Gay Vietnamese men often fear that disclosing their sexual orientation could be damaging to themselves and to their families, and so they are less likely to consult a doctor about their HIV status or about other STIs — being more worried about the impact of the diagnosis than they are about carrying any particular disease itself. It’s in part this reluctance to take the first step in getting a check-up or seeking medical advice that increases the risk of transmission.
There is also a statistically higher tendency among gay males to engage in sex and drug combinations. This dramatically increases the risk of contracting infection, because the drugs can mask the inhibitions that restrain people from risky behaviour, including sexual contact without protection. Many recreational drugs bring on a sense of invulnerability, distorting the way a user appreciates risks in general.
Because of this lack of screening and protection, the prevalence of HIV is very high in the gay population in this country, leaving homosexual men with a higher risk of being infected by HIV and other STIs than any other group in Vietnam.
A good example of this problem is syphilis. Medical professionals generally regard this as a historical disease, but syphilis is now making a big comeback, especially among the gay community. I’ve treated many gay patients with primary or secondary syphilis, and I believe many more cases are never diagnosed — especially as the symptoms are easy to miss. Unfortunately, tertiary syphilis is quite an insidious disease that can disfigure an infected patient. My impression is that the prevalence of syphilis in Saigon, and maybe more so in other cities such as Haiphong, is very high.
For anatomical reasons, anal sex puts people at a higher risk of contracting HIV, largely because of the breakage of small blood vessels in anal sex compared to vaginal sex.
The risk of contracting HIV comes from the quantity of the virus coming in from the infecting side. It depends on the surface exposed and the length of time these surfaces are exposed to the infecting fluid. With anal sex, the receptive side is exposed to infectious body fluid over a longer period of time, which makes the risk of contracting the disease higher. Being a larger mucosal surface, there are more exposed cells that are apt to receive the virus.
Anal sex can be practiced safely with the use of a condom. However, whenever there is an accident such as breakage (or if one is not used) then there is still the possibility to abort an infection by seeking a kind of treatment called post-exposure prophylaxis, or PEP. In addition, people who are aware of their potential for risk in advance may ask for PrEP — pre-exposure prophylaxis, which is a combination of two antiretroviral drugs (typically tenofovir and lamivudine under the brand name “Truvada”), taken before there is any contact. Although this is not yet recognized as a treatment in Vietnam, in other countries it is considered to have the potential to end the HIV epidemic.
It’s a sad fact that despite good logic and proper education, people still engage in risky sexual behaviour, whether for psychological reasons or because they are under the influence of drugs. Medical opinion abroad holds that with people who do engage in high-risk sexual behaviour, preventive treatment is a worthwhile consideration. In Western countries it is now common practice for doctors to give Truvada to their gay patients, at least those who are obviously at risk.
However, the PEP treatment is currently available in Vietnam and is highly effective. It must be taken for 28 days and started as soon as possible after possible exposure — at least within 72 hours, and the sooner the better in terms of efficiency. While this is an effective treatment, correct condom use remains the best defence against the transmission of HIV in both homosexual and heterosexual couples. As is often the case in medicine, prevention is much better than cure.
Dr. Serge Gradstein specialises in sexually transmitted infectious diseases following his work at Kaplan Hospital’s largest HIV centre in Israel. He runs a confidential walk-in STI clinic at the Family Medical Practice. For more information on STI screening, please visit goo.gl/qePzHa or download FMP’s newsletter at goo.gl/32W7am.