Confluence and consequence: globalisation, viscosities and transformation of HIV risk environments in Vietnam
Creators: name: Griffiths, Patrick
Publisher: name: RMIT University
Year: 2024

description: This thesis shows that illicit drug consumers in Vietnam who administer product via injection are vulnerable actors in a paradoxical global/local phenomenon rooted in historical complexities of globalisation. Therefore, responsibility for HIV risks should be shifted upstream from the level of individuals toward institutional processes that manufacture environments of harm. At the global level, the UN Milennium Development Goals do not provide the required level of leadership on HIV prevention for drug injectors. Association between globalisation, opiates and blood-born disease in Vietnam is not new and is inseparable from historical transportation, migration and trade processes. As a key locale in the Cold War, after 1975, and 1979 in particular, Vietnam was 'at distance' from increasing intra-regional trade flows across its western frontiers and northern border. As a consequence, it was hermetically sealed to nearby HIV sub-epidemics unfolding among heroin consumers. A latent HIV risk environment awaited Vietnam should geopolitical grievances be resolved and it became re-integrated among Mekong sub-regional flows. Neo-liberal financial flows returned to Vietnam in 1993 and the Mekong was spanned in 1994. In 1995 it normalised relations with the United States, joined ASEAN and announced the resurrection of transportation linkages across the northern border with China. Mid-decade, its borders were made more porous at the same time as local opium production was reduced as part of the UN global programme against drugs. Exploiting enhanced trans-boundary mobilities intended for goods, opiate traffickers quickly transformed Vietnam into a transit nation and a market for high-quality heroin well suited to a youthful population experiencing socio-economic change including new consumerism. Following traditional pathways, a radical transformation in the fluidity of drug consumption environs ensued, enabling more widespread and efficient flows of blood across complex boundaries. Analysis reveals that a spatio-temporal confluence of structural factors has created conditions which enabled this process. These factors are overlapping and they range from global influences, such as the collapse of the USSR, to micro-economic reform such as privatisation and modernisation of the domestic pharmaceutical sector. The transformation in opiate consumption from injecting opium to heroin injecting occurred faster than expert-driven prevention systems responded, even in time and space where this was most foreseeable. Although the opiate transformation was highly predictable, there has been a time-lag of almost a decade between risk transformations and policy responses equated with harm reduction principles. The thesis shows that blame for HIV sub-epidemics in Vietnam should not be attributed to vulnerable youths and young adults. Expert-driven economic transition associated with global intergration has manufactured circumstances in which drug availability has risen dramatically at a time when employment growth has been insufficient and a commercial sex industry has expanded. This research confirms the importance of new methods of risk environment analyses, particularly in relation to trans-boundary hazards associated with global flows, including trade and human mobilities.