Methamphetamine-type stimulant use in Lao PDR: qualitative findings from users aged 15-25 years in Vientiane Capital and Vientiane Province.

BACKGROUND: Methamphetamine is one of the most widely used illicit drugs in several Southeast Asian countries, including the Lao People's Democratic Republic (PDR). The purpose of this study was to examine the socio-cultural context of its use in Lao PDR. METHODS: We conducted a cross-sectional qualitative survey among young people, aged 15-24 years, who use methamphetamine (or Yaba as it is commonly known in the region) in Vientiane Capital and Vientiane Province, Lao PDR. In total, we conducted 21 in-depth interviews (6 female, 13 males and 2 transgender) and 8 focus group discussions with 47 participants (10 female, 29 male and 8 transgender). The data analysis drew on the theory and insights of the social theorist Pierre Bourdieu (1990, 1997) to understand the Yaba consumption practices among young Laotians. RESULTS: Yaba consumption among young people in this study was used to enhance both productivity and pleasure. Its pleasure-producing affects were often linked to core Laotian notions of having fun, partying and being together. Its increased productivity effects on the other hand, were used to pursue goals related to self-betterment within an emerging market economy. CONCLUSIONS: This study highlights the complex interaction between agency and identity, structure, context and practices. In terms of public health policy and programme responses, developing proper interventions implies a good understanding of how young people interpret Yaba consumption, its dynamics and the relationships and resources that mediate the behaviours.

It goes both ways: a cross-sectional study of buying and selling sex among young behaviourally bisexual men in Vientiane, Laos.

UNLABELLED: Background Transactional sex may increase risk of HIV and sexually transmissible infections (STIs). In Laos, men who have sex with men are disproportionately affected by HIV, and bisexual behaviour among men is relatively common. The occurrence of transactional sex among behaviourally bisexual men in Vientiane, Laos was explored. METHODS: In 2010, behaviourally bisexual men were recruited through enhanced snowball sampling to complete a behavioural survey. Reports of transactional sex partners (anal/vaginal sex) in the previous year, by direction of payment and partner gender, is described. RESULTS: Of 88 participating behaviourally bisexual men (median age 22 years), 17 (19%) reported only selling sex, eight (9%) reported only paying for sex and nine (10%) reported both selling and paying for sex. Men reporting any transactional sex reported a median of four transactional sex partners and reported a higher number of total sex partners in the previous 12 months (median: 18.5 partners) than men reporting no transactional sex partners (median: 6 partners). Of 26 men who reported selling sex, 15 (58%) were paid by females, 15 (58%) were paid by males and 14 (55%) were paid by transgender sex partner(s); 11 (42%) reported consistent condom use (CCU) when selling sex. Of 17 men who reported paying for sex, 13 (76%) paid females, six (35%) paid males and two (12%) paid transgender partner(s); eight (47%) reported CCU when paying for sex. CONCLUSIONS: Young behaviourally bisexual men engaging in transactional sex may be at increased risk of HIV and STIs. Prevention interventions should consider the transient and informal nature of transactional sex in this population.

Setting the scene: locations for meeting sex partners among behaviorally bisexual men in Vientiane, Laos, and opportunities for health promotion.

Behaviorally bisexual men (BBM) in Vientiane, Laos report high-risk sexual behaviors. We explore settings for meeting sex partners and associated risk behaviors among BBM in Laos. BBM and their sexual partners were recruited in Vientiane Capital using modified snowball sampling (2010). Settings for usually meeting sex partners and associations with risk behaviors were assessed. Among 88 BBM, the most common settings for men meeting male, kathoey, and female sex partners were private residences (48%, 37%, 51%, respectively) and hospitality settings (39%, 31%, 40%, respectively). Hospitality settings were more commonly reported by heterosexual-identifying BBM, and private residences more commonly reported by bisexual/homosexual-identifying BBM. Inconsistent condom use was high across partners and settings. Meeting partners in hospitality settings was associated with reporting a high number of female sex partners and frequently drinking alcohol before sex. Our results suggest that targeted health promotion initiatives in bars, clubs, and beer-shops could reach a high proportion of high-risk bisexual men, particularly heterosexual-identifying BBM.

The impact on child wasting of a capacity building project implemented by community and district health staff in rural Lao PDR.

Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland areas. We implemented a 3-year health/nutrition project in 12 villages in the highlands of Savannakhet province to reduce acute malnutrition in children. Volunteer nutrition teams in each village monitored child growth and promoted healthy feeding practices; a multisectoral district committee conducted monthly outreach to assess child growth, manage acute malnutrition and deliver primary health care services. We conducted a cross-sectional assessment before project activities began and at the end of the project. The baseline survey randomly sampled 60% of all households; the endline assessment aimed to survey all eligible registered participants. Anthropometric measures were taken from children aged 6-59 months; mothers with children aged <12 months were asked about infant feeding practices, antenatal and post-partum care; and child immunizations were recorded for children aged between 0-23 months. At baseline, 721 households were sampled, while the endline assessment surveyed between 82% and 100% of eligible participants in each age group. Acute malnutrition reduced from 12.4% (95% CI: 10.4- 14.3) to 6.1% (4.9-7.3). Unhealthy feeding practices declined: in 2008, 40.0% (34.7-45.3) of mothers breastfed their newborn within 2 hours of birth and 30.8% (25.7-35.8) threw the colostrum away; in 2011, these figures were 72% and 8% respectively. Maternal care and child immunisation coverage also improved. Improving the health environment and child feeding practices appears to have markedly reduced the level of wasting. Unsafe feeding practices were common but readily changed by the community-based nutrition teams.

Characteristics of a sexual network of behaviorally bisexual men in Vientiane, Lao PDR, 2010.

Men who have sex with both men and women (behaviorally bisexual men) may be at increased risk of HIV acquisition and transmission due to risky sexual behaviors. We recruited a sexual network comprised of behaviorally bisexual men and their sexual partners in Vientiane, Lao PDR in 2010 to inform our understanding of the potential for HIV transmission among heterosexual, homosexual, and bisexual networks. Participants completed a sexual behavior questionnaire and referred < 5 sexual partners. A total of 298 people were recruited, including 63 behaviorally bisexual men. Behaviorally bisexual men reported riskier sexual behaviors (number of sexual partners in the previous 12 months and consistent condom use) than behaviorally homosexual and heterosexual men. Using social network diagrammatic representation, heterosexual, homosexual, and bisexual networks are shown to be interlinked. This study demonstrates that behaviorally bisexual men are potential key drivers of HIV epidemics and require a targeted approach to sexual health promotion.

Promoting safer sexual practices among expectant fathers in the Lao People's Democratic Republic.

Men's decisions and behaviours influence the sexual, reproductive and maternal health of women and the health of their families, but men are rarely included in reproductive and maternal health care services. Men's attendance at antenatal care has the potential to prevent women from becoming infected with HIV during pregnancy and post-partum, when they are more vulnerable to infection and have a high risk of transmission to the infant. Greater involvement of men requires an understanding of social, cultural and organisational barriers in different contexts. In 2006, the Burnet Institute undertook fieldwork to inform a pilot project to encourage expectant fathers to attend antenatal care. A local Lao team conducted focus group discussions and interviews in Vientiane with expectant fathers, pregnant women, older women and health care providers. It was found that myths about the dangers of sex during pregnancy and women's decreased desire resulted in periods of sexual abstinence. Participants reported that unprotected extramarital sex was common but difficult for couples to discuss. Men lacked knowledge about sexually transmitted infections, including HIV. Men wanted information so they could better protect the health of their partners and babies during and after pregnancy, and reported being willing to attend antenatal care when invited. Our findings have useful implications for policy and implementation.

HIV prevalence and risk behaviour among men who have sex with men in Vientiane Capital, Lao People's Democratic Republic, 2007.

BACKGROUND: Men who have sex with men are at high risk for HIV infection. Here we report the results of the first assessment of HIV prevalence and risk behaviour in this group in Vientiane, Lao People's Democratic Republic. METHODS: Between August and September 2007, 540 men were enrolled from venues around Vientiane, using venue-day-time sampling. Men of Lao nationality, 15 years and over, reporting oral or anal sex with a man in the previous 6 months were eligible for participation. Demographic and socio-behavioural information was self-collected using hand-held computers. Oral fluid was tested for HIV infection. Logistic regression was used to evaluate risk factors for prevalent HIV infection. RESULTS: The median age of participants was 21 years; the HIV prevalence was 5.6%. Of participants, 39.6% reported exclusive attraction to men and 57.6% reported sex with women. Of those who reported having regular and nonregular sexual partner(s) in the past 3 months, consistent condom use with these partners was 14.4 and 24.2%, respectively. A total of 42.2% self-reported any sexually transmitted infection symptoms and 6.3% had previously been tested for HIV. Suicidal ideation was reported by 17.0%, which was the only variable significantly and independently associated with HIV infection in multivariate analysis. CONCLUSION: Although the HIV prevalence is low compared with neighbouring countries in the region, men who have sex with men in Lao People's Democratic Republic are at high behavioural risk for HIV infection. To prevent a larger HIV epidemic occurrence and transmission into the broader community, higher coverage of HIV prevention interventions is required.