FRAMING HEALTH MATTERS
"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
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. (Am J Public Health. 2008; 98:650-660. doi:10.2105/AJPH.2007.111534)
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] In Vietnam, married women are at risk of HIV infection because of their husbands' infidelity and inconsistent or no condom use. 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] Significant research has been conducted on the epidemiological, behavioral, and cultural attributes of sexual behavior in Vietnam.[3] Many of these studies and the participants of my study have pointed to Doi Moi (Renovation), the policy the government promulgated in 1986 to transform the Vietnamese economy, as a critical factor that is shaping the current context of the HIV/AIDS epidemic. Yet, there has been little specific explication of how the policies and processes of Doi Moi facilitate and structure the possibilities for men's extramarital sexual relations.[4]
Doi Moi policies unintentionally contribute to marital HIV risk by silently condoning and facilitating opportunities for men's extramarital sexual relations in Hanoi. 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] Historical and anthropological research on Vietnamese families, reproduction, and sexuality has demonstrated the extent to which people's intimate and private desires, sexual realities, and moralities reflect political and economic policies as well as cultural values at specific moments in time.[6] This research also has drawn attention to the ways in which unequal gender relations are socially, economically, and politically organized. Accordingly, to understand how married women and men are at risk of contracting HIV from husbands' extramarital sexual relations, we need to focus on men's behavior, but we must do so by recognizing that men's extramarital sexual relations are not simply the product of individual decisionmaking or moral failings. They are a gendered part of social organization and, in the case of Vietnam, the unintended effect of state policies.
I argue that the contemporary nature of the HIV epidemic in Hanoi has been shaped by 3 interrelated policies implemented by the Vietnamese government as part of Doi Moi: (1) the decision to shift from a socialist economy to a market-oriented economy, (2) the Happy Family campaign, and (3) a lessening of direct governmental control over population movement, the urban environment, and moral issues. My focus is not on the policies per se, but on the way in which they have shaped men's opportunities for extramarital sexual relations in Hanoi and how they have informed men's efforts to be modem. After elucidating the interaction between policy and individual behavior as it pertains to men's sexuality, I propose 4 strategies for reducing marital HIV transmission in Hanoi, each of which addresses the policies that shape men's opportunities for extramarital sexual relations and their wives' acquiescence to such infidelities.
RESEARCH DESIGN
The research I report was part of a National Institutes of Health — funded study, Love, Marriage and HIV: A Multi-site Study of Gender and HIV. It was designed to produce qualitative ethnographic data comparable across 5 country field sites: Uganda, Nigeria, Mexico, Papua New Guinea, and Vietnam. The principal goal of the study was to understand how men contribute to marital HIV risk.
The Vietnamese data came from ethnographic fieldwork conducted among the majority ethnic group in Hanoi, the Kinh, from February through July 2004.[7] I carried out the research in collaboration with Nguyen Huu Minh, the vice-director of the Institute of Sociology (IOS) at the Vietnamese Academy of Social Sciences in Hanoi.[8] The fieldwork consisted of 4 parts: marital case studies, key informant interviews, participant observation, and archival data collection. All respondents agreed to participate in the study after reading the institutional review board — approved protocols for informed consent. A researcher from IOS was hired to transcribe recorded interviews.
Two male and 3 female researchers from IOS were hired to conduct 23 marital case studies (23 husbands and 23 wives). We also interviewed 8 individuals whose spouses did not participate in the study.[9] The purpose of the marital case studies was to explore issues regarding courtship, early marriage, marital communication, decision-making, child rearing, dispute resolution, changes in spousal relationship over time, marital sexuality, extramarital sexual relations, and understanding and experience with HIV/AIDS. Participants were identified using the snowball method and chosen according to a sampling matrix that tracked variation in 3 characteristics: marital duration, husband's occupation, and husband's mobility and migration experience.
