Within the framework of the 2021 UN Free & Equal campaign, the Viet Nam Network of Young Key Populations (VYKAP) organized outreach, information sharing, and counseling on HIV and safe sex on 6 November 2021.  This community-led activity provided a reliable and reassuring environment for the youngsters to have HIV screening, with pre-test counseling and guaranteed confidentiality of the information. Two university students among those who volunteered for HIV screening tests turned out reactive. Confirmatory tests were done and results were positive.  Mai (not her real name) is a transgender woman who was assigned male at birth in 2003 and she was raised as a boy in a suburban district of Hanoi. She started being sexually active at the age of 15 with a male sexual partner. After moving away from family to study college in Hanoi downtown, she connected with multiple sex partners through social media platforms.  Mai “filtered” her sex partners simply by observing if there are any antiretroviral drugs at the persons’ place, without explicitly checking their HIV status or viral load. Tested as HIV-negative in her first self-screening test in May this year, she did not use condoms consistently with her sex partners from that time to October, which was the period of the fourth wave of COVID19 in Viet Nam.  “Is HIV infection caused by the scratches when I fell down on the street near the trash collection area, or the bruises I got in the cafeteria?” Instead of attributing to her unprotected sexual behaviors, she falsely suspected that her HIV infection was caused by her minor abrasions in the first place. The fragmented or lack of comprehensive sexual health
education knowledge hampered the ability of the youngster to take effective HIV harm
reduction and health care measures. Although she has come actress various sexual and reproductive health information through the MSM community’s social media platforms at a very young age, her knowledge of HIV is still inadequate and shallow. There is also a gap between her HIV knowledge, her mindset, and skills in practicing safe sex measures consistently.  Another HIV-positive case is Duc (not his real name), who was born and grew up in a northern mountainous province in Viet Nam. The 21-year-old man nearly fled from the testing booth out of shock when he received his HIV-reactive result.  Realizing his attraction to men at the age of 18, Duc started to be sexually active. Mistaking that homosexual behavior is less risky than heterosexual behavior, he did not use condoms and other protective measures regularly.  It was his very first time to receive HIV information, counseling, and screening test. “HIV is always associated with sex work and drug use. To avert peer discrimination, I tried all means to hide the fact that I am taking ARV drugs.” Duc shares, “I feel like I can never love again.”  Young men who have sex with men (MSM) are especially at high risk of HIV transmission. According to the Viet Nam Administration for HIV/AIDS Control (VAAC), more than 79% of
newly diagnosed HIV-infected cases in the first nine months of 2019 were through sexual
contacts, while transmission through drug injection accounted for only 9.9%. HIV prevalence among the MSM group rose from 5.7% in 2015 to 13.3% in 2020. Some limited available data in Ho Chi Minh City suggested that HIV prevalence among surveyed transgender women can be as high as 16% -18%. “Comprehensive sexuality education in particular knowledge and skills for practicing safer sex is essential to equip the young key populations properly for safer sex behaviors and HIV prevention.”, said Mr. Vu Tran Dzung, Viet Nam Network of Young Key Affected Population (VYKAP).  UN in Viet Nam is calling for greater efforts in filling the gap of knowledge on sexuality, sexual and reproductive health both in school and outside of school. Comprehensive sexuality education is a vital intervention—to prevent HIV among young people and also to empower young people to recognize and protect their overall sexual health and well-being. With comprehensive and accurate knowledge, young people can make responsible and safer decisions about sex and their sexuality. 
