Văn hoá nhóm và việc sử dụng chất kích thích dạng amphetamine trong nhóm nam tình dục đồng giới tại việt nam

Nghi§n edu Gia dinh va Gidi So -2012 Van hoa nhom va viec sur dung chat hjch thich dang Amphetamine nhdm nam tinh due dong gidi tai Viet Nam Nguyen Thj Trang Nhung, Tran Thj Diep, Hd Thj Hien Trircfng Dai hoc Y16' Cong cong Bui Thj Minh Hao, Tran Thi Hda Tmng tSm Nghien cifu va Dao tao H!V/AIDS, Tri/ong Dai hoc Y Ha Npi Tom tat: Viec sd dung chat kich thfch dang Amphetamine (ATS) dang trd mot van de xa hoi va y te cong cong Cac nghien ciiu gan day ciing chi su gia tang ciia xu huSng sii dung ATS khu vUc, dac biet cl cac pho' li3n va tiep theo la cac hau qua cua ATS do'i vdi ca nhan va xa hgi Nam tinh due dong gi6i (MSM) la mot nhflng doi tUcfng co nguy cU cao v6i sd dung ATS DUa tren viec phan tich so'Heu dmh tinh thu dUdc qua cac cugc phong va'n sau 40 MSM da va dang sii dung ATS c( Ha Noi, Da Ning va pho'Ho Chi Mmh khuon kho mgt nghien cUu Idn Cd quan Phong cho'ng ma tiiy va toi pham ciia Lien hiep quo'c (UNODC) tai trg, bai vi§'t nhSm mo ta van hoa nhom viec sii dung va tri sii dung ciia ATS Ket qua phan tich cho thay nh6m co mgt vai tro quan trgng viec bdt diu va tri sii dung ATS Ban be nhom ia ngUcli gidi thieu MSM bat dau dung ATS; nhom giiip hg tri "cugc so'ng co ATS" nhU hiin tien mua thuoc, di mua thuo'c cho cac vien nhom va quan he tinh due tap th^ nhom, Cac can thiep nham giam tac hai lien quan de'n sil dung ATS can phii hdp vfli van hoa nhom MSM va chu y tdi y§'u to'tac dgng ciia nhom Tijf khoa: MSM; Nam quan hg tinh due dong gidi; ATS; Thuoc lac; Da; Tac dgng nhom 112 Nghi^ncUuGiadlnh vdGidi Quy6'n22, s6'6, tr 111-118 D|t van de Sir diing chfl't ki'ch thi'ch dang Amphetamine (Amphetamine Type Slimukinis - ATS) dang gia liing d c^c nudc DOng Nam A AIS da v^ dang gop phdn lam mflt an ninh irSl tir cho c^c nud-c khu vtrc cung nhu dang trd ihiinh mdi vrin d^ y tC c6ng cdng can duac quan i.im (Farrell vii nhQ-ng ngu6i khac, 2002; UNODC, 2003) ATS gay cdc r6i loan lam Ihdn kinh nhu iritm cam lo au (UNODC, 2003; licyrcr va nhffng ngudi khiic, 2004) Ngoai cung cd nhidu nghidn cihi chi c6 mO'i lien quan giffa sir diing ATS vk bj mac cac bfinh vifim nhl^m lay qua dudng tinh due (Bcyrcr vii nhung ngu6i kh.ic, 2004; Inglcz-Dias va nhung ngudi khde 2008) MSM Ik mOl nhffng nhdm cd nguy ctt cao doi vcri su dung ATS (Inglez-Dias vii nhffng ngudi khac 2008: Rawsiomc, 2007) ATS cd lac dimg lam tang phan u'nh diic, khien ngudi sir dttng cd ihft quan hi tinh due tap ih^ vk khdng sii dung bao cao su Vi vfly sit dung ATS 1^ yfi'u 16' nguy ca vdi HIV nhdm MSM vk ngo^l cdng ddng (CDC 2006) Bai viel md la van hda nhdm vh phan lich lac dong ciia nhdm vific sir dung v^ iri sir dung AIS Irong nhdm MSM Kci qua nghien ctJu se cung ca'p bang chimg cho vific \;ty diJng cAc can ihifip giam lac hai phii hop cho ngudi su dung MS Ki M.SM Nghien cihi ap dung ihifi't kfi'djnh linh Co 40 cudc phong vS'n sau nam quan hfi tinh diic ddng gidi tt.l v.i dang stir dung ma liiy tdng hc^ tai ihanh phd: Hk Ndi, Da NSng \ ;i ihiinh phd H6 Chf Mmh S lifiu duoc phan li'ch Iheo chu d^ sir dung phdn in6m NVIVO 8.0 Ket q u a Siir d u n g A F S t r o n s n h d m M S M Vice sir dung ATS irong nhdm MSM la tuong