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 
 

Phong (not his real name) moved from Tien Giang province to Long An province for pursuing his own life. Being uninterested in studying, he dropped out of junior high school and started working at street-side food stalls at the age of 14. Gradually, he realized himself sexually attracted to males. Since the outbreak of COVID-19 in 2020, he started selling sex and using social media to accept clients’ appointments days and nights.   Once, he got a one-on-one sex service appointment and went to the venue suggested by the client. Unexpectedly, four other friends of this young client showed up in the room. In the first place, he tried to leave but they pulled his collar fiercely and threatened to beat him. The group used stimulant drugs to reduce inhibitions and intensify pleasure. Having zero prior knowledge of substance use for sex, Phong was forced to take the drugs by smoking under their coercion.  Chemsex (commonly known as high-fun) is intentional sex under the influence of various psychoactive drugs. It is on the rise among gay men and other men who have sex with men, which may involve unprotected sexual activity with multiple partners. For these reasons, it is associated with increased rates of sexually transmitted infections (STIs), including HIV and hepatitis.  Sex workers, whether male, female or transgender, may be coerced into consuming stimulant drugs with their clients, increasing the risk of unprotected sex and sexual violence.  Under the effect of the stimulant drugs, Phong could barely know whether they wore condoms properly or not before sex. Phong took the receptive position (“bottom”) during the unprotected anal sex. Stimulant drug use facilitated longer penetration and more intense acts. The prolonged and intense sexual session time causes him tremendous pain and bleeding.  “Having fun is not problematic but having fun regardless of the harm and risk is something I want to avoid. People who want to have sex with the use of stimulant drugs should have information about its risks.” said Phong, “Honestly, I was so scared, I did not know how to protect myself under such circumstances.” Entangled by the confusion and worries about the side effect of stimulant drugs, Phong mustered courage and sought help from the local sex worker self-help group for advice. His anus tore and bled. He felt dizzy, headache, and exhausted after smoking methamphetamine (also known as “crystal meth”). After a 10-day medical treatment and rest, he finally recovers and returns to normal life.  Since then, the trauma kept him away from alcohol and drug use when having sex. Phong has taken measures to protect himself, such as selecting the venue for having sex, instead of going to the place suggested by clients. He also took PrEP (pre-exposure prophylaxis) regularly to protect himself from HIV infection, even when his clients reject to use condoms in the future.  Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, mainly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. In addition, sharing of substance-using equipment such as needles and syringes, pipes, straws can elevate risks of transmitting HIV, Hepatitis A, and C, COVID-19, and tuberculosis. The safety awareness of chemsex among men who have sex with men who engage in chemsex remains low. People who use stimulant drugs for sex need access to health protection commodities as well as sexual and reproductive health information and services, including STI screening, diagnosis and treatment, family planning, and screening and treatment for the cervix and/ or rectum. The notions of self-care and care for others are important in avoiding unprotected sex and violence during chemsex.  “Shame, stigma, and punitive attitude towards drug use hinder people from seeking harm reduction information and professional help. Health care services and information with non-judgemental attitude before and after a chemsex event are key to reducing the risk of health-related implications of chemsex,” said Dr. Maria Elena Filio Borromeo, UNAIDS Country Director, UNAIDS in Viet Nam Country Director.  If you would like to know HIV harm reduction checklists for people who use stimulant drugs, please refer to the Technical Guide by UNODC (P.55-58).  If you would like to know more about HIV harm reduction checklists for people who use stimulant drugs, you may visit the “HighFun Safe” Facebook page for more information in Vietnamese.  Reference:  European Chemsex Forum (2018). A call to action for effective responses to problematic chemsex. Position paper from organizers and participants of the 2nd European Chemsex Forum, Berlin, 22–24 March 2018. Access from https://www.ilga-europe.org/sites/default/files/Final%20position%20paper.pdf UNAIDS (2019). Health, rights, and drugs harm reduction, decriminalization and zero Discrimination for people who use drugs. Accessed from https://www.unaids.org/sites/default/files/media_asset/JC2954_UNAIDS_drugs_report_2019_en.pdf  UNAIDS, UNODC & WHO (2019). HIV Prevention, Treatment, Care and Support for People Who Use Stimulant Drugs - TECHNICAL GUIDE. Access from ​​
https://www.unodc.org/documents/hiv-aids/publications/People_who_use_drugs/19-04568_HIV_Prevention_Guide_ebook.pdf