Background: People living with HlV/AlDS (PLWHA) in developing countries are rarely consulted about ways to promote their health and well-being. This study sought to identify and understand, from the perspective of PLWHA, challenges and opportunities for improving access to HIV treatment, care and support in Vietnam, a resource-limited setting with an epidemic driven by injecting drug use. Methods: PLWHA trained in participatory research methods completed fieldwork and data collection and co-facilitated focus groups with injecting drug users (IDUs) in Ho Chi Minh City. Qualitative data were analysed in Vietnamese and English using an inductive approach to code and compare content and identify key themes. Results: Results suggest considerable barriers to scaling up in this setting. Against a backdrop of punitive government policies, including mandatory detention of IDUs and sex workers, and widespread stigma and discrimination, many PLWHA lived with the fear of discovery and the threat of abandonment. Lack of confidentiality, limited financial resources and restricted access to essential medications provided powerful disincentives to health service utilisation. Conclusions: Opportunities for scaling up lie firstly in expanding access to confidential HIV counselling and testing. However, in the absence of affordable, quality care and access to anti-retroviral therapy, IDUs are unlikely to see testing as worthwhile. Efforts to scale up also need to address structural barriers including stigma and discrimination, poverty and institutional capacity. Finally, PLWHA in Vietnam are a significant but underutilised resource and consideration should be given to overcoming barriers to building confidence and capacity within affected communities. (C) 2006 Elsevier B.V. All rights reserved.
