Vietnam: Difference between revisions

==Contraception (Birth Control)==

Birth control is legal and widely accessible in Vietnam. It is estimated that 73%-75% of Vietnamese women (of reproductive age) use some form of birth control.<ref>[http://www.dktinternational.org/country-programs/vietnam/ DKT International: Vietnam]</ref> Typically, you'll be able to find oral contraceptive pills, IUDs, injectables (Depo Provera) and Implanon. The most commonly used forms of modern contraceptives tend to be IUDs and condoms. However, it is estimated that approximately 54% of Vietnamese women use modern methods of birth control; the remaining percentage use older methods, like withdrawal, the rhythm method or periodic abstinence.<ref>[https://www.guttmacher.org/about/journals/ipsrh/2002/12/accessibility-and-use-contraceptives-vietnam Accessibility and Use of Contraceptives in Vietnam]</ref>

Despite widespread contraceptive use in Vietnam, there is limited knowledge of all methods. According to one study in the late 1990s: "Several contraceptive methods, such as the pill and the condom, are not widely used even in urban areas, where they are easily obtainable. A study on oral contraceptives in Vietnam indicated that the major reason women who had used modern contraceptive methods had never used the pill was that they did not know about the method. If this lack of information is the result of the strong campaigns conducted in Vietnam in the 1980s to promote IUD use and in the mid-1990s to promote sterilization, contraceptive use depends not only on availability but also on the intensity of promotion. Thus, along with availability of contraceptives, access to information on individual methods could reduce the bias in Vietnam toward urban areas and toward IUD and traditional contraceptive use."<ref>[https://www.guttmacher.org/about/journals/ipsrh/2002/12/accessibility-and-use-contraceptives-vietnam Accessibility and Use of Contraceptives in Vietnam]</ref>

[[File:Contraceptivefilmvietnam.jpg|300px | thumb|left|'''Spermicide found in Hanoi pharmacy (Hoan Kiem district)''']]

* For the contraceptive patch, you can purchase it at private hospitals for about $18-20/month.

===Costs===

==Emergency Contraception (Morning After Pill)==

In Vietnam, emergency contraception is available directly from pharmacists without a prescription. There appears to be no age restrictions. However, if you want to purchase certain EC brands, like ella, Ciel EC and Mifestad 10 you may need a prescription.<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/vietnam/ EC Status and Availability: Vietnam]</ref>

Generally, Vietnamese pharmacists support EC usage but lack proper understanding of its usage and side effects. According to one study: "A series of focus group discussions and in-depth interviews conducted in 1995-96 with hospital-based family planning workers from Ho Chi Minh City, Viet Nam, revealed widespread support for the concept of emergency contraception, but a lack of accurate information about method use. Emergency contraception was regarded as especially appropriate for rape victims, unmarried adolescents, those not in a permanent union, and perimenopausal women. Providers from eight of the nine hospital sites had heard of or used Postinor (a levonorgestrel-only regimen), while participants at seven sites were familiar with the Yuzpe regimen (ethinyl estradiol and either norgestrel or levonorgestrel) and postcoital insertion of a copper-bearing IUD. Providers typically learned about postcoital methods during medical school or at a continuing education seminar. However, even those aware of emergency contraception had substantial misinformation about dosages, intervals between doses, and the maximum length of time after intercourse that the regimen can be initiated. Moreover, they tended to exaggerate side effects and specify unnecessary contraindications. All participants expressed a need for more comprehensive training. Because these methods are often available from pharmacies, respondents urged that druggists be trained to counsel women about the correct use of emergency contraception and suggested that the regimens be specially packaged with clear, simple instructions."<ref>[http://www.ibisreproductivehealth.org/publications/knowledge-attitudes-about-ec-among-health-workers-ho-chi-minh Knowledge and attitudes about emergency contraception among health workers in Ho Chi Minh City, Vietnam]</ref>

[[File:Victoriavietnam.jpg|300px | thumb|right|'''aseVictoria - an emergency contraceptive that can be purchased in Hanoi''']]

* Nordette

* Rigevidon

==Sexually Transmitted Infections (STIs/STDs)==

'''Important Notes - Learn about PEP and PrEP:''' If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click [https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/ here]. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click [http://www.whatisprep.org/ here].

Today, there is no conclusive data on STI rate in Vietnam, with estimated infection rates ranging from 300,000 to 2 million annually.<ref>[http://e.vnexpress.net/news/news/plastic-bag-is-the-new-condom-vietnamese-injured-after-strange-safe-sex-practice-3468256.html Plastic bag is the new condom? Vietnamese injured after strange safe sex practice]</ref>

For people living with HIV in Vietnam, lack of government funding and social stigma are harsh realities. The majority of HIV/AIDS program funding (70%) comes from international organizations with only about 13% coming from the Vietnamese government. There is also a shortage of health workers with only 1300 in 2011. And there is also social stigma. "Social stigma against HIV/AIDS patients presents a major obstacle to contain HIV/AIDS. HIV/AIDS patients are treated unequally in the hospitals and denied employment. Children with HIV are not welcomed in school. In 2009, parents in Ho Chi Minh City forced officials to expel children with HIV.[9] Discrimination thus discourages people to go for screening or to take medication in fear of revealing their HIV status."<ref>[https://en.wikipedia.org/wiki/HIV/AIDS_in_Vietnam HIV/AIDS in Vietnam]</ref>

Regarding HPV, Vietnam has a vaccination pilot program in place.

