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Van Minh H.,Hanoi Medical University | Giang K.B.,Hanoi Medical University | Liem N.T.,Institute of Population | Palmer M.,University of Melbourne | And 2 more authors.
Global Public Health | Year: 2015

Disability is shown to be both a cause and a consequence of poverty. However, relatively little research has investigated the economic cost of living with a disability. This study reports the results of a study on the extra cost of living with disability in Vietnam in 2011. The study was carried out in eight cities/provinces in Vietnam, including Hanoi and Ho Chi Minh cities (two major metropolitan in Vietnam) and six provinces from each of the six socio-economic regions in Vietnam. Costs are estimated using the standard of living approach whereby the difference in incomes between people with disability and those without disability for a given standard of living serves as a proxy for the cost of living with disability. The extra cost of living with disability in Vietnam accounted for about 8.8–9.5% of annual household income, or valued about US$200–218. Communication difficulty was shown to result in highest additional cost of living with disability and self-care difficulty was shown to lead to the lowest levels of extra of living cost. The extra cost of living with disability increased as people had more severe impairment. Interventions to promote the economic security of livelihood for people with disabilities are needed. © 2014 Taylor & Francis.


Nguyen K.T.,Yale University | Khuat O.T.H.,Institute for Social Development Studies | Ma S.,Yale University | Pham D.C.,Institute for Social Development Studies | And 2 more authors.
PLoS ONE | Year: 2012

Background: Significant health expenses can force households to reduce consumption of items required for daily living and long-term well-being, depriving them of the capability to lead economically stable and healthy lives. Previous studies of out-of-pocket (OOP) and other health expenses have typically characterized them as "catastrophic" in terms of a threshold level or percentage of household income. We aim to re-conceptualize the impact of health expenses on household "flourishing" in terms of "basic capabilities." Methods and Findings: We conducted a 2008 survey covering 697 households, on consumption patterns and health treatments for the previous 12 months. We compare consumption patterns between households with and without inpatient treatment, and between households with different levels of outpatient treatment, for the entire study sample as well as among different income quartiles. We find that compared to households without inpatient treatment and with lower levels of outpatient treatment, households with inpatient treatment and higher levels of outpatient treatment reduced investments in basic capabilities, as evidenced by decreased consumption of food, education and production means. The lowest income quartile showed the most significant decrease. No quartile with inpatient or high-level outpatient treatment was immune to reductions. Conclusions: The effects of health expenses on consumption patterns might well create or exacerbate poverty and poor health, particularly for low income households. We define health expenditures as catastrophic by their reductions of basic capabilities. Health policy should reform the OOP system that causes this economic and social burden. © 2012 Nguyen et al.


Nguyen H.N.,San Jose State University | Hardesty M.,University of Chicago | Hong K.T.,Institute for Social Development Studies
Journal of Sex Research | Year: 2013

Mostly operating from a risk and risk-reduction paradigm, existing research on migrants in Vietnam tends to conceptualize sex and risky sexual behaviors as isolated life domains. This study begins to develop a contextually rich understanding of migrants' sex lives by examining the relationships among sex, work, and the constant pendulum-like migrating movements of 23 Vietnamese married migrants in Hanoi and Ho Chi Minh City. Using data from in-depth interviews, it was found that most participants had no sex in the city; this was followed by visits to the home village, where they had sex with their spouses as often as possible to make up for the "long drought" in the city. Within this sexual schema, sex came secondary, and even peripherally, to migrants' working lives; thus, exhaustion from work was cited by migrants as the overwhelming factor leading to their sexual problems. This study suggests that migrants' intimate lives are more strongly linked to their working lives than has previously been recognized, and that their sexual behaviors should be viewed in tandem with the hardships of their working lives. Copyright © The Society for the Scientific Study of Sexuality.


Nguyen K.T.,Yale University | Hai Khuat O.T.,Institute for Social Development Studies | Ma S.,Yale University | Pham D.C.,Institute for Social Development Studies | And 2 more authors.
Social Science and Medicine | Year: 2012

With the 1980s " Doi Moi" economic reforms, Vietnam transitioned from state-funded health care to a privatized user fee system. Out-of-pocket payments became a major source of funding for treatments received at both public and private health facilities. We studied coping strategies used by residents of Dai Dong, a rural commune of Hanoi, for paying health care costs, assessing the effects of such costs on economic and health stability.We developed a 2008 survey of 706 households (166 poor, 184 near-poor, 356 non-poor; 100% response rate). Outcome measures were reported episodes of illness; inpatient, outpatient, and self-treatments; out-of-pocket expenditures; and funding sources for health care costs. Households of all income levels borrowed to pay for inpatient treatments; loans are also more heavily used by the poor and near-poor than the non-poor for outpatient treatments. Compared to low cost treatments, the use of loans is intensified for extremely high cost health treatments for all poverty levels, but especially for the poor and near-poor. The likelihood of reducing food consumption to pay for extremely high cost treatment versus low cost treatments increased most for the poor in both inpatient and outpatient contexts.Decreased funding and increased costs in health care rendered Dai Dong's population vulnerable to the consequences of detrimental coping strategies such as debt and food reduction. Future reforms should focus on obviating these funding measures among at-risk populations. © 2011.