Male respondents were aged between 28 and 66 years and were recently married with a child younger than 5 years, married with children living in the house, or grand lathers. Husbands' occupations included but were not limited to xe om (motorcycle taxi) drivers, printers, engineers, electricians, coffee roasters, doctors, beer sellers, lottery ticket salesmen, factory workers, high school teachers, contractors, lawyers, and bookkeepers. Interviews were conducted in a location chosen by the interviewee, typically in a cafe or at home, in 1 or 2 sessions. Husbands and wives were interviewed separately by male and female researchere. respectively.
I also conducted interviews with 15 key informants who had specialized knowledge on subjects pertinent to the study. Interviews typically took place at their work sites. Table 1 delineates the individuals we interviewed, their occupation, their gender, and the subject matter about which we spoke
Occasionally accompanied by members of the IOS research team, I conducted participant observation throughout the 6 months of fieldwork. Participant observation involves gathering cultural information by observing people's behavior in public and private spaces and participating in their lives. This proved valuable for gaining an understanding of the gendered organization of social and private life.[10] Table 2 outlines the social spaces in which we conducted participant observation and the types of observations made in those locations.
Finally, a researcher from IOS and I collected popular cultural and archival material related to marriage, sexuality, and HIV/AIDS.
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." The 2006 United Nations Programme on HIV/AIDS update estimated that there were 37000 new HIV cases in 2005 and that the number of people living with HIV infection more than doubled between 2000 and 2006, from 122000 to 280000. 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 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]
RESEARCH FINDINGS
Although men and women certainly engaged in extramarital sexual relations prior to Doi Moi,[14] men's opportunities to do so were far less restricted and much more frequent after Doi Moi than they were before. The findings from our research corroborated existing behavioral studies and indicated that Hanoi men of different occupations and socioeconomic circumstances were seeking sexual intercourse outside marriage.[15] Nine of the 27 married men we interviewed reported having had extramarital sexual relations. Among our informants, 2 factory workers (aged 34 and 36 years), a rice seller (aged 38), 2 private drivers (aged 31 and 51), 2 xe om drivers (aged 55 and 44), an electrician (aged 41), and a lawyer (aged 58) admitted to having had extramarital sexual relations.[16] The majority had liaisons with sex workers. At least half of these men spent time with sex workers in the context of a group of men socializing together. Significantly, all 27 men had some friends or acquaintances who were having extramarital sexual relations, which led the research team to believe that extramarital sexual relations among our sample were more prevalent than reported.
Attitudes toward men's extramarital sexual relations varied. 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." Some dismissed such notions and instead explained that the men who were having extramarital sexual relations were newcomers to Hanoi who had money for the first time and did not know what to do with it so they spent it on sex workers. A key informant explained that lots of people were experimenting with sexual relations these days, not just married men, as a result of having seen new images from the United States All of our informants attributed the current prevalence of men's extramarital sexual relations to Doi Moi.
DOI MOI'S GENDERED MARKET ECONOMY
We found that Doi Moi has instigated an iterative process among a global market economy that produces men's desire for women outside the home (and supplies these women), facilitates a notion of masculinity tied to commercialized and sexualized leisure (ensuring the demand for sex workers), and generates the means to purchase these sexual "commodities." This process began in 1986 when the Vietnamese government started to transform the economy from a centrally planned economy to a market economy with a socialist direction. The larger aim was competing in the global economy. In addition to dismantling agricultural-based cooperatives in favor of household production, the state removed most welfare subsidies, resulting in the eradication of social safety nets, including health care, childcare, and care for the infirm, and reductions in educational support.[17] The state began to downsize and close state factories, promoted private enterprise, and enabled the expansion of import and export markets.
The state's decision to integrate with the global market economy has led to a widening of employment opportunities, a profusion of household-based business ventures, and a multitude of private leisure establishments now accessible to Hanoi residents, whose standard of living has doubled since 1986. Integration has brought an abundance of consumer items such as DVD players, motorized vehicles, and cell phones, as well as access to the Internet and foreign films, literature, and news, items not available on a large scale a decade ago.[18] Media from around the world, particularly from the West, have provided new images of marriage, love, romance, sexual intimacy, and sexual relations.
Rapid economic and social transformation has created unintended consequences. Hanoi is becoming increasingly socially stratified with the emergence of a highly visible moneyed class, and it now possesses a burgeoning sex industry, of which, according to our research, many men are taking advantage.[19] 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.