There seems to be PEP (Post-Exposure Prophylaxis) in Vietnam: According to UNAIDS: " In such cases, there is PEP at some private clinics if the person can afford, such as the Family Medical Practice clinics in Ha Noi and Ho Chi Minh City."<ref>[http://unaids.org.vn/en/frequently-asked-questions/ Frequently Asked Questions: Vietnam]</ref> Furthermore, "Mylan Pharmaceuticals donated a supply of tenofovir/emtricitabine tablets to provide free post-exposure prophylaxis (PEP) after high-risk sexual exposure to HIV in Hanoi and Ho Chi Minh City."<ref>[http://carmah.vn/partners.html Carmah]</ref>

There are no known specific or appropriate HIV treatment centers in Vietnam. But here are some resources in Hanoi and Vietnam:

'''Important Note:''' Avoid self-diagnosing or seeking treatment (before diagnosis) at a pharmacy. According to one study: "Even though 74% (51 of 69) of pharmacists and drug sellers know that they should not treat STD patients, in fact 84% (250 of 297) did treat. When they did treat, no one gave the correct combination of drugs for treatment by the syndromic approach, as only 12% (36 of 297) gave tetracycline or doxycycline, and of those who sold them no one gave them for a sufficient number of days. Quinolones were by far the most common drug given but are not recommended by the Vietnam Institute of Venereology..."<ref>[http://sti.bmj.com/content/76/4/299.full STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers]</ref>

==Medications & Vaccines==

For a long time, Vietnam (along with many other Southeast Asian countries) was known as place where you could buy virtually any medication or antibiotic over the counter. In Vietnam, this is no longer the case. Antibiotics and stronger medications are more strictly regulated at pharmacies. However, you will still find some pharmacies that are more lenient in their sales. Remember that some pharmacies focus on "herbal" or traditional medicine, meaning that they do not carry modern pharmaceutical products. Other pharmacies do carry modern products, but they may sell medications that are inauthentic (i.e. incorrect or sugar-pill like medicine) or expired. Try to visit pharmacies that you know or trust, or that someone who has experience in a Vietnamese city recommends. Overall, Vietnamese pharmacists speak very little English. So it is recommended to know that name of the medication you need in advance or to bring a translation device.

[[File:Canestenvietnam.jpg|300px | thumb|left|'''Canesten - yeast infection medication, which requires that you insert pills vaginally''']]

* If you have a yeast infection, try to say "Nhiễm nấm âm đạo" (can someone confirm if this is correct?). If you go to a pharmacy, you can ask for "Canesten." This is basically the Asian version of Monistat. Note that you may receive a pill version, which means you have to insert pills into your vagina through an insertion device. The pills need to actually dissolve inside of you and, if they're clumpy at all, the pills may not work. So the pharmacists may also recommend that you buy some sort of vaginal lubricant/cleaner that will help dissolve and clean out the pills.

* If you have a urinary tract infection (UTI), you can try to say "nhiễm trùng đường tiết niệu," though we're not sure if this is accurate (can someone confirm?). If you go to a pharmacy, may be given Midasol at a Hanoi pharmacy. But first confirm that you have a UTI before you proceed wit medication.

==Menstruation==

There is little social stigma attached to menstruation in Vietnam, where both pads and tampons are available. But there is not yet widespread knowledge of alternative menstrual products, like menstrual cups or menstrual underwear. The country does not have a massive range of international or foreign brands, so these products are not yet on Vietnam's radar. But this could easily change in the coming years as the economy grows and the government continues to ease restrictions on foreign investment.

==Gynecological Exams==

==Pregnancy==

In Vietnam, new mothers get 4-6 months off for maternity leave with 100% of income covered.<ref>[https://en.wikipedia.org/wiki/Parental_leave Wikipedia: Parental Leave]</ref> According to a 2013 Save the Children report: "Vietnam, for example, though quite poor, scored relatively well as a place for moms, in part by cutting its newborn death rate by an impressive 47 percent over 20 years."<ref>[https://www.washingtonpost.com/news/worldviews/wp/2013/05/08/heres-a-map-of-the-best-and-worst-countries-to-be-a-mother/ Here’s a map of the best and worst countries to be a mother]</ref>

Pregnancy tests are widely available at pharmacies throughout the city. Pharmacies in tourist areas most likely have someone who speaks English.

==Abortion==

[[File:Php2C2C8tAM.jpg|400px | thumb|right|'''Vinmec - an international hospital in Hanoi that provides abortion services''']]

In Vietnam, abortion became fully legal since reunification in 1975. Since that time, and especially since the 1980s, the country has had a rather high abortion rate. Between 1982 and 1994, the abortion rates rose six-fold. In 1996, the abortion rate was 83.3 abortions per 1000 women. In 2014, it was reported that 40% of pregnancies end in abortion. As reported: "Sexual behaviour among young Vietnamese has radically transformed in the last few decades -- they have sex earlier and marry later -- but the state's old-fashioned family planning services offer little advice or suitable contraception to young, unmarried couples, experts say.As a result they suspect that abortion -- permitted up to 22 weeks and widely available, particularly at legal but largely unregulated private clinics -- is being used to prevent unwanted pregnancies more often than in other countries." <ref>[http://www.dailymail.co.uk/wires/afp/article-2848236/Sky-high-abortions-Vietnam-family-planning-excludes-youth.html Sky-high abortions in Vietnam as family planning excludes youth]</ref>

==Advocacy & Counseling==

==List of Additional Resources==

==References==