The results of this systematic review strongly suggest that HIV prevalence among MSM in Vietnam has been on the rise over time. In fact, the Ho Chi Minh City AIDS Committee17
estimates that by 2012, the number of new HIV infections contracted by MSM in Ho Chi Minh city each year is projected to be higher than the annual number of new infections in each of the other two identified high-risk groups in the city, IDU and FSW. Behavioural data, such as HIV testing, number of sexual partners and unprotected anal intercourse, also suggest reason for concern.
Knowing one's HIV status and associated counselling have been found to be associated with decreased high-risk sexual practices.18
Although HIV counselling and testing is increasing among IDU and FSW, it remains inadequately low among MSM, and has not increased since the 2006 round of IBBS which may suggest the need for alternative testing strategies for this at-risk group.5
Low rates of HIV testing over time may be a contributing cause to the alarming rise in HIV prevalence among MSM in Vietnam. While male-to-male sex is preferred by most of those surveyed in the studies identified above, significant numbers of MSM are also having female sexual partners due to continued family and societal pressure to conform to masculine norms. The low level of consistent condom use with these women, coupled with already relatively high rates of HIV prevalence among MSM and low rates of protective behaviour with other male sex partners reveals yet another contributing factor to elevated HIV prevalence among MSM in Vietnam.16
Nguyen et al14
found that unprotected sex among surveyed MSM correlated with low perception about risk of HIV transmission, HIV prevalence and the number of casual sex partners. The findings of this review identify a need for greater HIV awareness among this group, as well as programmes delivering consistent and segmented prevention messages. Coupled with HIV awareness raising and prevention messages, the data analysed in this review point to the need for greater access to MSM-friendly HIV services, such as HIV testing and counselling, condom/lubrication provision, HIV care and treatment, which would contribute to slowing the pace of HIV infections among this high risk group. For example, given that HIV diagnosis often leads to safer sexual practices, according to the findings of an original study by Nguyen and Kiethly19
among People Living with HIV (PHIV) in Vietnam, testing and counselling services need to be expanded and segmented based on the needs of each high-risk group in order to increase HIV testing uptake.
Findings from this review also suggest the need to identify and appropriately address the socio-cultural and economic aspects that influence HIV infection among MSM.20
Currently, MSM continue to report not being treated equally when they present themselves to public service providers, such as health clinics, schools or public administration offices. Stigma continues to be a significant barrier to accessing basic and necessary services.21
Awareness raising campaigns should also be segmented for greater effectiveness, with the delivery of directed information and messaging to families, government entities and the Vietnamese population.
A limitation of the study design includes the omission of literature published in languages other than English; however, efforts were made to contact MSM experts and practitioners in Vietnam to ensure review's inclusiveness and breadth. Another limitation of the study design is that it included abstraction of both behavioural and biological data sets, and therefore the application of PRISMA had to be combined with the ePPI Quality and Relevance appraisal framework in order to ensure appropriate scoring methodology for diverse studies. A key strength of this review is its inclusion of behavioural data sets, as these provide insight on the rapid rise of HIV prevalence among MSM in Vietnam.