  Reference UNFE (2021). 2021 UN FREE & EQUAL CAMPAIGN LAUNCH: FOR SAFER SCHOOLS FOR LGBTIQ+ PEOPLE. Access from: https://vietnam.un.org/en/156414-2021-un-free-equal-campaign-launch-safer-schools-lgbtiq-people?fbclid=IwAR2SpQBNm999FKGt8TSEOEUyembGTsOc-RnzTNjMllfVXd1qtNnDr7SrHkM

Minh (not his real name) grew up in Ho Chi Minh City as the only son in his family, being indulged. The beginning of his addiction went back to his teenage years. Under his peers’ influence, he started smoking heroin. As time went on, his obsession intensified, and the time of sobriety shortened. He spent his days deluging with the rush of euphoria by injecting heroin.  Minh’s battle with addiction was a struggle for his family as well. Relying on his father’s earnings, his family maintained a rather good financial status. He kept turning to his family for money to meet his mounting demands for heroin doses. Finally, after all the futile attempts to help Minh out of the addiction, his parents gave up on him. COVID19 raged across Viet Nam and deprived his father’s life in April 2021. Everything he had taken for granted collapsed. Not until that moment did he realize the responsibility of taking care of the family weighed on him. He voluntarily participated in the methadone maintenance therapy in a nearby clinic. By June 2021, he regularly took a dose of methadone every day. He worked as a motorbike driver for Grab company, which provides ride-hailing and delivery services. The average income was around 200,000 VND- 300,000 VND per day. He earned 7million Vietnamese Dong for a month, which is quite a significant amount for him as a person who used drugs and relied on family for a living. Soon, as the lockdown rule tightened in July, transportation was dispensed, activities on the street were banned and Minh lost his job. He could barely go to the out-patient clinic to take the daily methadone doses, and not to mention to make a living.  The strict social distancing rules enforcement created barriers to the patients to get their daily medication. The Ministry of Health quickly issued a letter to all provinces allowing for the implementation of multi-day take-home methadone doses as an emergency response to ensure continuity of access to HIV harm reduction in the context of COVID19 control measures. The initiative was immediately embraced by Ho Chi Minh City, the most severely impacted by the pandemic, with specific technical guidance from the Viet Nam Administration for HIV/AIDS Control (VAAC) under the Ministry of Health.  As part of UN support for this initiative in Ho Chi Minh City, WHO and UNAIDS mobilized bottles of methadone for take-home doses until the end of October 2021. In cooperation with VNP+, UNAIDS also provided subsidies for the monthly fee (330,000 VND to 350,000 VND) to methadone patients most in need. The funding helped fill in the gaps of MMT commodity and lessen the financial barrier that may jeopardize people who use drugs adherence to methadone treatment.  Through the multi-day take-home methadone doses program, many patients like Minh, who were on the pathway to recovery, could maintain access to the health services essential for their well-being. Methadone maintenance therapy (MMT) could decrease the injection of drugs and there to moderate HIV risk behaviors and increase access to HIV-related health services among people who use drugs.  “Multi-day take-home methadone doses program and the subsidy of monthly methadone fee for clients most in need are timely compatible measure in response to COVID19 lockdowns.” Said Nguyen Anh Phong, representative of VNP+ in Ho Chi Minh City, “We as community workers have witnessed so many challenges faced by people living with HIV and key populations and their despair in the raging of COVID-19. We are thankful for agile HIV policy response and all the emergency support including from UNAIDS in the context of COVID-19**. We welcome to see differentiated HIV service delivery such as take-home methadone doses becoming a regular option.” UNAIDS also joins efforts with UNODC and WHO to advocate for the institutionalization of a multi-day take-home methadone program in Viet Nam for people who use/inject drugs to receive their essential medication with minimized time cost, better medication adherence, and greater integration in social life. 