dd'i phd bifi'n Nhicu dd'i lucmg tham gia plumg \;in s.ui (3/4) ndi ring ly le dung thudc lac irong nhdm MSM kha cao Mm sd MSM nghifin cihi ndi thfim rSng khdng cd su khac bifit \'e ly 10 sir dung ATS giffa cac nhdm ddng tfnh khde MSM cd sir dung ATS bao gdm nhidu phin khac nhu "bdng kin", "bdng Id"; can bd cdng chiic, hoc sinh v^ sinh vifin Dd iu6i su dung ATS cdc nhdm ddng tfnh cung da dang: Trong nh6m em c6 10 ngudi thi 7-8 ngudi si^ dyng Ihufic tac (MSM, Da Ning) DLI loai phSn d6, thSnh phan thudng dan, bSc sT, ky su cung c6 choi rdi nhifng ba gia d6 cung choi (MSM, TP H6 Chi Minh) NHiiyrn Thi Trang Nhung va cac tac gia 113 Gia nhap nhdm MSM Ik mdi nhu cSu ciia MSM de duoc khang djnh minh Ho ,sc khdng bi ky ihj la mdi MSM Nhidu MSM chia se ho gia nhap nhdm vii str dung ATS vdi hy vong se duoc cha'p nhap the'gidi cita ho Chfnh vi bon chau la MSM chau Iu6n c^m lhay x^u hd tui than vdi b^n than minh cho nfin chSu sir dung c^c loai ma tdng hop 66 minh qu6n di n6i bu6n n6i s^u ciJa mmh (MSM, Ha N6i) Tac dong nhdm \di \ itc bai dau sir dung ATS Do nhdm MSM cd ty Ic sir dung ATS cao, gia nhap nhom MSM khien cac Ihanh \'icn cd nguy ca sir dung ma niy va iri sir dung ma niy cao Loai thudc hp diing Mn diiu lien da sd Ik thud'c lac, nhien mdi ty 16 khdng nhd ndi rang ho dung ca thudc lac va da (melhamphetamine dang linh Ih^) Dac bifit, hp thudng dupe sir dung midn phf [An Aku tifin tai noi sinh hoat cdng ddng cua ho Co hdi tidp xiic iSn dSu lien cd thd ia liic dang di choi, tham dtr sinh nhat, Id ici (nd-en, let duong lich), tai cac quan bar hay vti irudng; hodc la du Id khai truong cua hang ciia ban Ho dupe ban be cho/mdi hoac ru de rdi "thir cho biet" Cac ddi tupng nghien ciJu cQng cho bifi'l \k ban be diing nen hp "a dua" theo Hp ddu duac cho mdt lidu ra't nhd de thir, nhu chi du nfi'm (cd the chi la mdt ph^n tu mdt phan nam hoac nhidu nha't la mdt nira vien thud'c) Mac diJ nghien cuu khdng cd sd' lieu ve ty lfi MSM tff chd'i Idi mdi sir dung ATS ciia nhdm song cd the tha'y rang Idi gidi thieu ciia nhdm/ ban be nhdm cd y nghia viec bat dau su dung ATS cua MSM Mot MSM chia se ve Mn dau lifin sudung thudc lac: Co mot anh nhom day thi anh ay di mua ve xong anh ay chia cho, nhiJng ngudi choi lau roi co the can ca vien hoac hon mot vien, nhiing dUa mdi chrt CO the can mgt phan hoac mot phan hai (MSM, Ha Noi), Tuy nhien cd MSM Ihanh phd Hd Chf Minh da neu mpt vi du ve tac ddng lich cue cua nhCmg ban be nhdm viec han che MSM sur dung ATS Hom qua n6 co mua ve nhung ma bon chau bao la thoi ngUng khong choi nffa, thi no cung khong choi (MSM, phd Hd Chi Mmh) Mdi trudng sir dung Nghien cihi cho tha'y vu trudng, quan bar cd vai trd quan trpng vdi MSM Day la noi hp giao luu, hen ho vdi ban be chia se vdi nhiJng ngudi ciing cd xu hudng tinh due vdi hp Tham gia vao nhdm cd the ph^n nao giam dupe ap luc irong cudc sd'ng hang Cac ddi tupng nghidn cffu cho rang quan bar, vu irudng la mdi trudng thuan lpi cho lie'p can va sff dung ATS Mdi MSM d Da Nang da cho rang "minh thd'y nhu Id da sold 114 Nghien cUu Gia dinh vi Gidi QuyS'n 22, so 6, tr 111-118 dimg ATS d n ndng ' Mdi MSM khde d th^nh phd Hd Chf Minh cung cd chung ^ kifi'n: ''Dong !