Love, Marriage and HIV: A Multisite Ethnographic Study of Gender and HIV Risk

Fieldwork in Vietnam

Table of contents

• Vietnamese Field Work Team
• Photos
• The Setting: Ha Noi, Viet Nam
• Summary of Fieldwork Activities
• Preliminary findings
• HIV interventions
• Recent presentations and forthcoming publications
• Local collaborating agencies
• Contact us

Vietnamese Field Work Team

Researchers from the Institute of Sociology, including Nguyen, Huu Minh the Co-Director of the research.

• Dang, Thanh Truc
• Duong, Chi Thien
• Nguyen, Huu Minh
• Nguyen, Nga My
• Pham, Quynh Huong
• Do, Minh Khue
• Tran, Quy Long

Photos (click on photos to enlarge and to view captions)

Wedding	Internet Café	HIV/AIDS public health message regarding the ways HIV/AIDS is not transmitted
Men hanging out at sidewalk stand	Courting couple at Westlake	Nguyen Cuu Street
Lan Chin Bia Hoi

The Setting: Ha Noi, Viet Nam

Field work in Ha Noi began in February 2004. Ha Noi is a city of 2.67 million people and is the capital of Viet Nam. Although I had lived there twice before (1993-1994 and 1995-1996), much had changed since my last visit. The first thing I did was to begin reacquainting myself with Ha Noi, noting down all the changes that I saw, talking with my new neighbors, as well as friends and acquaintances about life in Ha Noi. Economic change, initiated in 1986 with the advent of Doi Moi [Renovation] has led to significant change in Viet Nam, most notably in the cities. Since my last visit Ha Noi had become much more fully integrated into the global market economy, resulting in a significant increase in access to foreign mass media and consumer goods than was the case in 1996. These economic changes have had a significant impact on social life. Whereas in 1996 most people were still riding bicycles (though the increase in motorbikes and cars was clearly evident), in 2004 the majority were driving motorbikes. In 1996 few people had a cell phone or a television, but in 2004 it seemed many had both. Whereas in 1996 the government's "Social Evils Campaign" sought to eradicate foreign language signs and control the importation of foreign mass media, by 2004 I could watch a variety of films filled with violence and sex on MTV, get international news from CNN, and watch Australian outdoor adventure programs. Advertisements and billboards alluding sex and romance sell consumer products, including cell phones, maternity clothes, lingerie, motorbikes, and televisions. Internet cafes had also sprung up in my absence. Another change is the near absence of cyclos (pedicabs); the government has limited the number of people eligible to drive cyclos on city streets, preferring instead taxi cabs which are now everywhere. Most striking, in light of this project, was the plethora of different kinds of cafes and mini hotels to which one could go to procure sex or to have sexual intimacy. Also notable was the increased disparity in wealth between the newly emerged middle class and the laborers/peasants.

Summary of Fieldwork Activities

Marital Case Studies: I spent the first few weeks of February working with Minh, my colleague at the Institute of Sociology at the National Center for Social Sciences and Humanities, to figure out how best to accomplish our research objectives. We decided to hire two male (Thien, Khue) and three female (Truc, Huong, and My) researchers from the Institute of Sociology to help us conduct the marital case history interviews. We asked Long, also from the Institute, to transcribe and type the interviews into a computer. The research team's first task was to discuss and revise the questions to make sure they were relevant for Hanoi residents. Initially the researchers were highly skeptical that anyone would talk to us about their personal experiences of sex and extra-marital relations. We decided to do a test run with the revised instrument to see how much information we could elicit. The Vietnamese researchers were surprised and delighted to find that their interviewees were fairly forthcoming.

Six months later we had conducted 22 marital case studies. Among the people we interviewed were xe om drivers [motorcycle taxi], construction workers, teachers, construction engineers, business men, booksellers, a doctor, a candy seller, a tailor, a beer seller, a policeman, and a former mini-hotel manager. The male researchers interviewed the husbands and the female researchers interviewed the wives. We decided to use the snowball approach to locating potential interview subjects, a research methodology new to all of the research assistants. This meant that each researcher located people to interview through personal contacts or through acquaintances in order to meet the projects criteria of finding specific types of individuals (married less than five years, married with children, grandparents, migrant, different socio-economic levels and education). All of the marital case study interviews were tape recorded, with permission.

Key Informants: Minh and I decided to wait to conduct the key informant interviews until the majority of the marital case studies were completed. This enabled us to focus our questions on topics that had emerged from our marital case studies, issues on which we wanted clarification or socio-historical context. Among the key informants we interviewed were: a senior researcher of women's studies, a senior member of the Women's Union, a xe om driver and former hotel manager, a lawyer for the Women's Union, a commune official in an area of town that is dealing with high IV drug use, a sociologist, and a director of a community based HIV/AIDS awareness program. All of these interviews were tape recorded. I also conducted less informal interviews with gay men, Hanoi residents, public health professionals, and a journalist. I also spent a significant portion of my time meeting with health professionals working at local and foreign NGOs, and at Vietnamese governmental and international aid organizations.

