Văn hóa nhóm và việc sử dụng chất kích thích dạng Amphetamine trong nhóm nam tình dục đồng giới tại Việt Nam

Nghi§n edu<br /> Gia dinh va Gidi<br /> So 6 -2012<br /> <br /> <br /> <br /> <br /> Van hoa nhom va viec sur dung<br /> chat hjch thich dang Amphetamine trong<br /> nhdm nam tinh due dong gidi tai Viet Nam<br /> <br /> Nguyen Thj Trang Nhung, Tran Thj Diep, Hd Thj Hien<br /> Trircfng Dai hoc Y16' Cong cong<br /> Bui Thj Minh Hao, Tran Thi Hda<br /> Tmng tSm Nghien cifu va Dao tao H!V/AIDS, Tri/ong Dai hoc Y Ha Npi<br /> <br /> <br /> <br /> Tom tat: Viec sd dung chat kich thfch dang Amphetamine<br /> (ATS) dang trd thanh mot van de xa hoi va y te cong cong. Cac<br /> nghien ciiu gan day ciing chi ra su gia tang ciia xu huSng sii<br /> dung ATS trong khu vUc, dac biet cl cac thanh pho' li3n va tiep<br /> theo do la cac hau qua cua ATS do'i vdi ca nhan va xa hgi. Nam<br /> tinh due dong gi6i (MSM) la mot trong nhflng doi tUcfng co nguy<br /> cU cao v6i sd dung ATS. DUa tren viec phan tich so'Heu dmh tinh<br /> thu dUdc qua cac cugc phong va'n sau 40 MSM da va dang sii<br /> dung ATS c( Ha Noi, Da Ning va thanh pho'Ho Chi Mmh trong<br /> khuon kho mgt nghien cUu Idn do Cd quan Phong cho'ng ma tiiy<br /> va toi pham ciia Lien hiep quo'c (UNODC) tai trg, bai vi§'t nhSm<br /> mo ta van hoa nhom trong viec sii dung va duy tri sii dung ciia<br /> ATS. Ket qua phan tich cho thay nh6m co mgt vai tro quan<br /> trgng trong viec bdt diu va duy tri sii dung ATS. Ban be trong<br /> nhom ia ngUcli gidi thieu MSM bat dau dung ATS; nhom giiip hg<br /> duy tri "cugc so'ng co ATS" nhU hiin tien mua thuoc, di mua<br /> thuo'c cho cac thanh vien nhom va quan he tinh due tap th^<br /> trong nhom, Cac can thiep nham giam tac hai lien quan de'n sil<br /> dung ATS can phii hdp vfli van hoa nhom MSM va chu y tdi y§'u<br /> to'tac dgng ciia nhom.<br /> <br /> Tijf khoa: MSM; Nam quan hg tinh due dong gidi; ATS; Thuoc<br /> lac; Da; Tac dgng nhom.<br />  112 Nghi^ncUuGiadlnh vdGidi. Quy6'n22, s6'6, tr. 111-118<br /> <br /> <br /> 1. D|t van de<br /> Sir diing chfl't ki'ch thi'ch dang Amphetamine (Amphetamine Type<br /> Slimukinis - ATS) dang gia liing d c^c nudc DOng Nam A. AIS da v^<br /> dang gop phdn lam mflt an ninh irSl tir cho c^c nud-c trong khu vtrc cung<br /> nhu dang trd ihiinh mdi vrin d^ y tC c6ng cdng can duac quan i.im<br /> (Farrell vii nhQ-ng ngu6i khac, 2002; UNODC, 2003). ATS gay ra cdc r6i<br /> loan lam Ihdn kinh nhu iritm cam. lo au (UNODC, 2003; licyrcr va<br /> nhffng ngudi khiic, 2004). Ngoai ra cung cd nhidu nghidn cihi chi ra c6<br /> mO'i lien quan giffa sir diing ATS vk bj mac cac bfinh vifim nhl^m lay qua<br /> dudng tinh due (Bcyrcr vii nhung ngu6i kh.ic, 2004; Inglcz-Dias va<br /> nhung ngudi khde. 2008).<br /> <br /> MSM Ik mOl trong nhffng nhdm cd nguy ctt cao doi vcri su dung ATS<br /> (Inglez-Dias vii nhffng ngudi khac. 2008: Rawsiomc, 2007) .ATS cd lac<br /> dimg lam tang hung phan u'nh diic, khien ngudi .sir dttng cd ihft quan hi<br /> tinh due tap ih^ vk khdng sii dung bao cao su. Vi vfly sit dung ATS 1^ yfi'u<br /> 16' nguy ca vdi HIV trong nhdm MSM vk ra ngo^l cdng ddng (CDC. 2006).