*VNP+: Vietnam Network of People living with HIV 
** UNAIDS has been providing emergency health/HIV/STIs and daily necessities support packages for people living with HIV and most affected by HIV in the context of COVID-19 Reference:  UNAIDS (2017). Methadone. Access from: https://www.unaids.org/en/file/111118  UNODC (2021). UNODC Supports Harm Reduction in Viet Nam Through Take-Home Methadone Doses. Access from https://www.unodc.org/unodc/en/frontpage/2021/February/unodc-supports-harm-reduction-in-viet-nam-through-take-home-methadone-doses.html 

This pair of eyes belongs to Hien (not her real name), a 30-something-year-old female sex worker living with her husband and two small children.  The family moved from Kien Giang province to Ho Chi Minh City 8 years ago. Working in a karaoke bar and selling sex, Hien’s income was much higher than her husband who occasionally took some seasonal jobs before the COVID19 pandemic. In order to get more clients, she arrived at the bar in the early morning and worked till late evening every day. So her husband bore the responsibility of taking care of the children at home. In the afternoon, he often drank and hung out with friends at the street sidebars.  As a COVID-19 recurring wave hit Viet Nam in 2021, all the entertainment establishments closed. Hien lost her source of income. Their meager saving was used up. Her husband’s alcoholism got severe. Compounding stress caused by income loss, her husband struck her and her children just as the lockdown started.  “As I did not have money for him to buy alcohol, he shoved, punched, and slapped me.”, Hien shared, “He scolded me and insulted me as a sex worker. I kept silent, as I didn’t want my little kids to know my job.”  Violence escalated as her husband managed to get alcohol to drink, usually in the afternoons. Hien was intimidated and lingered in the lane where her house is located and with neighbors in order to avoid him. However, at night, violent acts continued behind the door.  Domestic abuse spiked during COVID-19. Gender-based and sexual violence most often is perpetrated by someone a survivor knows, and this includes intimate partners. Hien’s story was unveiled by a member of the Viet Nam Network of Self-help Groups Supporting Sex Workers (VNSW) who spotted her black eyes when disseminating the UNAIDS-funded COVID-19 daily necessities emergency package. Worrying that no one would take care of two small children if she goes back to full-time work later, Hien endured the domestic violence in silence throughout the 4-month lockdown. More importantly, she is not aware of where and how to get help.  “In the pandemic, female sex workers become an easy target during the prolonged stay-at-home time with compound stress from loss of livelihoods. User-friendly and trustworthy services for domestic violence victims should be incorporated in the emergency COVID-19 response and become more easily accessible. The health and social services should be inclusive, remain open and accessible without stigma and judgment.”, said Ms. Do Thuy An My, chairwoman of VNSW.  Many sex workers like Hien are living under the shadow of violence in silence. Self-stigmatization of sex workers impacts their ability to seek help.  Collaborative efforts must develop the safety net for all women and girls. Government plays a pivotal role in guaranteeing all women and girls can access health and social services, accommodation, legal services, and protection from violence. Communities should be fueled with resources to provide timely and user-friendly support services to respond to different forms of gender-based violence. Every effort matters to put an end to gender-based violence.  If you or someone you know needs help, you can call <094 140 9119> to report any cases of gender-based violence. All information will be confidential.  Reference UNAIDS (2020). Six concrete measures to support women and girls in all their diversity in the context of the covid-19 pandemic. Accessed from https://www.unaids.org/sites/default/files/media_asset/women-girls-covid19_en.pdf WHO (2002). World report on violence and health
http://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf;jsessionid=53B91BBF0185D8675E49A057DC5C45FC?sequence=1 
 

