Paper: "Rice is essential but tiresome; you should get some noodles": Doi Moi and the political economy of men's extramarital sexual relations and marital HIV risk in Hanoi, Vietnam

"Rice is essential but tiresome; you should get some noodles": Doi Moi and the political economy of men's extramarital sexual relations and marital HIV risk in Hanoi, Vietnam

Reference: Phinney HM. "Rice is essential but tiresome; you should get some noodles": Doi Moi and the political economy of men's extramarital sexual relations and marital HIV risk in Hanoi, Vietnam. Am J Public Health. 2008 Apr;98(4):650-60. doi: 10.2105/AJPH.2007.111534. Epub 2008 Feb 28. PMID: 18309136; PMCID: PMC2376991.

Link: https://ajph.aphapublications.org/doi/10.2105/AJPH.2007.111534?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

Abstract

Research from around the world has suggested that married women's greatest risk for contracting HIV is from having sexual intercourse with their husbands. On the basis of 6 months of ethnographic research in Hanoi, Vietnam, I argue that the contemporary nature of the HIV epidemic in Hanoi is shaped by 3 interrelated policies implemented in 1986 as part of the government's new economic policy, Doi Moi (Renovation). Together, these policies structure men's opportunities for extramarital sexual relations and encourage wives to acquiesce to their husbands' sexual infidelity, putting both at risk of HIV. I propose 4 structural intervention strategies that address the policies that contribute to men's opportunities for extramarital liaisons and to marital HIV risk.

Important quotations:

INTRODUCTION

Ethnographic and epidemiological research from around the world has suggested that married women’s greatest risk for contracting HIV is from having unprotected sexual intercourse with their unfaithful husbands and from the differential power relationship between husbands and wives.1

Public health officials in Vietnam recognize married men to be a bridge between sex workers (1 of the 3 populations in Vietnam with high HIV/AIDS prevalence rates) and their wives.2

Current medical anthropological theory and research recognize that behavioral and cultural approaches to preventing HIV transmission are limited because of their focus on the individual and advocate a broader structural approach that takes into account social and economic factors that shape individual risk.5

The majority of our informants responded with comments such as, “Vietnamese men, like all Southeast Asian men, need and like to experience new and exotic things,” or “Men need more sex than women.”

HIV INFECTION IN VIETNAM

The first case of HIV infection in Vietnam was reported in 1990 in Ho Chi Minh City. By 1999, HIV infection had been reported in all 61 provinces of the country.

From the mid- to late 1990s the epidemic was mainly driven by injection drug use (heroin) among young urban men, who accounted for as much as 80% of reported HIV cases. 

More recently, the epidemic has developed among female sex workers, injection drug users’ female partners and their children, and urban men who have sexual intercourse with other urban men. In September 2005, the Ministry of Health announced that injection drug use, sex work, and husband-to-wife transmission were fueling the Vietnamese epidemic.11

It currently is estimated that 100 people are infected daily and that the number of infections caused by sexual transmission is higher than those caused by injection drug use.12 

The 2006 United Nations Programme on HIV/AIDS update estimated that there were 37 000 new HIV cases in 2005 and that the number of people living with HIV infection more than doubled between 2000 and 2006, from 122 000 to 280 000. 

The epidemic continues to move into the general population and shows no sign of abating. 

Prevention of HIV has been hampered by government policies that stigmatize individuals who engage in behaviors that put them at risk of HIV infection.13

DOI MOI’S GENDERED MARKET ECONOMY

The result of the sexualization of men’s leisure and societal pressures to engage in masculinity that is based on the demonstration of one’s ability to enjoy women outside the home is putting men at risk of contracting HIV from sex workers and other young women positioned to attract men to commercial establishments and, thus, at risk of transmitting HIV to their wives.

A common factor underlying men’s infidelity in our study was the role of the market economy in shaping men’s opportunities for, access to, and personal motivations for extramarital sexual relations in 3 ways. First, the global market economy has led to the commercialization and sexualization of men’s leisure in Hanoi.20 Compared with past generations, men today are more likely to spend their leisure time and disposable income at establishments that use women to attract customers.21 Second, the market economy has produced a new male identity that links consumption to sexual activity. Third, Hanoians have more time and money than they did before Doi Moi, which enables them to consume the goods marketed to them.

*By sexualization, I mean providing sex workers or other women as part of a customer’s options.

Not all men go out looking for sexual intercourse; a few of our male informants spoke of being pressured to enjoy the services of young women or sex workers when socializing with other men. A private driver (aged 26 years) stated, “If a pretty girl sits on my lap and I refuse her she will ask me if I am crazy or if I lost my penis or whether it does-n’t work anymore.” 