<br /> Bai viel md la van hda nhdm vh phan lich lac dong ciia nhdm trong vific<br /> sir dung v^ duy iri sir dung AIS Irong nhdm MSM Kci qua nghien ctJu se<br /> cung ca'p bang chimg cho vific \;ty diJng cAc can ihifip giam lac hai phii<br /> hop cho ngudi su dung .MS Ki M.SM<br /> Nghien cihi ap dung ihifi't kfi'djnh linh. Co 40 cudc phong vS'n sau nam<br /> quan hfi tinh diic ddng gidi tt.l v.i dang stir dung ma liiy tdng hc^ tai 3 ihanh<br /> phd: Hk Ndi, Da NSng \ ;i ihiinh phd H6 Chf Mmh S lifiu duoc phan li'ch<br /> Iheo chu d^ sir dung phdn in6m NVIVO 8.0.<br /> <br /> 2. Ket q u a<br /> <br /> Siir d u n g A F S t r o n s n h d m M S M<br /> <br /> Vice sir dung ATS irong nhdm MSM la tuong dd'i phd bifi'n. Nhicu dd'i<br /> lucmg tham gia plumg \;in s.ui (3/4) ndi ring ly le dung thudc lac irong<br /> nhdm MSM kha cao. Mm sd MSM trong nghifin cihi con ndi thfim rSng<br /> khdng cd su khac bifit \'e ly 10 sir dung ATS giffa cac nhdm ddng tfnh khde<br /> nhau. MSM cd sir dung ATS bao gdm nhidu thanh phin khac nhau nhu<br /> "bdng kin", "bdng Id"; can bd cdng chiic, hoc sinh v^ sinh vifin. Dd iu6i<br /> su dung ATS trong cdc nhdm ddng tfnh cung da dang:<br /> Trong nh6m em c6 10 ngudi thi 7-8 ngudi si^ dyng Ihufic tac (MSM, Da Ning)<br /> DLI loai thanh phSn d6,... thSnh phan thudng dan, bSc sT, ky su cung c6 choi<br /> rdi nhifng ba gia d6 cung choi (MSM, TP H6 Chi Minh).<br />  NHiiyrn Thi Trang Nhung va cac tac gia 113<br /> <br /> Gia nhap nhdm MSM Ik mdi nhu cSu ciia MSM de duoc khang djnh<br /> minh. Ho ,sc khdng bi ky ihj la mdi MSM. Nhidu MSM chia se. ho gia<br /> nhap nhdm vii str dung ATS vdi hy vong se duoc cha'p nhap trong the'gidi<br /> cita ho.<br /> Chfnh vi bon chau la MSM chau Iu6n c^m lhay x^u hd tui than vdi b^n than<br /> minh cho nfin chSu sir dung c^c loai ma tuy tdng hop nay 66 minh qu6n di n6i<br /> bu6n n6i s^u ciJa mmh (MSM, Ha N6i)..<br /> <br /> Tac dong nhdm \di \ itc bai dau sir dung ATS<br /> Do nhdm MSM cd ty Ic sir dung ATS cao, gia nhap nhom MSM khien<br /> cac Ihanh \'icn cd nguy ca sir dung ma niy va duy iri sir dung ma niy cao.<br /> Loai thudc hp diing Mn diiu lien da sd Ik thud'c lac, tuy nhien mdi ty 16<br /> khdng nhd ndi rang ho dung ca thudc lac va da (melhamphetamine dang<br /> linh Ih^). Dac bifit, hp thudng dupe sir dung midn phf [An Aku tifin tai noi<br /> sinh hoat cdng ddng cua ho. Co hdi tidp xiic iSn dSu lien nay cd thd ia liic<br /> dang di choi, tham dtr sinh nhat, Id ici (nd-en, let duong lich), tai cac quan<br /> bar hay vti irudng; hodc la du Id khai truong cua hang ciia ban. Ho dupe<br /> ban be cho/mdi hoac ru de rdi "thir cho biet". Cac ddi tupng nghien ciJu<br /> cQng cho bifi'l \k do ban be diing nen hp "a dua" theo. Hp ddu duac cho<br /> mdt lidu ra't nhd de thir, nhu chi du nfi'm (cd the chi la mdt ph^n tu. mdt<br /> phan nam hoac nhidu nha't la mdt nira vien thud'c).