Table 3 Illustrative Statements of HIV Risk Behaviors, Knowledge, Awareness, and Attitudes

Overall Awareness

▪ “I met her when I just started the job. I used to think nothing about disease, but after meeting [the outreach worker] I recognized the risk...I have to work, but I know how to avoid being infected by diseases.” – CSW in An Giang

▪ “We don’t learn much information from city wards or through papers. We learn more from [the outreach workers], just through normal conversation.” – MSM in Hà Noi

Transmission Routes

▪ “At first when she gave me condoms, I asked her what they were for. She asked me if I [used] condoms. I said no. Then she said: ‘My goodness, you don’t use condoms, then you’ll catch sida [AIDS]’ At that time I didn’t know what sida [AIDS] was all about... I said: ‘You’re exaggerating that disease,’ I thought only injection drug users contracted that disease...[The outreach worker] gave me some books on HIV, I sat there and read, I understood. I was a bit scared.” – MSM in HCMC

▪ “Through [the HE], I know many more things. I am quite clear about the transmission of AIDS through sexual relations. Concerning diseases related to MSM sex, before I only knew some. When we talked, I asked a lot of MSM-related questions and she answered them.” – MSM in HCMC

▪ “I thought that [HIV] could be transmitted through sharing food or drink. Now I know that’s not true.” – CSW in Hà Noi

▪ “As she shows me ways of transmission, I feel more nervous … Since then, I use condoms with 100% of customers.” – CSW in An Giang

Attitudes Towards PLHIV, Being HIV+

▪ “If I suffer from [HIV], I should lead an optimistic life. [I] shouldn’t be too pessimistic, and with hatred spread the disease out of revenge.” – PWID in Hà Noi

▪ “I used to think that if I get a positive [test] result, that’ll be the end of my life. Since I talked with the PE, I also want to have a blood test; so that I can have medicines to drink if I have disease.” –PWID in An Giang

▪“I’ve changed a lot. In the past, whenever I saw some dirty-looking sex workers, I dared not approach [them]. But now that I know a little more, I’m not afraid anymore.” – CSW in Hà Noi

▪ “I have learned and now know so much more … People living with HIV have to take regular blood tests and we should not discriminate against them. We should try to socialize with them and let them live and work.” – MSM in Can Tho

Condom Use

▪ “After talking [to the PE], I know how to protect myself. When I have sexual relations, I use condoms even with my lover. I’ve taught my boyfriend to use [condoms].” – CSW in Hai Phòng

▪ “When I was younger … sometimes 4 or 5 of us had sex with one girl and nobody used a condom. I was counseled and now I use condoms 100% [of the time].” – PWID in Hà Noi

▪ “Previously I didn’t use [condoms] much, but now I use condoms all the time. If customers don’t want to, I have to talk them into it. If customers still refuse to, I will have to walk out. Money is not everything.” – CSW in Can Tho

▪ “I changed my opinion about sex … I use condoms all the time I have anal sex.” – MSM outside of HCMC

Injection Drug Use

▪ “I’ve changed my habits. I used to use a lot, so much that I had to steal from others. They [peers] advised me to use less... [Before we met the peer], we bought needles at drug stores to use...But I just rinsed them with boiling water, not with sterilizer like [the peers] show us.” – PWID in An Giang

▪ “Before meeting [outreach workers] I thought nothing about problems concerning sharing syringes and injection needles. Now, I no longer share syringes or needles with others.” – PWID in Hà Noi

▪ “In the past, when I was not aware, I had a libertine way of living...Now when they’ve told me, I try to avoid unsafe habits … [The PE] told me not to share needles.” – PWID in Hai Phòng

▪ Before having the chance to meet [the PE] and know the club, I used to share syringes and injection needles and had no knowledge of prevention. Since I met him, I have learned how to prevent HIV.” – PWID in Can Tho

▪ “When I didn’t know [the PE] … I still used old needles twice or three times... [Now] I apply the instructions she gives. For example, about using injection syringes and needles, I just use them for myself.” – PWID in An Giang

▪ “I’ve changed a lot, I’ve thought of it a lot … After listening to him, I don’t [share]. I used to use the kits again … Now I wash them with boiling water twice or three times according to the formula.” – PWID outside of HCMC

Attitudes Towards Testing

▪ “Why do I have to go for a test when I’m healthy? First, I think I’m healthy, and second, I don’t have the time … If someday I’m really weak, I’ll go there; now I don’t suffer from any disease, so I don’t go as it’s too far away.” – CSW in Hà Noi

▪ “I had the result after 1 week. Positive...I have no time; also, I felt less confident after that first test, so I won’t go there again. Maybe I’ll go to have a check again now. They have given me a letter to go to a medical establishment and get some medicine to take, but I haven’t gone. As I feel fine, I haven’t gone. I don’t go just because I don’t have time … [The PE] also advised me that just one time is not enough for an accurate result. I should have a check for one or two more times. But I don’t have time to go.” – PWID in Hai Phòng

▪ In response to: ‘Are the testing and counseling services helpful’? “Yes, [they are] very useful because these are the things that we need to know. Knowing a little is not the same as really knowing – MSM in Can Tho

Attitudes Towards Health Workers

▪ “I totally believe in those places [HIV testing and counseling clinics]. The staff counseled me a lot and solved a lot of my problems. I could get a free test there, but I had to pay for the medicines.” – MSM in Hà Noi

▪ “The truth is, if they are in a good mood, they ask us questions; if not, they ask nothing … [When a staff person called out his name] I raised my objection, but they said it’s their duty. So I didn’t feel comfortable... Frankly speaking, we are drug addicts … we are still discriminated [against]; they look down on us. From my heart, I realize that.” – PWID in Hai Phòng

▪ “We can have HIV testing there and the outreach workers are very enthusiastic about providing us with counseling and advising us. When we receive our results, they also caution us to not overlook anything, and that … if I need to know anything, they will explain.” – MSM in Can Tho

▪ “The way they greeted us really offended us. [The receptionist’s] manner was very hierarchical, and she shouted and scolded us.” – CSW in Hà Noi