The result of the sexualization of men’s leisure and societal pressures to engage in a masculinity that is based on the demonstration of one’s ability to enjoy women outside the home is putting men at risk of contracting HIV from sex workers and other young women positioned to attract men to commercial establishments and, thus, at risk of transmitting HIV to their wives.

1986 LAW ON MARRIAGE AND THE FAMILY AND THE HAPPY FAMILY CAMPAIGN

Although bearing and raising children has always been key to a woman’s familial and social status in Vietnam,38 a consequence of the patrilineal and patrilocal kinship system, women’s reproductive role has become intensified under Doi Moi.39 This is a result of the government establishing the household as the primary economic unit, making the family, rather than the commune or nation, the focus of state-building efforts. Two Doi Moi policies in particular serve to intensify women’s focus on motherhood and family: (1) the 1986 Law on Marriage and the Family, which garnered public discussion and acknowledgment that women’s identity is first and foremost grounded in being a mother, and (2) the Happy Family campaign, the new population policy that links the nation’s efforts to modernize to couples’ ability to create “happy, wealthy, harmonious, and stable families.”40

In contrast with trends around the world, in which companionship is a “deliberate goal of marriage” and “individual fulfilment and satisfaction rather than (or in addition to) social reproduction” define the marital project,41 the underlying criteria for the Vietnamese Happy Family policy is determined by the success of the marital project itself, a project our informants described in terms of social reproduction and economic stability, not individual or couple satisfaction. These attitudes were reflected in their notions of the ideal spouse, shared topics of conversation, how they spend time together, and their definitions of marital fidelity.

This kind of activity doesn’t have much impact on our families. A husband’s job is to provide for the family, to make sure his children are well brought up. And, the relationships men have with sex workers are short and cho vui [for fun] only.

According to these men, a sex worker posed no risk to family stability. Taking a lover, on the other hand, risks draining a man’s resources if he should become emotionally involved or if she should become pregnant. Ironically, extramarital sexual relations with commercial sex workers enable husbands to enjoy “erotic sex” that they believed did not pose a risk to family happiness. However, the shared silence around men’s extramarital sexual activities does pose a threat to wives through risk of HIV infection.

Not all men go out looking for sexual intercourse; a few of our male informants spoke of being pressured to enjoy the services of young women or sex workers when socializing with other men. A private driver (aged 26 years) stated, “If a pretty girl sits on my lap and I refuse her she will ask me if I am crazy or if I lost my penis or whether it doesn’t work anymore.” 

The unintended irony of this marital project is that it structures men’s opportunities for engaging in extramarital liaisons in ways that put men and their wives at increased risk of HIV infection. This is because the Happy Family and marital fidelity are ultimately defined not in terms of sexuality but in terms of economics. 

One young newlywed said she had no idea what her husband did at work or with his friends. She did not ask; she just had to trust him. When we inquired about shared topics of conversation, all our informants responded that they principally discuss family issues: household finances, upkeep of the house, children’s education, and extended-family members. Romance, sexuality, and their relationship were typically not discussed.

Thus, whereas Doi Moi policies have driven men into the commercial economy for status and leisure activities, they tend to reinforce women’s orientation to the home, allowing husbands’ greater access to extramarital sexual liaisons without the risk of being caught by their wives. Furthermore, economic and social restructuring have led to wives’ dependency on the marital unit, inhibiting their ability to protect themselves from HIV infection and other sexually transmitted diseases within marriage.

POPULATION MOVEMENT, PUBLIC AND PRIVATE SPACE, AND MORAL ISSUES

“Rice is essential but tiresome; you should get some noodles.” As this joke implies, your spouse is your rice (com), but is bland and gets tiresome, so you should go out for some noodle soup (pho). Pho is sweet and delicious. Like men’s opportunities for new kinds of sexual experiences, pho became more available outside the home in the mid-1990s when this saying began to circulate in Hanoi.54 This joke foreshadowed increasing economic freedom and a modern male masculinity that for some would become increasingly linked to the global economy, consumption, and sexuality. It also speaks to shifting marital ideals and a changing urban environment. These social changes have been shaped by the state’s decision to loosen its direct control over population movement and public and private spaces. In the process, despite its efforts to the contrary, the state is losing command over moral issues.55 These factors have contributed to the ease with which married men seek extramarital sexual relations and have hampered efforts to reduce heterosexual HIV transmission.

The government does make sporadic attempts to crack down on prostitutes. For instance, in its efforts to stop the transmission of HIV, the government issued the Three Reductions Campaign, which labels sex work as 1 of its 3 evils. The problem is that criminalization of sex workers portrays sex workers—not their clients—as the source of the problem, which allows men to deny the social (or medical) harm that results from their extramarital trysts. The inability or unwillingness of the state to sanction men directly and its passive accommodation in the development of the sex industry suggests a loss of control over “immoral” behavior.