() ngitcyi d vu trudng thi 7-H ngifdi dung Uan chffng irfin cho tha'y vific lifi'p xtic vdi mdi irudng nguy cd cao xung quanh nhom MSM Id nguy ccf cho vific sff diing ATS b nhdm cdng ddng Dia difi'm sff dung ma tiiy Id khde dd'i vdi cdc nhdm MSM khac Mdt sd nhdm su dung phong rifing lai nha cdc ihdnh vjfin M co cao cung Id ly cho \iec su dung ML-thamphelamine nhdm n.iy (Shennan va nhung ngudi khac, 2008) Didu ndy duoc gun thfch rdng ca die cua mdi ngudi chung ta mud'n thfi' hifin la minh hda ddng hay "thudc \d" mdt nhdm nao dd (I kiiiLTty BMK vd R K 1995) Nghifin cull cung chi su anh hudng mang tfnh chd'l vong xoay giua sff dung ATS va dp luc nhdm ciia qudn thfi' ATS D^u lifin, ATS giup ket nd'i hp vdi thdnh nhdm (rii thfim ban be, cd ihfim ban tinh) Sau dd nhdm lai la giup hp u-i vd'n dd sff dung ATS Mdi irong nhung ly giai cho anh hudng ciia ban be Ifin su su dttng ATS irong nhom nhirng Nguye'n Thj Trang Nhung va cac tac gia 117 ngudi dd Id su ky thi hay thifi'u quan Idm ciia gia dinh dd'i vdi nhdm Hifin kht MSM d Vifii Nam \';\ii chira dirpc thffa nhan va dang dupe xem Id mdt benh xa hdi thi nhffng dp lire linh thdn tir mdi trudng bfin ngoai va gia dinh dfi ddn nhffng ngudi vao mdi irudng nguy ca cao (vu trudng, quan bar) va bi Idi ken bdi nhung hanh vi tifiu cue Didu gpi y rang cdc can thifip giam vific sff diing ATS nfin bdt ddu tir su quan tdm ciia gia dinh dd'i vdi MSM hay su giam ky thi d ngoai cdng ddng dd'i vdi qudn thd ndy Kfi't qua nghifin cffu cung chi anh hudng li'ch cue ciia nhdm len han ehd sff diing ATS irong MSM Vi vfly chdng ta cd thd su dung su anh hudng cua ban be Irong nhdm de giao due hodc giam ly lfi sff dting ATS Chung ta cd Ihd hd trp nhung ngudi khdng sff dung ATS dac bifit la nhflng ngudi dffng dau nhdm tuyfin truyen, thdm chi xdy dung van hda "khdng ATS" cac nhdm, hay tuyfin truyen Idc hai cua ATS Mdi didu nua dang luu y irong nghifin cffu la nha nghi dupe chon Id mdt nhung dia didm thudng diing dfi" sff dung ATS ciia cac nhdm Ddy chfnh la mdi irudng thudn lpi gdp phdn cho vific quan hfi tinh due sau sff dung Ihud'c cua cac nhdm Kfi'l qua nghien cffu cung nhu nhidu nghifin cffu tren the' gidi (Semple vd nhffng ngudi khac, 2002; Cheng va nhung ngudi khac, 2010) da chi rdng da sd cac nhdm ddu quan hfi tinh due sau dd vd ho cd thd quan hfi linh due vdi "bd't cff ai", hifin tupng qudn hdn la ph6 bifi'n sau sff dung ATS Va day la nguyen nhan chi'nh cho nguy ca lay truyen HIV irong qudn the Vi vay, viec quan ly cac nhd nghi hay sff dung cac nhan vifin/quan ly nha nghi cho vific tuyfin truydn giam tdc hai ATS can dupe xem xet cac chfnh sach ve ATS Trong khudn khd ctia bai vifi't chiing tdi khdng phdn li'ch sau vd hanh vi tinh due sau su dung ATS cung nhu phan tfch vd nguy ca nhifim HIV trfin nhdm dd'i lupng Can cd nhOng nghifin cffu sdu vd quan hfi linh due ldp the, hanh vi sff dung bao cao su \'a cac rao can tinh due an loan nhdm MSM Han the' nffa, cd ihd xem xet sff diing mot sd thang dinh lupng da dijng dd danh gia anh hudng ciia nhffng ngudi xung quanh tdi vd'n di sff dung Melhamphetamine trfin ihfi'gidi (Koram va nhung ngudi khac, 2011) nhdm cd them nhung bdng chiing cho vific hoach dinh chi'nh sach Kfi't qua nghien cffu nhd'n manh cd su tac ddng nhdm vdi sff dung irong nhdm MSM Dfi' han chfi'vific sff