A recent study details how gender-based stereotypes and culturally defined roles negatively impact how Vietnamese women living with HIV engage with healthcare, their coping strategies and their support systems.

According to Dr Lin Chunqing and colleagues, women living with HIV in Vietnam avoid sharing their status, isolate from family and friends, and internalise the guilt and shame associated with their condition. This can lead to delays in accessing healthcare, reduced employment opportunities and less ability to fulfil traditional family-caring roles. But the study also highlights women’s resilience, determination and the support they get from family and peers.

HIV stigma continues to be an obstacle to HIV treatment and care. Women and girls – who comprise a large proportion of people living with HIV worldwide – are more likely to experience HIV-related stigma and more susceptible to internalising those experiences. In other words, they may turn social narratives, perceptions and labels about HIV and people living with HIV into personal views and self-perceptions. This process of internalising stigma can lead to developing anxiety and depression, and leaving healthcare needs unmet.

In Vietnam, behaviours that can lead to HIV acquisition such as injecting drug use and sex work are perceived as social misconduct, immoral or criminal behaviours, and are defined as ‘social evils’ by the country’s constitution.

Women in Vietnam face significant disparities in economic and employment opportunities, with lower rates of workforce participation and access to paid work. They navigate a religiously diverse but predominantly patriarchal culture, that places a lot of emphasis on women’s modesty, purity, and virtue.

These cultural and religious beliefs can affect how women with HIV understand themselves. For example, Buddhist beliefs about karma can sometimes lead to perceptions that HIV is a result of wrongdoing in a previous life. Confucian concepts of hierarchy, which traditionally see women as supportive caregivers, can restrict their sense of autonomy. Taoist ideas of harmony can lead to a subtle acceptance of life adversities and a less proactive approach to facing challenges.

With this background in mind, the new study aims to understand the intersecting burden of stigma, gender inequality and cultural beliefs for women in Vietnam.

In 2021 and 2022, researchers conducted in-depth interviews with 30 women living with HIV recruited through HIV clinics and community organisations in Hanoi, the capital city. Interviewees were all cisgender women and Kinh (the majority ethnic group). The researchers acknowledge that a limitation of their study is that it does not represent the experiences of rural women, ethnic minority women or transgender women.

Half of the interviewees were between 36 and 45 years old, 80% had some middle or high school education, and 70% had irregular or unstable employment. Two-thirds reported acquiring HIV through sex, less than half (43%) were married, one-third had a husband or partner living with HIV and most had either one (60%) or two (30%) children at the time of the interview.

Overall, women reported a reduction in HIV-related stigma and discrimination in Vietnam over the last two decades, potentially related to advances in the country’s HIV response. Nonetheless, cultural beliefs and gender biases still have a significant role in shaping attitudes and behaviours towards women living with HIV, as detailed below.

Gender-differentiated stigma

Women reported gender-based stereotypes and assumptions about their HIV status being linked to non-monogamous relationships or sex work, whilst men’s HIV was thought to be related to drug use. There were cultural expectations of female virtuosity, while men’s risk-taking behaviour tended to be accepted.

“If men use drugs, their family has money, there are multiple reasons why they should be accepted. But I am a woman, if I get in trouble, people will say terrible things about me. For example, she did bad things and got the disease, so now she must face the consequences”.

They also reported double standards of Vietnamese patriarchal culture that meant a husband was often encouraged to leave a marriage if her wife got HIV first, whilst the wife was more likely to maintain a marriage if it happened the other way around. Even when women contracted HIV from their partners, they faced stigma and social isolation rather than sympathy.

Women living with HIV tended to experience more directly discriminatory behaviours than their male peers. There was a general sense that women are emotionally and physically weaker, and wouldn’t retaliate in the same way as men:

“That’s why even though people do discriminate, they dare not behave [with men] they way they do to [women with HIV]”.