POLICY RECOMMENDATIONS

Unless efforts are undertaken to change the structural factors that shape men’s opportunities for extramarital sexual relations, it will be difficult for men, sex workers, and married women to change their sexual behavior and reduce their HIV risk. I recommend a strategy that works with the private business sector and mass governmental organizations.

Our research demonstrated that many of our male informants were continually asked to participate in homosocial sexualized leisure activity as part of their company’s business practices. A structural approach to HIV prevention would strive to find alternative means for businesses to become economically competitive in the marketplace without having to provide women to their clients—for the men who engage in business transactions and for the commercial establishments that provide sexual services. The business community should take responsibility for the way it structures men’s opportunities for extramarital sexual relations.

A second recommendation is to create new work-based patterns of sociality that focus on heterosociality rather than on homosociality. Research has indicated that married couples who spend time with other married couples in social situations and who know each other’s families are less likely to engage in extramarital sexual relations than do men who do not know each other’s spouses.65 A promising project in Uganda that promotes heterosociality suggests that if men socialize with one another’s wives, they may be less likely to engage in homosocial behavior that enables infidelity.66 In turn, commercial establishments will begin to recognize a shift in demand for spaces that are enticing to men and their wives. The goal is to transform the social conditions that enable infidelity to take place.

A third recommendation is for mass organizations such as the Youth Union, the Women’s Union, and the Farmer’s Union to make men responsible for sexual fidelity, not just economic fidelity. First, the government could make it legal for all commercial establishments that offer private spaces for sexual intercourse and sex workers to sell condoms.67 This would place condoms in locations where they need to be used and help make men responsible for their actions rather than the sex workers who are in an unequal power relationship with their clients. Second, the Women’s Union should cease propaganda that enables a public discourse that places responsibility for men’s sexual transgressions on their wives.

Finally, the United States government should rescind its antiprostitution pledge, which requires the President’s Emergency Plan for AIDS Relief recipients to declare their opposition to commercial sex work, and should instead work with the Vietnamese government on decriminalizing sex work so that the responsibility for marital HIV transmission is directed at men and not at sex workers.68 Taking a structural approach to HIV prevention will alter the factors that make changing risky behaviors difficult.

1. Women and HIV/AIDS: Confronting the Crisis (New York: Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, and United Nations Development Fund for Women, 2004); Economic and Social Progress in Jeopardy: HIV/AIDS in the Asian and Pacific Region, ST/ESCAP/2251 (New York: United Nations Economic and Social Commission for Asia and the Pacific, 2003); Ministry of Health/Family Health International, “HIV/AIDS Estimates and Projections 2005–2010,” http://www.unaids.org.vn/resource/topic/epidemiology/e%20&%20p_english_final.pdf (accessed September 5, 2006); United Nations Programme on HIV/AIDS Vietnam. “Key Messages,” http://www.unaids.org.vn (accessed September 5, 2006); J.R. Glynn et al., “HIV Risk in Relation to Marriage in Areas With High Prevalence of HIV Infection,” Journal of Acquired Immune Deficiency Syndromes 33 (2003): 526–535; J.R. Glynn et al., “Why Do Young Women Have a Much Higher Prevalence of HIV Than Young Men? A Study in Kisumu, Kenya and Ndola, Zambia,” Journal of Acquired Immune Deficiency Syndromes 15, suppl. 4 (2001): S51–S60; Ann O’Leary, “Women at Risk for HIV From a Primary Partner: Balancing Risk and Intimacy,” Annual Review of Sex Research 11 (2000): 191–234; S. Newmann et al., “Marriage, Monogamy and HIV: A Profile of HIV-Infected Women in South India,” International Journal of STD & AIDS 11 (2004): 250–253. Google Scholar

2. T.N. Tran et al., “Drug Use, Sexual Behaviors and Practices Among Female Sex Workers in Hanoi, Vietnam—a Qualitative Study,” International Journal on Drug Policy 15 (2004): 189–195. Crossref,

5. See Richard Parker, “Sexuality, Culture and Power in HIV/AIDS Research,” Annual Review of Anthropology 30 (2001): 163–179; John H. Gagnon and Richard G. Parker, “Conceiving Sexuality,” in Conceiving Sexuality: Approaches to Sex Research in a Postmodern World, ed. Richard G. Parker and John H. Gagnon (New York: Routledge, 1995); Richard Parker, Regina Maria Barbosa, and Peter Aggleton, Framing the Sexual Subject: The Politics of Gender, Sexuality, and Power (Berkeley: University of California Press, 2000). Google Scholar