Awareness campaign says safe sex possible with HIV persons

A gay couple, one with long hair, featured in one of the K=K's short films that target HIV stigma and misconceptions. Photo courtesy of Maika Elan.

In Vietnam, the common perception is that HIV positive people are dangerous because they can easily infect other people.

There are many number of stories of parents not allowing their children to be in classrooms with HIV positive children or even HIV negative children with HIV positive parent or parents.

In such a situation, safe sex with a HIV positive person would be unthinkable, even with condoms.

Well, the science is that safe sex with a HIV positive person is possible, even without condoms.

Since it is not common knowledge in Vietnam that people with HIV can enjoy a safe and fulfilling sex life without transmitting the disease to their partners, there are several campaigns attempting to remove stigmas and correct misconceptions.

One of them is the Undetectable = Untransmittable, or U=U (K=K in Vietnamese) campaign.

K=K, which targets the self-stigma people living with HIV in Vietnam have, is a brainchild of the U.S.’s Centers for Disease Control (CDC), the Partnership for Health Advancement in Vietnam (HAIVN) - a project of Harvard Medical School and Beth Israel Deaconess Medical Center, and the creative agency The Lab.

Their collaboration resulted in a toolkit with actionable messages, including two short films, each lasting one minute and showing two serodifferent couples making out.

At the end of the footage, one of them turns around to look at the camera and says: "I’m positive. He will never be."

Interestingly enough, the film with the gay couple got more than three times more views, likes and shares than the other, the creative agency said.

The campaign was first started in the U.S. by the people living with HIV community in 2016 to overcome the self-guilt and shame associated with HIV and trumpet their ability to have normal sex without being afraid of transmitting the disease.

A groundswell of research confirms that once the HIV viral load in the body reduces to an ‘undetectable’ level for at least six months through antiretroviral therapy (ART), a person will not pass on HIV even if they don't use condom, according to Dr John Blandford, country director of CDC Vietnam and Dr Todd Pollack, Assistant Professor of Medicine at Harvard Medical School and country director of HAIVN.

"A lot of stigma comes from fear; fear that somehow people will get HIV if they stay near or with people living HIV, but the science is very clear about how HIV can be transmitted," Pollack of HAIVN told VnExpress International.

A shift in message delivery

In the 1990s, Vietnam started to focus on raising awareness of the HIV/AIDS epidemic.

Most Vietnamese would remember how scary HIV imagery in the early 2000s was: there was a poster of a dying person with a needle sticking out of their arm, another with human figures with hands on their head and on all fours with a needle above them and the slogan ‘don’t let HIV ruin your life’.

"The most effective way at that time was to instill fear in people by saying that if you inject drugs or sleep around and get AIDS, that’ll be the end of your life and your family's," The Lab Saigon creative director Tuan Le and project managers Ly Tong and Phuong Anh said.

HAIVN provided the agency with the latest research data, and they did their own research on how HIV-related campaigns have evolved in Vietnam since the 90s. They also talked to community workers and people with HIV to get a sense of the struggles they still face today.

The Lab said: "'AIDS is the epitome of social evils’ campaigns worked well: the number of yearly new infections peaked in 2002 and has been steadily decreasing, falling to just 1/3 of that now. The side effect is that people with HIV are now seen by many as evil and dirty. That’s what we needed to change with this campaign."

Although ART is available and covered by health insurance and external donors at public hospitals, it does not mean people with HIV would instantly reach out for it, Blandford of the CDC Vietnam, said.

The Lab said when people discover they are positive, most enter a state of numbness and denial that lasts a few weeks, months or even years, preventing them from taking the first steps in treatment, and that is something health practitioners and community workers have to be sensitive about and patient with.

Dr Hoang Dinh Canh, deputy director of the Vietnam Administration of HIV/AIDS Control, said that an estimated 50,000 people with HIV have not been diagnosed or treated.

Ho Chi Minh City is home to the largest number of HIV patients in Vietnam: 48,000, accounting for nearly 25 percent of the country’s total number.

The good news, Pollack said, is that the HIV stigma in Vietnam has dwindled over the years. People are more educated about the issue and the image of someone living with HIV has changed.

"Now the imagery is a lot more about healthy looking people. But stigma and discrimination still exist, not just in Vietnam."

The issues are even more pronounced for men who have sex with men (MSM) since the number of people with HIV in this group is growing.

Gay men have it worse

Pollack said the groups at the highest risk of HIV in Vietnam include injection drug users, sex workers and MSM. "In Vietnam, in addition to stigma against HIV infection, stigma and discrimination also exists towards drug users and MSM. That can compound the problem."

The LGBTQ (lesbian, gay, bisexual and transgender) community is still not as widely accepted in Vietnam as in western countries. So LGBTQ individuals with HIV are burdened by an extra layer of stigma and discrimination, the Lab Saigon said.

Those doing sex work among MSM get a third layer of stigma.

Binh (name changed), 27, a gay Saigon man, said: "Back in university, I went to donate blood. However, a form I had to fill out stated that if I was gay/ had been sleeping with men, my blood would not be accepted. I assume this was due to the HIV stigma."

Considering the stigma the community faces, the films had to make do with actors and not actually people with HIV.

Everyone involved in the campaign reached out to people living with HIV and consulted them about the use of language in Vietnamese so that it does not come across as stigmatizing.

The Lab said: "They were honest and supportive, but it is a very different matter to reveal your status in a public campaign like this. Even people lucky enough to have loved ones who know and support them need to keep it from their extended family, friends and coworkers. It just shows the widespread stigma there is."

"We avoid saying ‘HIV-infected people’, we say ‘people living with HIV’," Blandford said, implying how a change in terminology could help reduce the stigma.

Nguyen Anh Ngoc, research and partnership manager at Glink Vietnam Social Enterprise, said: "HIV doesn't kill a person but stigma does."

As a gay person and someone who has worked in the field of HIV and sexual health counseling for those at risk for 14 years, Ngoc himself has faced stigma.

Once a boyfriend, after discovering he worked in the HIV field, sent him a copy of his HIV test result by email with a hint that he also wanted to know about Ngoc’s status.

Ngoc said: "When you are gay and positive, the stigma is double. Stigma and discrimination, including self-stigma are key barriers to the gay community's access to healthcare services."

Pollack said since a lot of stigma comes from a fear of transmission, the U=U message focuses on normalizing sexual relationships and reducing fear of transmission between partners when one partner is living with HIV and on successful treatment. The ultimate goal is encourage more at-risk people to get tested and, if positive, to get on treatment as soon as possible, he said, referring to UNAIDS’s 90-90-90 goal.

"Vietnam embraces the UNAIDS 90-90-90 goal. It means 90 percent of all people living with HIV will know their HIV status, 90 percent of all people diagnosed with HIV will get sustained antiretroviral therapy and 90 percent of all people receiving antiretroviral therapy will have viral suppression."

Achieving this would significantly reduce new HIV infections and eventually end the AIDS epidemic, he said.

There are 209,000 HIV patients in Vietnam. The government has only managed to keep track of 175,000 of them and provided ARV drugs to 130,000.

Dr Hoang Dinh Canh said only 80 percent of people with HIV in Vietnam know their status.

Every year there are around 10,000 new cases.