Gender roles and family responsibility

In Vietnamese culture, women are often expected to assume multiple family roles. They are meant to care for both her and the husband’s family, handling household chores and looking after the children, whilst men are expected to provide the main source of income and are not expected to get involved in domestic tasks.

Many of the women interviewed felt disappointment and faced discrimination from their families if HIV-related health issues prevented them from fulfilling these traditional roles. Some were threatened with being outed, resulting in many of them avoiding family contact to protect their privacy and wellbeing. 

“A few people from my husband family know about it (my HIV). I’m still threatened in terms of how I raise my child. If I didn’t let my daughter visit (my husband’s family) there, they would tell everyone that I am HIV positive, and tell everyone to keep away from me.”

Modern Vietnamese society expects women to be both family caretakers and financial breadwinners, but there are widespread assumptions about the health of people living with HIV being impaired. Many interviewees had internalised this idea – and also the guilt and shame associated with their perceived failure to carry out their family role.

“I don’t have a voice in the family. The truth is that my health is not good, I can’t do anything for my family…Sometimes there is discrimination from my family, but I don’t blame them, although sometimes I feel self-pity, I really do…I can’t take care of my family, and my younger sister has to do it instead of me”.

Healthcare seeking challenges

Stigma in healthcare settings remained the biggest challenge for women living with HIV in Vietnam, who experienced avoidance, segregation, suboptimal care and breaches of confidentiality.

“I brought the referral letter and my medical record…,which has an HIV sign on the cover. Then I gave it to the nurse who stood outside the reception greeting patients…And she suddenly said out loud ‘Oh you got HIV, right?’ Then all the people waiting right next to me…stood a few meters away from me. They were afraid to come close.”

Taboos surrounding their sexuality, and fear of being recognised or their status being shared with their community, impacted women’s decision-making around HIV care, with some travelling longer distances to avoid local spaces. 

Internalised stigma based on misunderstandings of HIV made women cautious and hesitant to access care:

“Disease is disease. HIV is more than a disease, (it is) contagious. And the transmission happens just not in (sexual) relationship. I even lost confidence going to the beauty salon now. I do not have the confidence even go to hospital now”.

This reluctance to engage with healthcare could lead to misunderstandings and misinformation about treatment, leading to delays in seeking care.

Coping strategies and support systems

Understanding the prejudice and discrimination towards people living with HIV, women saw non-disclosure as the simplest way to maintain their relationships, secure employment and avoid stigma. Keeping their HIV status secret led women to isolate themselves and avoid taking medication in front of others.

Despite challenges, resilience and determination were also key to maintaining good health and having active and healthy lifestyles. In participants’ words, it takes a lot of work to live “like a normal person” and be “very useful to society”.

“To be honest, I’m already determined. My life, no matter how hard it is, I will bear it on my own. So I just kept quiet. If anyone asks, I just keep silent. That’s all”.

Several participants described getting support from family members and also found comfort from peers, in groups of women living with HIV. These spaces helped them meet multiple needs, share personal matters, exchange resources and information, and motivate each other to overcome obstacles. Participants accompanied each other to healthcare appointments and looked after each other at times of ill health.

“I have developed more connections. I have gained more knowledge…We have been together for ten years. Honestly, I feel closer to them than to my blood relatives”.

Conclusion

The links between culture, gender norms and stigma exacerbate the challenges faced by women living with HIV in Vietnam. Their vulnerabilities must be addressed through a multi-layered approach.

Culturally rooted programmes with religious elements like mindfulness, balance and meditation may help support women in coping with stress induced by stigma and gender-based bias. Additionally, vocational training and money lending programmes have the potential to enhance financial stability and personal autonomy.

Interventions engaging partners and family members – who can be both a source of stigma and support – may facilitate changes in gender-based family norms, encourage shared caregiving and promote health-seeking behaviour.

Lastly, changes are required at community and policy levels to dispel HIV misinformation, develop empathic views about people living with HIV and reinforce gender equity policies.

The researchers say that such an approach may lead progress towards gender equity and better health outcomes for women living with HIV in Vietnam.