitting HIV. IDUs who purchased >1 syringe at a time were less likely to have high HIV behavioral risk. Structural interventions that increase syringe accessibility may be effective in reducing HIV risk behavior among HIV-positive IDUs. Study limitations are noted in the text.