Stigma, depression, and sexual risk for HIV infection among men who engage in transactional sex in ho chi minh city, Vietnam

Background: Commercial sex workers experience high levels of stigma in the context of sex work in Vietnam, and are at high risk for HIV transmission/acquisition. Little research has explored sexual risk, sex work-related stigma and other factors among this group. Methods: In 2010, 300 male sex workers (MSWs) completed a behavioral and psychosocial survey. Stigma was assessed by 6 questions on a 4-point Likert scale, with a composite stigma score on a scale of 0 to 18. Associations between demographic and psychosocial factors and stigma were assessed using regression models. Results: Mean age was 22.3 years (SD=5.0); 50.3% identified as homosexual, 31.5% bisexual, and 16.1% heterosexual. In one month, mean number of clients was 11.7 (SD=12.9) and non-commercial male partners 9.0 (SD=10.9). Participants' mean stigma score was 7.1 (SD=4.4; median=7.0; interquartile range=4-10) and 47.3% were depressed. Factors associated with increased stigma included disclosure of sexual orientation to healthcare workers (b=1.83, 95%CI=0.77, 2.88), meeting clients in the street/park (b=1.36, 95%CI=0.26, 2.46), being forced to have unprotected sex (b=2.39, 95%CI=1.30, 3.47), and higher education (b=1.16, 95%CI=0.05, 2.26). Factors associated with decreased stigma included meeting clients on the telephone/internet (b=-1.16, 95%CI=-2.30, -0.023) and financial support from family/friends (b=-1.19, 95%CI=-2.34, -0.043). In an adjusted model, stigma was associated with higher odds of depression (AOR=1.07, 95%CI=1.00, 1.14). Conclusions: Stigma in the context of sex work and depression are relevant among MSWs. Addressing stigma and depression in HIV prevention interventions is crucial for tailoring these programs to MSWs' needs, and may result in decreased HIV spread.