<br /> <br /> Mac diJ nghien cuu nay khdng cd sd' lieu ve ty lfi MSM tff chd'i Idi mdi<br /> sir dung ATS ciia nhdm. song cd the tha'y rang Idi gidi thieu ciia nhdm/ ban<br /> be trong nhdm cd y nghia trong viec bat dau su dung ATS cua MSM. Mot<br /> MSM chia se ve Mn dau lifin sudung thudc lac:<br /> Co mot anh 6 trong nhom day thi anh ay di mua ve xong anh ay chia cho,<br /> nhiJng ngudi choi lau roi co the can ca vien hoac hon mot vien, con nhiing dUa<br /> mdi chrt CO the can mgt phan hoac mot phan hai (MSM, Ha Noi),<br /> <br /> Tuy nhien. cd MSM trong Ihanh phd Hd Chf Minh da neu ra mpt vi du<br /> ve tac ddng lich cue cua nhCmg ban be trong nhdm trong viec han che<br /> MSM sur dung ATS.<br /> Hom qua n6 co mua ve nhung ma bon chau bao la thoi ngUng khong choi nffa,<br /> thi no cung khong choi (MSM, thanh phd Hd Chi Mmh).<br /> <br /> Mdi trudng sir dung<br /> Nghien cihi nay cho tha'y vu trudng, quan bar cd vai trd quan trpng vdi<br /> MSM. Day la noi hp giao luu, hen ho vdi ban be. chia se vdi nhiJng ngudi<br /> ciing cd xu hudng tinh due vdi hp. Tham gia vao nhdm cd the ph^n nao<br /> giam dupe ap luc irong cudc sd'ng hang ngay. Cac ddi tupng nghidn cffu<br /> cho rang quan bar, vu irudng la mdi trudng thuan lpi cho lie'p can va sff<br /> dung ATS. Mdi MSM d Da Nang da cho rang "minh thd'y nhu Id da sold<br />  114 Nghien cUu Gia dinh vi Gidi QuyS'n 22, so 6, tr. 111-118<br /> <br /> <br /> dimg ATS d vn n ndng ' Mdi MSM khde d th^nh phd Hd Chf Minh cung<br /> cd chung ^ kifi'n: ''Dong !() ngitcyi d vu trudng thi 7-H ngifdi dung . Uan<br /> chffng irfin cho tha'y vific lifi'p xtic vdi mdi irudng nguy cd cao xung quanh<br /> nhom MSM Id nguy ccf cho vific sff diing ATS b nhdm cdng ddng nay.<br /> Dia difi'm .sff dung ma tiiy Id khde nhau dd'i vdi cdc nhdm MSM khac<br /> nhau. Mdt .sd nhdm su dung phong rifing lai nha cdc ihdnh vjfin. M co cao cung Id ly do cho \iec su dung<br /> ML-thamphelamine trong nhdm n.iy (Shennan va nhung ngudi khac,<br /> 2008). Didu ndy duoc gun thfch rdng ca die cua mdi con ngudi chung ta<br /> mud'n thfi' hifin la minh hda ddng hay "thudc \d" mdt nhdm nao dd<br /> (I kiiiLTty BMK vd R K.. 1995)<br /> Nghifin cull nay cung chi ra su anh hudng mang tfnh chd'l vong xoay<br /> giua sff dung ATS va dp luc nhdm ciia qudn thfi' ATS. D^u lifin, ATS giup<br /> ket nd'i hp vdi nhau thdnh nhdm (rii thfim ban be, cd ihfim ban tinh). Sau<br /> dd nhdm lai la giup hp duy u-i vd'n dd sff dung ATS. Mdi irong nhung ly<br /> giai cho anh hudng ciia ban be Ifin su su dttng ATS irong nhom nhirng<br />  Nguye'n Thj Trang Nhung va cac tac gia 117<br /> <br /> ngudi nay dd Id su ky thi hay thifi'u quan Idm ciia gia dinh dd'i vdi nhdm<br /> Hifin nay. kht MSM d Vifii Nam \';\ii chira dirpc thffa nhan va dang dupe<br /> xem Id mdt benh trong xa hdi thi nhffng dp lire linh thdn tir mdi trudng bfin<br /> ngoai va gia dinh dfi ddn nhffng ngudi nay vao mdi irudng nguy ca cao (vu<br /> trudng, quan bar) va bi Idi ken bdi nhung hanh vi tifiu cue. Didu nay gpi y<br /> rang cdc can thifip giam vific sff diing ATS nfin bdt ddu tir su quan tdm ciia<br /> gia dinh dd'i vdi MSM hay su giam ky thi d ngoai cdng ddng dd'i vdi qudn<br /> thd ndy.