Doi Moi has transformed Hanoi from a quiet city with little commercial activity to a city bursting with commodities.[22] As Drummond pointed out, Doi Moi has
made possible and eneouragod the commercialization of leisure space
and the commodification of leisure itself. Leisure is now
consumption, direct or indirect, where previously conspicuous
or even moderate consumption of leisure was frowned upon and
discouraged.[23]
The new leisure establishments provide private spaces for couples to meet, in contrast to the pre — Doi Moi era, when the only places to go in Hanoi were people's homes, the park, or street-side stalls run by residents who more than likely knew one's identity.
The sexualization of commercialized leisure spaces developed in the late 1980s with the aid of the emerging business sector. In the early phases of Doi Moi, male entrepreneurs from state and privately owned businesses treated clients to food, drink, and the services of sex workers for the purpose of establishing personal ties that would facilitate economic transactions.[24] Such practices have become obligatory in many industries today and have spawned a new set of enterprises geared to providing sexual services for men.[25] These businesses offer men with different needs, incomes, work schedules, and marital situations with a range of opportunities to engage in extramarital sexual relations.[26] A former manager (aged 57 years) of a mini-hotel told me,
We provided male guests the service of finding pretty girls so the
men would not be lonely while they were away from their families.
A lot of mini-hotels were built in the mid- to late 1990s. Providing
women enabled us to remain economically competitive.[27]
The changing Hanoi landscape now includes a dizzying array of spaces where men can go for sexualized encounters with women,[28] either to purchase sexual intercourse or where lovers can go for privacy: nha nghi (rest houses),[29] karaoke;[30] hairdresser's, barbershops, nightclubs, garden cafes, cafes,[31] massage parlors, fishing huts, bus stations, dance halls, train stations, and of course, the street.[32] We witnessed 2 trysts one day in a cafe after lunch: 2 separate couples (aged approximately in their late 20s to early 30s) arrived at the cafe, but instead of drinking coffee in the front room with the other patrons, they were furtively escorted to private rooms in the back where they would not be seen. This is just 1 example of the way in which commercial establishments provide anonymous spaces for people to be alone, spaces that were not available to such a degree prior to Doi Moi.[33]
As men's leisure has become increasingly commoditized, men's consumption has become a means for demonstrating their social mobility and social class.[34] During our research in 2004 and 2005, men's ability to pay for food, drink, and prostitutes enabled them to exert a masculinity that was not socially condoned or available to an earlier generation. One of my informants who worked for a United Nations agency told me that his Vietnamese office mates frequently boasted about their weekend sexual exploits. Another male informant recounted his boss's pride in having an affair with an attractive young secretary. She accompanied him on business trips; his wife must stay home with the children.
Our informants told us about cases that provided evidence that many different kinds of men were demonstrating their masculinity by engaging in homosocial activities, including sexualized leisure activities. Homosociality, in this context, refers to heterosexual men who, while spending time with other men, perform for each other (not women) as a means (whether acknowledged or not) to demonstrate their masculinity. When women are present, they typically serve as objects through which men prove their manliness. The most common situations involve groups of men socializing with one another:[35] A factory worker (aged 34 years) recounted a trip he and his male friends took to Hai Phong to cat, drink, and spend time with each other and "pretty girls." He stated that they did this before they were married and continued to do so because it did not cost that much and they enjoyed spending time together this way. He did not tell his wife where he went, explaining that it did not matter because he used a condom and he has a strong relationship with his wife.[36]
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 ubiquity with which men are offered opportunities to spend time with other women was reflected by one man (aged 50 years) who reported that he had been offered sexual favors when he went to get his hair cut and that a few months earlier, alter he checked into a hotel down south, a young woman knocked on his door offering to keep him company. Because of the way businesses and homosocial relations are structured and male status is constructed, men are prompted to engage in extramarital sexual relations even if they do not begin with that intent, because the social risks of refusing may outweigh the epidemiological risks of participating.
