Co ´ vay co ´ tra ; (What goes around comes around): culture, risk and vulnerability to blood-borne viruses among ethnic Vietnamese injecting drug users HIEN THI HO 1 & LISA MAHER 2 1 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia and Hanoi School of Public Health, Vietnam, and 2 National Centre in HIV Epidemiology and Clinical Research and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia Abstract Introduction and Aims. Ethnic and cultural differences in vulnerability to drug-related harms have received little attention in Australia. The current study aimed to explore the influence of cultural beliefs and practices on vulnerability to blood-borne viral infections (BBVIs) among ethnic Vietnamese IDUs and to identify barriers to this group accessing health and preventive programmes. Design and Methods. Observational fieldwork and in-depth interviews (n ¼ 58) were conducted in South Western Sydney. Participants were recruited using a mix of snowball and theoretical sampling strategies. Open coding was used to inductively classify data into themes and data examined for regularities and variations in relationships between and within themes. Results. Participants embraced pluralistic approaches to prevention, diagnosis and treatment, relying on co-existing layers of beliefs and utilising both traditional and western remedies. Four main cultural characteristics influenced vulnerability to BBVIs: trust and obligation, stoicism, the importance of ‘face’ and beliefs in fate. Other factors influencing injecting risk included low levels of knowledge, being in a state of withdrawal, availability of sterile injecting equipment and environmental constraints. Barriers to accessing services included stigma and discrimination, concerns in relation to confidentiality, long waiting times, resistance to pharmacotherapy treatment and language and financial barriers. Discussion and Conclusions. Results indicate a need for interventions based on culturally specific meanings and contexts of health, illness and risk. By understanding how culture impacts risk and protective behaviours among ethnic Vietnamese IDUs, clinicians and other service providers will be better equipped to meet the needs of this vulnerable group. [Ho HT, Maher L. Co ´ vay co ´ tra ; (What goes around comes around): culture, risk and vulnerability to blood-borne viruses among ethnic Vietnamese injecting drug users. Drug Alcohol Rev 2008;27:420–428] Key words: culture, injecting, hepatitis C, HIV, risk, Vietnamese. Introduction Vietnam is experiencing an epidemic of HIV among injecting drug users (IDUs) [1 – 3]. By the end of 2005, an estimated 260 000 adults and children were living with human immunodeficiency virus (HIV) [4]. Fifty to 60% of those reported to be living with HIV in Vietnam are injecting drug users (IDUs) [5], and prevalence rates of more than 59% have been observed among IDUs in Hai Duong, Hai Phong, Quang Ninh and Ho Chi Minh City [3]. In contrast, Australia has an international reputation for its achievements in the area of harm reduction and HIV prevalence among IDUs has remained consistently at less than 2% [6]. However, in Victoria, almost a third of 38 HIV notifications between 1996 and 2001 among IDUs with no history of male-to-male sex involved people born in Vietnam, Laos or Cambodia, with 29% reporting Vietnam as their country of birth [7]. A study of Vietnamese Australians diagnosed with HIV in Victoria found that IDU cases diagnosed in 2000 – 01 were significantly younger than those diagnosed over the previous four years (median age 23.5 years versus Received 27 March 2007; accepted for publication 7 September 2007. Hien Thi Ho, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia and Hanoi School of Public Health, Vietnam, Lisa Maher, National Centre in HIV Epidemiology and Clinical Research and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. Correspondence to Associate Professor Lisa Maher, National Centre in HIV Epidemiology and Clinical Research, Level 2, St Vincent’s Medical Centre, 376 Victoria Street, Darlinghurst, NSW 2010, Australia. E-mail: L.Maher@unsw.edu.au Drug and Alcohol Review (July 2008), 27, 420–428 ISSN 0959-5236 print/ISSN 1465-3362 online/08/040420–09 ª Australasian Professional Society on Alcohol and other Drugs DOI: 10.1080/09595230801914743