<br /> <br /> Kfi't qua nghifin cffu cung chi ra anh hudng li'ch cue ciia nhdm len han<br /> ehd sff diing ATS irong MSM. Vi vfly. chdng ta cd thd su dung su anh<br /> hudng cua ban be Irong nhdm de giao due hodc giam ly lfi sff dting ATS.<br /> Chung ta cd Ihd hd trp nhung ngudi khdng sff dung ATS. dac bifit la nhflng<br /> ngudi dffng dau nhdm. tuyfin truyen, thdm chi xdy dung van hda "khdng<br /> ATS" trong cac nhdm, hay tuyfin truyen Idc hai cua ATS.<br /> Mdi didu nua dang luu y irong nghifin cffu nay la nha nghi dupe chon<br /> Id mdt trong nhung dia didm thudng diing dfi" sff dung ATS ciia cac nhdm.<br /> Ddy chfnh la mdi irudng thudn lpi gdp phdn cho vific quan hfi tinh due sau<br /> khi sff dung Ihud'c cua cac nhdm. Kfi'l qua nghien cffu nay cung nhu nhidu<br /> nghifin cffu tren the' gidi (Semple vd nhffng ngudi khac, 2002; Cheng va<br /> nhung ngudi khac, 2010) da chi ra rdng da sd cac nhdm ddu quan hfi tinh<br /> due sau dd vd ho cd thd quan hfi linh due vdi "bd't cff ai", hifin tupng qudn<br /> hdn la ph6 bifi'n sau khi sff dung ATS. Va day la nguyen nhan chi'nh cho<br /> nguy ca lay truyen HIV irong qudn the nay. Vi vay, viec quan ly cac nhd<br /> nghi hay sff dung cac nhan vifin/quan ly nha nghi cho vific tuyfin truydn<br /> giam tdc hai ATS can dupe xem xet trong cac chfnh sach ve ATS.<br /> Trong khudn khd ctia bai vifi't nay chiing tdi khdng phdn li'ch sau vd<br /> hanh vi tinh due sau khi su dung ATS cung nhu phan tfch vd nguy ca<br /> nhifim HIV trfin nhdm dd'i lupng nay. Can cd nhOng nghifin cffu sdu vd<br /> quan hfi linh due ldp the, hanh vi sff dung bao cao su \'a cac rao can tinh<br /> due an loan trong nhdm MSM. Han the' nffa, cd ihd xem xet sff diing mot<br /> sd thang do dinh lupng da dijng dd danh gia anh hudng ciia nhffng ngudi<br /> xung quanh tdi vd'n di sff dung Melhamphetamine trfin ihfi'gidi (Koram va<br /> nhung ngudi khac, 2011) nhdm cd them nhung bdng chiing cho vific hoach<br /> dinh chi'nh sach.<br /> Kfi't qua nghien cffu nay nhd'n manh cd su tac ddng nhdm vdi sff dung<br /> irong nhdm MSM. Dfi' han chfi'vific sff dung hoac su "lay lan" sff diing ATS<br /> trong qudn thd nay cdn tifi'n hanh cac can thifip kip thdi, chii trong dfi'n dd'i<br /> lupng di'ch khdng chi la nhung ca nhdn ridng bifii ma phai la ca mang ludi<br /> xa hdi, cu the la cac dac difi'm v5n hda nhdm. Cdn tie'n hanh do ludng danh<br /> gia, djnh lupng dd so sanh md'i lifin quan giffa sff dung ATS va cdc su anh<br /> hudng ciia nhdm."<br /> 11 8 Nghifin cffu Gia dinh vi Gidi. Quye'n 22, s6' 6, tr. 111-118<br /> <br /> <br /> Tai 11611 thnm khao<br /> Farrcll. M . cl al. 2002. 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