Back in 2018, Vietnam announced a national PrEP (pre-exposure prophylaxis) program to curb the rising number of HIV cases in the country, making it the second Asian country to implement a nationwide PrEP program right after Thailand [1]. PrEP is a daily medicine that allows individuals who are negative for HIV but still at risk to decrease their chances of getting infected by 92%. Under this plan, Vietnam plans on making PrEP available to at least 13,923 people in about 11 provinces by 2020 [2].
The burden of HIV in Vietnam is concentrated in several key populations: gay and bisexual men, people who inject drugs, sex workers, and transgender women [1]. In fact, HIV prevalence is about 18% in transgender women [3]. As a result, the Vietnamese government and international donors have supported creating “one-stop-shop” clinics, community-led HIV healthcare services for at risk populations. VAAC (Vietnam Administration for HIV/AIDS Control), USAID (United States Agency of International Development), and the Vietnamese Ministry of Health have worked with community leaders in local provinces to launch pilot PrEP services to these local clinics. When PrEP became available at these clinics, community leaders realized that the medicine required better promotion towards the transgender community, as only about 7.6% of the transgender women who heard about PrEP actually used it in a 2018 survey [3].
Moreover, a 2018 study done by the Center for Applied Research on Men and Health found high levels of indications for PrEP but low awareness of of PrEP among transgender women, highlighting the need for more effective dissemination of PrEP and its benefits in tackling HIV among the transgender community in Vietnam [4]. After reaching out into the transgender community, community leaders realized that one of the main reasons why transgender women were hesitant in using PrEP was that there was a fear that PrEP interfered with levels of gender-affirming hormones. Therefore, transgender leaders, clinic staff, and PrEP experts needed to create an approach that would directly address these valid concerns. Additional services such as routine hormone-level testing, referrals for gender-affirming surgery, and substance abuse and mental health support were integrated into these clinics [3].
The expansion of transgender services within these clinics have had promising results. There was an immediate increase in PrEP initiations to about 20 enrollments a month. Enrollments went from 266 in the fourth quarter of 2019 to 409 in March of 2020 [3]. The three-monthly refill rate has also increased, as 74% of transgender women returned for refills and testing from October 2018 to September 2019 [3].
The promising results of these new implementations have been used to inform health officials in Vietnam about further developments and guidelines for PrEP use within the transgender community. The newfound successful promotion of PrEP among transgender is a lesson that emphasizes the idea of reaching to minority communities and understanding their struggles when implementing health policies.
References:
[1] Vietnam Launches National Program for Pre-exposure Prophylaxis for HIV | Press Release | Vietnam | U.S. Agency for International Development. https://www.usaid.gov/vietnam/press-releases/nov-30-2018-vietnam-launches-national-program-pre-exposure-prophylaxis (accessed Oct 17, 2020).
[2] Vietnam launches national program for pre-exposure prophylaxis for HIV. https://www.path.org/media-center/vietnam-launches-national-program-pre-exposure-prophylaxis-hiv/ (accessed Oct 17, 2020).
[3] Cairns, G. Community-run PrEP programme for Vietnamese trans women sees hundredfold rise in users in three years. https://www.aidsmap.com/news/jul-2020/community-run-prep-programme-vietnamese-trans-women-sees-hundredfold-rise-users-three (accessed Oct 17, 2020).
[4] Oldenburg, C.; Le, B.; Toan, T.; Thien, D.; Huyen, H.; Friedman, M.; Stall, R.; Colby, D. HIV Pre-Exposure Prophylaxis Indication And Readiness Among HIV-Uninfected Transgender Women In Ho Chi Minh City, Vietnam. AIDS and Behavior 2016, 20 (S3), 365-370.