Smoking behaviour, tobacco sales and tobacco advertising at 40 'Smoke Free Hospitals' in Vietnam.

BACKGROUND: Tobacco remains the leading cause of preventable death globally. Vietnam's 2012 Law on Prevention and Control of Tobacco Harms establishes all healthcare facilities as smoke-free environments. We aimed to evaluate the implementation of these policies within health facilities across Vietnam. METHODS: A cross-sectional study was undertaken at 40 central, provincial, district and commune healthcare facilities in four provinces of Vietnam. The presence of tobacco sales, smoke-free signage, evidence of recent tobacco use and smoking behaviours by patients and staff were observed over a 1-week period at multiple locations within each facility. Adherence with national regulations was reported using descriptive statistics. RESULTS: 23 out of 40 facilities (57.5%) followed the requirements of the national smoke-free policy regarding tobacco sales, advertising and signage. Smoking was observed within health facility grounds at 26 (65%) facilities during the observation period. Indirect evidence of smoking was observed at 35 (88%) facilities. Sites where smoking was permitted (n=2) were more likely to have observed smoking behaviour (relative risk (RR) 2.16, 95% CI 1.83 to 2.56). Facilities where tobacco was sold (n=7) were more likely to have smoking behaviour observed at any of their sites (RR 1.53, 95% CI 0.93 to 2.51). CONCLUSIONS: Implementation of current smoke-free hospital regulations remains incomplete, with widespread evidence of smoking observed at three levels of the Vietnamese healthcare facilities. Further interventions are required to establish the reputation of Vietnamese healthcare facilities as smoke-free environments.

Recreating kinship: Coping options of HIV+ AIDS widows in Vietnam.

In this retrospective study we explore the life trajectory of Vietnamese HIV-positive AIDS widows over a period 2 years after their husbands' deaths in a patrilinear and patrilocal setting where HIV is stigmatized. Some options, such as widows living with their eldest son, are not available to young HIV-positive widows, but the women in our study furthered their own interest by joining support groups, looking for new partners, and strengthening relations with their own family. Most women who returned to live with their family found a new intimate relationship through support groups for HIV-positive persons.

HIV-positive mothers in Viet Nam: using their status to build support groups and access essential services.

Various support and self-help groups for people living with HIV and their families have developed in Viet Nam in recent years. This paper reports on a case study of Sunflowers, the first support group for HIV positive mothers in Hanoi, begun in 2004, and a sister group begun in 2005 in Thai Nguyen province. From April 2004 to early 2007, we carried out semi-structured interviews with 275 health care workers and 153 HIV-positive women and members of their families, as well as participant observation of group meetings and activities. Sunflowers have successfully organised themselves to access vital social, medical and economic support and services for themselves, their children and partners. They gained self-confidence, and learned to communicate with their peers and voice their needs to service providers. Based on personal development plans, they have accessed other state services, such as loans, job counselling and legal advice. They have also gained access to school and treatment for their children, who had previously been excluded. Although the women were vulnerable to HIV as wives and mothers, motherhood also provided them with social status and an identity they used to help build organisations and develop strategies to access the essential services that they and their families need.

Holding the line: family responses to pregnancy and the desire for a child in the context of HIV in Vietnam.

Health services around the world offer many guidelines for HIV-positive women who are pregnant or who want to become pregnant, and for women with HIV infected partners. These guidelines are addressed to women and, increasingly, also to men, but pay little or no attention to the role of other members of the family in fertility decisions. This study looked at factors influencing decisions about fertility in families with an HIV-positive member. In Vietnam, the whole family takes a crucial role in deciding whether a woman should become pregnant and whether she will keep her child. This decision is taken in the context not only of the close family but also under the influence of ancestors and the weight given to them within the culture. Key in this regard is the need for parents and grandparents to have male offspring. Health workers share these ideas about preferred family composition and support men and women in the quest for male offspring. Policies and guidelines should take into account these additional family factors and goals as a basis for the design of appropriate programmes to reduce HIV transmission.