dung hoac su "lay lan" sff diing ATS qudn thd cdn tifi'n hanh cac can thifip kip thdi, chii dfi'n dd'i lupng di'ch khdng chi la nhung ca nhdn ridng bifii ma phai la ca mang ludi xa hdi, cu the la cac dac difi'm v5n hda nhdm Cdn tie'n hanh ludng danh gia, djnh lupng dd so sanh md'i lifin quan giffa sff dung ATS va cdc su anh hudng ciia nhdm." 11 Nghifin cffu Gia dinh vi Gidi Quye'n 22, s6' 6, tr 111-118 Tai 11611 thnm khao Farrcll M cl al 2002 "Melhamphetamine: dmg use and psychoses ^^°^^^^ major public health issue in ihc Asia Pacific region" Addiction 97(7): p UNODC 2011 Wcnid Drug RepoiI 2011 UNODC 2003 Ecstasy and amphetamines Global Survey 2003 Beyrer C et al 2004 "Mclhamphclamine users in northern Thailand: changing demogiaphics and risks for HIV and ^TD among ncatment-secking substance abusers" Iniernalwnal Icmrnal ofSTD & AIDS I5{10): P 697-704 Inglez-Dias A., et al 2008 "Trends in melhamphetamine use in young injection drug usns in San Francisco from 1998 to 2004 the UFO Sludy" Drug and Alcohol Review 27(3): p 286-91 Rawslorne P et al 2007 '•Associations between crystal mclhamphelammc use and polenlially unsafe sexual ;iciivii> among gay men in \uiiralia" Archives ofSe.xual Behavior 36(5): p 646-^4 CDC 2006 "Mclhamphelammc use and HIV iisk bchavion; among heterosexual men—preliminary results from five northcm California counties, December 2001-November 2003" Morbility Moituhty \\,\U\ Report 55{\Qt): p 273-7 UNODC 2012 Cac chfii kich tliich diuig Amphetamine is Vici Nam: mdi danh gi.i miic dd siin CO sff dung Nil tac dong doi vdi siic khi" \-uant0kUi \.ih6i Vici N.un Knowlton A.R W Hua and C Lalkm 20(1? "Social support networks and medical service use among IllV-positivc injection drag users: impliciiions to inier\'ention" AIDS Care, 17(4) p 479-92 Valenle TW 2003 "Social Nciuoik Influences on AdolcsLLiii Substance Use: An Introduction" Coiuiecdons 25(2) p 11 Koram N., ct al 2011 "Role of social network dimensions in the iransition to injection drug use: actions speak louder Ihan words" AIDS Behavior, 15(7): p 1579-88 Sherman S G et al 2008 "Initiation of methamphclamine use among young Thai drug users: AqualiLUivc sludy" Join nai of Adolescent Health 42(1) p 36- 42 Hagerty HMK and P K 1995 "Developing a measure of sense of belonging" Nursing Research, 44(1); p 9-13 Semple S.J., TL Patterson, and Gram 2002 "Motivations as.sociated wiih melhamphetamine use among HIV+ men who have sex with men" / Subsl Abuse Tl eat 220): p 149-56 Cheng W.S., et al 2010 "Binge use and sex and drug use behaviors among HIV(-) heterosexual methamphetamine users in San Diego" Subsi Use Misuse 45il-2): p 116-33  ... tr 111-118 D|t van de Sir diing chfl't ki'ch thi'ch dang Amphetamine (Amphetamine Type Slimukinis - ATS) dang gia liing d c^c nudc DOng Nam A AIS da v^ dang gop phdn lam mflt an ninh irSl tir... nhdm bao gdm c:ic chudn muc, quy dmh hay ddc difim ciia nhdm dd nhu la sudpng vicn hay hd Irp trong nhdm Trong nghifin cffu na> chung tdi tim thdy anh hudng ciia ca ba khi'a canh ndy Ifin vd'n d^... 2002 "Melhamphetamine: dmg use and psychoses ^^°^^^^ major public health issue in ihc Asia Pacific region" Addiction 97(7): p UNODC 2011 Wcnid Drug RepoiI 2011 UNODC 2003 Ecstasy and amphetamines