Archival data: We hired Long, the transcriber, to collect newspaper articles, magazines, and music. Long collected articles for a two year period every ten years, beginning with 1970 and 1971. This time frame will enable us to compare discussions related to marriage, sex, and love over 5 different time periods (1970/1971 (pre-war north), 1980/1981 (post-unified country), 1990/1991 (4 years post Doi Moi), 2000/2001 (Doi Moi full swing, post Asian economic crisis), and 2004.

Participant Observation: Participant Observation took place throughout the six month fieldwork period and included:

• Observing social activities at dancing clubs and night clubs
• Spending weekends and afternoons in parks and around the lakes with friends and their families and with my family.
• Checking out the vast array of places where couples can go for privacy and/or sexual intimacy
• Spending time with the women and children on the ally where I lived, talking and watching the daily routines of life. I also hung out at sidewalk stalls, fruit and tea stands by my self and with my two young children who provided a valuable entry point for conversation.
• Attending two weddings — of two families from very different socio-economic and educational circumstances.
• Spending time in internet cafes, stores, markets to see how the consumer culture had changed.

Preliminary findings

Preliminary analysis of fieldwork data indicates that many married men in Ha Noi, particularly those with disposable incomes, have engaged or do engage in extramarital sex. Not all of our informants were initially forthcoming with this information, but by the end of the interview a number of men did acknowledge they had had an extra-marital affair. Few women were as forthcoming. Almost all of the individuals with whom we spoke knew of one or more situations where a husband or wife had had an extra-marital relationship. Men's extra-marital sexual activity was typically dismissed as unfortunate but understandable whereas women's extra-marital relationships were often attributed to poor character.

There are three types of women with which a man may have sexual relations: his wife, his lover, and a sex worker. Many men with whom we spoke do not consider having sex with sex workers to be inconsistent with their love for their wives. The men feel that as long as they do not become romantically involved with women who might bear a child or cause him to divert resources from his wife and children, then extra-marital affairs are harmless. Despite a high rate of male extra-marital sexual activity, and acknowledgement by women that men tend to need more sex than women, extra-marital sex was not, in itself, a cause for seeking divorce. Marriage continues to be very important for both men and women, creating a family and having children, and taking care of one another and one's relatives being the principal concerns. For many women, marriage provides women with social status and economic security, which makes them reluctant to seek divorce. Though most of the couples felt that sexual compatibility was important for a good sexual relationship, this did not mean that they enjoyed sex with one another to the same degree. However, there did appear to be a generational difference with regard to the degree to which individuals believed that infidelity would or would not cause a strain in the couple's affective relationship — an issue I need to tease out further. I found particularly interesting the fact that some middle aged women spoke about the possibility of, or were exploring a different kind of emotional and sexual relationship with someone other than their husbands. Not withstanding, men were more likely to have extra-marital relations than women, simply by virtue of the fact there are a large number sex workers available to men and due to the gendered differences in patterns of socializing and mobility.

Preliminary analysis indicates that economic factors such as work place prestige systems, gendered economic opportunity structures, and women's economic dependence on their husbands combine with socio-cultural factors (masculinizing practices, shifting yet conventional gendered sexualities, kinship organization, women's social dependence on their marital status, and new sexual imaginings) to put married women increasingly at risk of contracting HIV from their husbands. Another factor shaping married women's risk is that married men tend not to use condoms with their wives or with their lovers. I have come to view men's extramarital sexual activities as a structural aspect of Ha Noi society. Therefore, in order to effectively prevent HIV marital transmission, interventions need to take into account the structural sources of married women's HIV risk.

HIV interventions

There are many organizations working to prevent the transmission of HIV/AIDs in Viet Nam at this time. The government recently released the "National AIDS Strategy to 2010 with visions to 2020." This national strategy adopts many practices taking place elsewhere on HIV/AIDS prevention, care, support and treatment - from harm reduction for drug users and sex workers to anti-retroviral treatment for AIDS patients. As of 2005, anti-retroviral drugs will be offered for free from different programs such as the government's treatment program, the US President Emergency Plan for AIDS Relief, the Global Fund support project and the French's GIP-Esther project. In addition, there is a new effort to eradicate HIV-related stigma and discrimination, a serious problem in Viet Nam. General public knowledge on HIV/AIDS transmission and how to prevent it is fairly widespread in Ha Noi. Billboards, TV and radio programs spread public health messages regarding HIV/AIDS.

While I was in Ha Noi, I conducted a workshop for social work students at Ha Noi National University on the risks of marital HIV transmission, on the research project and its methodology. I plan on returning in 2006 to provide a follow-up workshop on the results of this project.

Recent presentations and forthcoming publications

• American Public Health Association, December 14, 2005,Philadelphia;
• American Anthropological Association, December 2005, Washington, DC
• National Institutes of Health, December 1, 2005
• Brown University, Population Studies and Training Center, March 2, 2006

Local collaborating agencies

The Institute of Sociology, National Center for Social Sciences and the Humanities sponsored the research and made the necessary arrangements for the research to take place.

In addition, a number of individuals at the following organizations collaborated with us to help us obtain the information we were seeking:

Ha Noi Women's Union
Center for Women's Studies
Quang Mai Commune People's Committee
Vietnam Institute for Community Awareness on HIV/AIDS (VICOMC)
UNDP
WHO

Contact us