Hirsch J.S.,Columbia University | Giang L.M.,Hanoi Medical University | Parker R.G.,Columbia University | Duong L.B.,Institute for Social Development Studies
Journal of Health Politics, Policy and Law | Year: 2015

Drawing on the changing landscape of responses to HIV in Vietnam, this article describes the key players and analyzes the relationships between global players and local interests, including both the omnipresent state and an emerging civil society presence. We discuss the critical importance of timing for policy intervention and the role of health policy in shaping the broader social terrain. The interventions of external actors such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund were instrumental in improving both policies and programs at a critical juncture, when the national responses to the epidemic had been ineffective. At the same time, those global interventions met resistance and led to unintended consequences, bothwelcome and unwelcome. Furthermore, the looming specter of donor withdrawal and the very gradually emerging national ownership raise many questions about capacity for scale-up and sustainability of the significant achievements to date. Further monitoring and in-depth analysis of the Vietnamese responses to the HIVepidemic in the next few years or so, we contend, have the potential to provide unique insights into the challenges faced by developing countries caught in the complex webs of health politics and policies at both the global and the national levels. © 2015 by Duke University Press.


Nguyen H.N.,San Jose State University | Hardesty M.,University of Chicago | Hong K.T.,Institute for Social Development Studies
Culture, Health and Sexuality | Year: 2011

Having emerged only recently due to fast urbanisation and globalisation, pendulum migrant labourers in Vietnam are economically, culturally and socially difficult to locate-though they are estimated to number in their millions. Defined by their frequent migration between village and city, pendulum migrant labourers occupy an extended period of liminality. Are they traditional villagers or liberal city people when it comes to sex? Does city life radically change their views on sexuality? Starting with the premise that living environments play a key role in structuring the practical and symbolic realities of sex, this paper explores how extended periods of circular migration between the village and city-living environments that differ markedly in terms of socioeconomic and cultural conditions-affect the sexual views and perspectives of Vietnamese pendulum migrant labourers. Analysis from in-depth interviews with 23 married pendulum migrant labourers revealed that even though they had been living the pendulum life for several years, they continued to identify themselves, sexually, as traditional villagers. Among labourers the link between sexuality and living environment was a matter of pragmatism-matching 'suitable' sexual behaviour to social, even if imagined, location-and of privilege or 'leagues' - matching behaviour and comportment to social pedigree. © 2011 Taylor & Francis.


Khuat T.H.,Institute for Social Development Studies | Nguyen V.A.T.,Institute for Social Development Studies | Jardine M.,University of Melbourne | Moore T.,University of Melbourne | And 3 more authors.
Harm Reduction Journal | Year: 2012

The findings of our research show that while police play multiple roles in the fight against drug-related crime, they often perceived their tasks - especially preventing and controlling drug use on the one hand, and supporting harm reduction on the other - as contradictory, and this creates tensions in their work and relations with their communities. Although they are leaders and implementers of harm reduction, not all police know about it, and some remain skeptical or perceive it as contradictory to their main task of fighting drugs. Methadone treatment is seen by some as in competition with their main task of coordinating conventional drug treatment in the rehabilitation center.The history of drug use and the evolution of discourses on drug use in Viet Nam have created these conflicting pressures on police, and thus created contradictory expectations and led to different views and attitudes of police regarding various harm reduction measures. This might aid understanding why, despite the comprehensive and progressive policies on HIV/AIDS and harm reduction in Viet Nam, it is not easy for police to actively and effectively support and be involved in harm reduction at the ground level.To promote the wider acceptance of harm reduction the concept of community safety must be expanded to include community health; harm reduction must be integrated into the " new society" movement; and laws and policies need further revision to reduce contradiction between current drug laws and HIV laws.Harm reduction guidelines for police and other actors need to be disseminated and supported, embodying better ways of working between sectors, and all sectors in the partnership require support for building capacity to contribute to the overall goal. © 2012 Khuat et al.; licensee BioMed Central Ltd.


Phinney H.M.,Seattle University | Khuat Thu Hong,Institute for Social Development Studies | Vu Thi Thanh Nhan,Institute for Social Development Studies | Nguyen Thi Phuong Thao,Institute for Social Development Studies | Hirsch J.S.,Columbia University
Critical Public Health | Year: 2014

This paper focuses on the interactions between medical professionals in Hanoi, Vietnam, and their HIV-positive patients who desire children. Drawing on ethnographic research, we argue that despite ongoing state and civil society efforts to reduce discrimination against people living with HIV (PLHIV), doctors do stigmatize patients who choose to reproduce, even if the patients are found to have carefully considered all associated risks. While the effects of the Social Evils Campaign linger, the doctors’ prejudicial stance towards PLHIV’s reproductive desires and risks also reflects the messages communicated by the more recent governmental campaign on Population Quality. The result of this stigmatization is a stratification of reproduction among the Vietnamese citizenry whereby PLHIV are considered obstacles to ‘the cleanliness of the race.’ © 2014, © 2014 Taylor & Francis.


PubMed | Institute for Social Development Studies, Data Management, Seattle University and Columbia University
Type: Journal Article | Journal: Critical public health | Year: 2014

This paper focuses on the interactions between medical professionals in Hanoi, Vietnam and their HIV-positive patients who desire children. Drawing on ethnographic research, we argue that despite ongoing state and civil society efforts to reduce discrimination against people living with HIV (PLHIV), doctors do stigmatize patients who choose to reproduce, even if the patients are found to have carefully considered all associated risks. While the effects of the Social Evils Campaign linger, the doctors prejudicial stance towards PLHIVs reproductive desires and risks also reflects the messages communicated by the more recent governmental campaign on Population Quality. The result of this stigmatization is a stratification of reproduction among the Vietnamese citizenry whereby PLHIV are considered obstacles to the cleanliness of the race.

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