Background: HIV-positive people who use injection drugs (PWID) face significant challenges that influence their engagement in HIV treatment, particularly in meeting normative expectations related to gender and drug use behavior. In contexts, like Vietnam, where heterosexual transmission of HIV is substantial, PWIDs'' female sexual partners (FSPs) are at risk of drug use and HIV infection. Understanding more about the relationship between gender expectations for PWID and FSPs with drug use and HIV treatment would help inform retention programs.
Methods: We describe how expected gender roles may contribute to HIV treatment engagement among HIV-positive male PWIDs and FSPs. In-depth interviews were conducted with 30 male PWIDs and 21 FSPs in September 2017. The interviews were in Vietnamese, translated into English, and analyzed using NVivo 11 software.
Results: Male PWIDs often presented later to treatment and were less likely to consistently stay in treatment than FSPs for several reasons. The perceived criminalization of drug use led to a higher level of discrimination reported by male PWIDs, compared to FSPs who were often perceived as victims of their partner''s behavior. FSPs who also inject drugs were also highly stigmatized. Perceived norms around the roles of men as the head of the household economically, in maintaining the family lineage and ancestor worship practices may negatively influence PWIDs'' retention, either because they had to travel for work, or had to hide their HIV status and treatment due to family''s expectations. FSPs, on the other hand, were more likely to stay in treatment because of their expected roles in taking care of their family and in-laws, although it could also be challenging as FSPs reported reluctance to seek support from their in-laws or their own family.
Conclusions: While the couple approach is important for HIV treatment retention, specific interventions need to be tailored to assist male PWIDs and FSPs overcome the challenges. The sharp differential treatment of male PWIDs vs. FSPs by families and communities imply that:
1) more focused support for FSPs is needed for their long-term treatment and
2) an increasing number of FSPs who inject drugs could remain hidden, posing an additional challenge to HIV programs.