A hidden HIV epidemic among women in Vietnam

<p>Abstract</p> <p>Background</p> <p>The HIV epidemic in Vietnam is still concentrated among high risk populations, including IDU and FSW. The response of the government has focused on the recognized high risk populations, mainly young male drug users. This concentration on one high risk population may leave other populations under-protected or unprepared for the risk and the consequences of HIV infection. In particular, attention to women's risks of exposure and needs for care may not receive sufficient attention as long as the perception persists that the epidemic is predominantly among young males. Without more knowledge of the epidemic among women, policy makers and planners cannot ensure that programs will also serve women's needs.</p> <p>Methods</p> <p>More than 300 documents appearing in the period 1990 to 2005 were gathered and reviewed to build an understanding of HIV infection and related risk behaviors among women and of the changes over time that may suggest needed policy changes.</p> <p>Results</p> <p>It appears that the risk of HIV transmission among women in Vietnam has been underestimated; the reported data may represent as little as 16% of the real number. Although modeling predicted that there would be 98,500 cases of HIV-infected women in 2005, only 15,633 were accounted for in reports from the health system. That could mean that in 2005, up to 83,000 women infected with HIV have not been detected by the health care system, for a number of possible reasons. For both detection and prevention, these women can be divided into sub-groups with different risk characteristics. They can be infected by sharing needles and syringes with IDU partners, or by having unsafe sex with clients, husbands or lovers. However, most new infections among women can be traced to sexual relations with young male injecting drug users engaged in extramarital sex. Each of these groups may need different interventions to increase the detection rate and thus ensure that the women receive the care they need.</p> <p>Conclusion</p> <p>Women in Vietnam are increasingly at risk of HIV transmission but that risk is under-reported and under-recognized. The reasons are that women are not getting tested, are not aware of risks, do not protect themselves and are not being protected by men. Based on this information, policy-makers and planners can develop better prevention and care programs that not only address women's needs but also reduce further spread of the infection among the general population.</p

Do international surveys and censuses exhibit ‘dry season’ bias?

This study aims to assess whether Demographic and Health Surveys (DHS) and population censuses in developing countries are predominantly conducted during drier months and are therefore subject to seasonal bias. We examined field implementation dates of 176 DHS conducted in 64 countries and enumeration dates of the latest population censuses in 59 of those countries. We compared dry versus wet season implementation rates, distinguishing seasons using mean precipitation estimates and Koppen climate classes for each country. For countries with seasonal precipitation climates, 23% of 39 censuses were conducted in the wet season, compared with an expected 47%. In the same countries, 43.3% of DHS fieldwork took place in the wet season, compared with an expected 45.4%. There was thus a slight tendency for DHS and greater, statistically significant tendency for censuses to be implemented in drier months. Thus, the recent censuses analysed exhibit greater ‘dry season’ bias than DHS when viewed internationally. Since past studies have identified seasonal patterns in diarrhoea incidence, water source and malarial bednet use, care should be taken when comparing census and survey results for these variables internationall

Introduction of complementary food to infants within the first six months postpartum in rural Vietnam

Aim: To document the introduction of complementary food and factors influencing the decision to feed infants with solid food within 6 mo postpartum in rural Vietnam. Methods: A longitudinal study of 463 women who gave birth during August-October 2002 was conducted. Results: An early introduction of complementary food was found, which increased from 16.4% at week 1 to 56.5% at week 16 and nearly 100% at week 24. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% of women at weeks 1, 16 and 24, respectively. Logistic regression analysis found that at week 24 postpartum, it was less likely for the infant to be fed with solid food if the mother was a farmer (OR 0.52, 95% CI: 0.18-0.95) and passed secondary school (OR 0.28, 95% CI: 0.10-0.54), whose husband was satisfied with the infant's sex (OR 0.30, 95% CI: 0.17-0.53), her mother-in-law preferred exclusive breastfeeding (OR 0.18, 95% CI: 0.04-0.75), or her friends practised exclusive breastfeeding (OR 0.41, 95% CI: 0.16-1.10). However, infants were likely to be fed with solid food when their parents had higher income and lived independently (OR 1.76, 95% CI: 1.01-3.06).Conclusion: Community mobilization for sharing the workload with women could help them to cope with employment and breastfeeding

Determinants of breast-feeding within the first 6 months post-partum in rural Vietnam

Objective: This study explored the determinants of breast-feeding practices within the first 6 months post-partum among women residing in rural Vietnam.Methods: The study was conducted in Quang Xuong district, in the Thanh Hoa Province of Vietnam. In the first phase, 463 women were prospectively studied at weeks 1, 16 and 24 post-partum. During the second phase, 16 focus group discussions were undertaken to obtain complementary information.Results: Exclusive breast-feeding dropped from 83.6% at week 1 to 43.6% at week 16 and by week 24, no infant was exclusively breast-fed. A logistic regression analysis found 'mother's education level', 'mother's decision-making on breast-feeding', 'mother's comfort to breast-feed in public places', 'father's occupation', 'feeding preference of father' and 'having sufficient food for the family' significantly influenced the exclusive breast-feeding practice. Qualitative data provided in-depth information on factors relating to mother, infant, close relatives and providers.Conclusion: Providing appropriate training and supportive supervision on breast-feeding counselling to health workers and supporting working mothers to exclusively breast-feed their infants through community mobilization were recommended to improve breast-feeding in rural Vietnam