Hanh (not her real name), a 50-ish female sex worker in Long An province, shares her feeling of facing sexual violence.  A raft of strict lockdowns took place in response to the fourth wave of COVID-19 infections since April 27, 2021, which was considered Viet Nam’s most severe outbreak since the pandemic began. The tightened social distancing rules have profoundly upended the livelihood of street-based sex workers, like Hanh. Cutting all ties with her family, Hanh inhabits a small 2-room house with three other street-based female sex workers in a suburban area of Tan An city. The monthly rent is 600,000 Vietnamese Dong (VND) per person in the shared room. As an older street-based sex work, she only has 1 to 2 clients per day now and the charge is low, ranging from 120,000 - 200,000VND per client. To make ends meet, every night she also collects scrap items from door to door and sells them to recyclers as individuals or small shops. As COVID-19 raged and mobility on the street was restricted, all her sources of income halted. Her income dropped to zero.  Between July and October in 2021, the Government had provided cash support, trice already, to unemployed people or those who have lost jobs because of COVID-19. However, Hanh and many other sex workers were not able to receive any cash or social support.  COVID-19 outbreaks have exacerbated the hardships, inequalities, and violence faced by sex workers. Many are either not eligible or excluded from social protection services. According to a quick survey conducted by VNSW* in the 15 most heavily impacted Southern Provinces in late October 2021, more than 50% of interviewed sex workers could not access any or all the three social protection packages provided by the government in 2021. “Some of us do not dare to apply for the government relief, as sex work is illegal and not like other informal work such as lottery selling. We do not want to expose to stigma and discrimination”, Hanh said. The ravages of poverty left the sex workers no choice but to tread a tightrope. They contacted their clients by mobile, took turns to sneak out and sell sex at clients’ places at night, and even bore the risk of being caught by local security forces for violating lockdown rules.  Once, a male client initially invited Hanh secretly to his place to provide one-on-one sex service. She was fetched by his motorcycle from her house. Upon her arrival, she found that there were two other men in the room. Considering the potential increase in earnings, reluctantly, Hanh agreed to have sex with three of them one by one even though she only got one condom and lubricant with her. Only one of the clients used the condom, the other two did not use any protective measures.  Yet, regardless of Hanh’s willingness, three of them surged up like ravenous wolves. Suffering from their brutal and violent act, Hanh was hurt in severe pain and extremely traumatized.  Afterward, those men backed out from the initial agreement and pressed her to charge 200,000 VND for the three of them, which is barely equal to her standard service charge for one client. Her simmering anger boiled over and she argued with them.  “Slap!” One of them slapped her in the face and threatened her to cut down the fee or they would not drive her home implying – she needed to bear the risk of being caught by local forces for violating lockdown restrictions. Considering all the risks, she aggrievedly compromised. Hanh returned home with pain, anger, and trauma. Due to the illegal nature of sex work in Viet Nam, she did not dare to report the case to the authorities. The only support she managed to get was empathy and counseling from her peers in the sex workers self-help group.  “Social protection is there, and it’s just-out-of-reach for somebody like me. Living on the fringe of the society, I and other sex workers do not have any protection.”, shared by Hanh in despair, “I had no choice but was forced to put my health, safety, and security at increased risk to make a living, to survive.” Sex workers are entitled to safe working conditions, access to social protection, and autonomy over one’s own body and sexuality, without discrimination (UNAIDS, 2021). Exclusion from financial support measures denies sex workers the essential health and social safety nets being put in place for other workers. In addition, the lack of access to emergency social protection measures diminished their ability to leave or influence the abusive workplace.  UNAIDS calls on multisectoral stakeholders to take immediate, critical action, grounded in human rights principles, to protect the health and rights of sex workers. Measures should
include, among others, access to national social protection schemes for sex workers,
including income support schemes. If you or someone you know needs help, you can call <094 140 9119> to report any cases of gender-based violence. All information will be confidential.  *The Viet Nam Network of Self-Help Groups Supporting Sex Workers (VNSW): Viet Nam Network of Self-Help Groups Supporting Sex Workers Reference: UNAIDS (2020). Press Statement - Sex workers must not be left behind in the response to COVID-19. Access from https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/april/20200408_sex-workers-covid-19  UNAIDS (2021). HIV and Sex Work - Human Rights Factsheet series. Access from https://www.unaids.org/sites/default/files/media_asset/05-hiv-human-rights-factsheet-sex-work_en.pdf WHO (2004). Violence Against Women and HIV/AIDS: Critical Intersections. Access from https://www.who.int/reproductivehealth/topics/violence/hiv/en/