Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. BRAVO - NCT01936857 , September 2013.

中文翻译：

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越南阿片类药物使用障碍和艾滋病毒患者使用甲基苯丙胺和酒精的情况：一项定性研究

海洛因的使用继续推动越南艾滋病毒的传播，但甲基苯丙胺和酒精的使用正在迅速增长，而且与其他国家一样，多种物质的使用也很普遍。本研究的目的是了解越南阿片类药物使用障碍 (OUD) 和艾滋病毒患者中海洛因、甲基苯丙胺和酒精使用之间的相互作用。我们对在越南五家 HIV 诊所参加丁丙诺啡与美沙酮 BRAVO 试验的 OUD 和 HIV 患者进行了 44 次深入、面对面的定性访谈。访谈调查了参与者使用海洛因、甲基苯丙胺和酒精的经历及其与 HIV/OUD 治疗的相互作用。采访内容经过专业转录并使用主题分析方法进行分析。接受采访的 44 名参与者中有 42 名是男性，平均年龄 38.8 岁，其中 30 名报告有甲基苯丙胺使用史，33 名报告有饮酒史。出现了几个主题：1) 甲基苯丙胺和酒精被认为比海洛因具有更低的成瘾潜力 2) 社会环境是酒精和甲基​​苯丙胺使用的关键促进因素 3) 一些参与者（但不是全部）使用甲基苯丙胺来帮助戒除海洛因 4) 饮酒量减少5) 许多参与者认为使用甲基苯丙胺与艾滋病毒治疗不相容。参与者的经历反映了多物质使用对艾滋病毒和 OUD 治疗的重大影响。人们普遍认为酒精和甲基​​苯丙胺的成瘾性较低，因此多种物质的使用模式受到影响，而这些物质深深地融入了越南许多 OUD 患者的社会生活中。随着越南和全球接受 OUD (MOUD) 药物治疗的人数不断增加，迫切需要采取干预措施来解决复杂的社会规范和多物质使用的潜在危害。BRAVO - NCT01936857，2013 年 9 月。