Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam

Kathy Trang; An Thanh Ly; Le Xuan Lam; Carolyn A Brown; Margaret Q To; Patrick S Sullivan; Carol M Worthman; Le Minh Giang; Tanja Jovanovic

doi:10.1016/j.socscimed.2021.113978

Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam

Soc Sci Med. 2021 Jun:279:113978. doi: 10.1016/j.socscimed.2021.113978. Epub 2021 Apr 29.

Authors

Kathy Trang¹, An Thanh Ly², Le Xuan Lam³, Carolyn A Brown⁴, Margaret Q To⁵, Patrick S Sullivan⁴, Carol M Worthman⁶, Le Minh Giang³, Tanja Jovanovic⁷

Affiliations

¹ Institute of Human Development and Social Change, New York University, New York, NY, United States. Electronic address: kt2455@nyu.edu.
² Australian Research Center in Sex, Health and Society, LaTrobe University, Melbourne, Australia; Department of Global Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Viet Nam.
³ Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam.
⁴ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
⁵ Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States.
⁶ Department of Anthropology, Emory University, Atlanta, GA, United States.
⁷ Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State, University, Detroit, MI, United States.

Abstract

Introduction: Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam.

Methods: Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA.

Results: Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs.

Conclusions: Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.

Keywords: HIV; Men who have sex with men; Mental health; Qualitative; Task-shifting; Vietnam.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Mental Health
Qualitative Research
Sexual and Gender Minorities*
Vietnam

Grants and funding

UL1 TR002378/TR/NCATS NIH HHS/United States