AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #122 - Effects of modernisation programmes on HIV vulnerability of Black Thai communities in Vietnam
Authors: Presenting Author: Ms Pauline Oosterhoff - Royal Tropical Institute
Additional Authors: Ms. Joanna White, Ms. Huong Thi Nguyen,
Aim: Dien Bien, a mountainous rural province in the Vietnamese Northwest, is experiencing the fastest growing HIV problem in Vietnam due to injecting drug use. The aim of the study is to enhance understanding of the distinct and changing cultural contexts of the Black Thai in Vietnam that affect HIV vulnerability. Little is known about the Black Thai who constitute the largest minority ethnic group in this area. The Black Thai traditionally practiced Zu kuay, a form of temporary matrilocality which enabled couples to avoid risks associated with hasty marriages. The study examined the effects of the decline of Zu kuay as a response to policies adopted under the government programme of Doi Moi (‘modernisation’) and its effect on women’s vulnerability to HIV.
Method / Issue: Qualitative and quantitative data were collected in October 2009 in three villages in the same commune of a district in Dien Bien which has a known HIV problem related to injecting drug use. The three village study sites have different ethnic compositions: Villages Ban Lau and Mau Lau are Black Thai communities; Hoa Dan is a Kinh community. The locations were strategically chosen so that geographical access was unlikely to be the principal issue influencing utilisation of ANC and other RH services. A village-based study was conducted over two weeks by a team of five Vietnamese researchers and one international specialist. Focus group discussions (FGDs) were held separately with men and women of mixed ages at all locations. One-to-one interviews were held with a total of 84 women across the three villages. To select respondents for interview we used a purposive, stratified sample of women of reproductive age (15-49 years) who had already delivered at least one child. The sample was generated across four age ranges to provide historical perspective on certain cultural changes and maternal health-seeking behaviour.
Results / Comments: As part of its modernisation drive, the Vietnamese government, like other governments in the region, undertook considerable efforts to improve health services and the utilisation of available services, including initiatives to modernise the family, motherhood and childbirth. Ambitious family planning, health and poverty eradication programmes were implemented in areas populated by minority ethnic people, but there are significant differences among ethnic groups. The patrilocal, patrilinear cultural norms of the majority ethnic Kinh people were promoted. Traditional local practices such as zu kuay were discouraged at a time when heroin availability increased dramatically. A third of the households reported to have a male drug user and harm reduction programmes are small or not yet in place. This historical coincidence appears to have heightened certain Thai women’s vulnerability to marriages with HIV positive injecting drug users. Traditional birthing practices that may have modern elements such as the use of gravity and allowing husbands to attend are discouraged, while medicalized deliveries in formal health settings are promoted. This contributes to the avoidance of reproductive services, including HIV testing by black Thai women.
Discussion: Southeast Asian governments implement ambitious programmes to reduce population growth and maternal mortality in areas with large minority ethnic populations. Although some of these programmes introduce new social and health practices that meet their broader aims, they may pay inadequate attention to the protective and medically beneficial aspects of traditional practices. Policies and guidelines on marriage and reproductive health should take into account the role of minority ethnic traditions, as well as local health-seeking practices, in order not only to improve reproductive programmes but also to reduce HIV vulnerability.
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