Our informants believed that the economic expansion under Doi Moi has created an environment in which people have the time to think about sexuality and the money to pay for it if necessary. One female key informant (aged 37 years) explained, "People are not starving anymore like they were in the 1980s; they have money and time to spend on other things in life like food and sex."[37] A retired male sewing factory employee (aged 68 years) noted that until relatively recently he and his friends had no money or places to go to spend money on women. Nowadays, he has more time and he has money so he and his co-workers go to places with young women (karaoke or massage), especially when they are away on business.
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]
Our ?-esearch showed that these 2 policies have shaped our informants' marital lives in at least 2 ways. First, they make individuals dependent on the marital unit for survival in the new market economy, which renders economic stability the benchmark of a successful marriage and induces women to acquiesce in their husband's extramarital sexual activity to maintain economic and social status. Second, they encourage a gendered division of marital labor, which reinforces patriarchal norms that promote male homosociality. These unequally gendered consequences in turn provide opportunities for and structure the type of sexual relations men seek outside marriage, promoting short-term liaisons with sex workers. Because men do not always use condoms with sex workers, their trysts put them and their wives at risk of HIV infection.
In contrast with trends around the world, in which companionship is a "deliberate goal of marriage" and "individual fulfillment 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.
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. When we asked our informants what characteristics made an ideal spouse, economic stability was foremost on their lists, as was good character.[42] All but our youngest respondents felt that if a man provides for his family, he is fulfilling his familial obligations regardless of whether he is having extramarital sexual relations.[43] He is being faithful to his wife and family.
In some cases, tolerance for a husband's extramarital sexual relationships was an articulated expectation of the husband. For example, when the middle-aged manager of a massage parlor told his wife she had better get used to his spending time with other women because it was his profession, she put up with it for the benefit of her children and marriage. She did what many women are reputed to do — swallow their anger at infidelity.[44] By remaining silent and continuing to take care of the children and the house, she in turn was fulfilling her wifely duties.[45]
The inability of the wives in our study to discuss sensitive issues was exacerbated by the fact that their husbands may not talk to them about issues beyond the family (e.g., their professional or social activities, places they go, or conversations with other men). A xe om driver (aged 55 years) who frequently went out with married male friends to drink and find women explained, "It would not be appropriate." A private driver (aged 68 years) said it would "not be interesting." 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.
As Robin Sherrif has pointed out, silence is not necessarily an individual choice; it is a "shared silence" that is socially organized, expected, and recognized.[46] This shared silence enables the couple to maintain the semblance of a happy family, upon which their economic and social status rests. This silence also makes it difficult for women to determine whether their husbands are engaging in risky behavior that could put both of them at risk of HIV infection.[47]
Gendered patterns of labor structure husbands' and wives' time differently, ultimately providing men the justification for spending time away from home in situations in which they encounter opportunities to engage in extramarital sexual relations. The 1986 Law and the Happy Family campaign, by tying women's identity and status to reproduction and the family, has reinvigorated traditional patterns of household labor, making women more responsible for domestic work than men. This trend has been augmented by other economic policies that have caused women to be laid off from state-sector jobs more readily than men, leading to an increase in women's household-sector employment, which keeps women closer to home.[48] Our participant observation revealed that married women with children did most of the domestic work, leaving them with far less leisure time than their husbands.
The husbands' role, on the other hand, as "pillar of the family" requires them to have a good understanding of society; it encourages and enables men to explore the urban environment and to socialize with male friends in new gendered social spaces. When we asked our informants how they spent their leisure time, men said they spent it at home or out with other men eating, or drinking tea or beer. Men's marital roles typically require them to be mobile, a key factor associated with men's extramarital sexual relations and HIV risk.[49] The gendered division of labor provides men with more leisure time and mobility to encounter social situations in which women or sex workers make themselves available. By contrast, when women have free time, they spend it with the family and with other women who have children near home. I cannot count the number of times I have socialized with men whose wives could not join us because they were taking care of children. It is not surprising then that we rarely observed manned women enjoying time together or older married couples spending time alone in commercial leisure spaces in Hanoi, aside from the lunchtime break.
The emphasis Dot Moi policies place on economic fidelity in turn structures the type of extramarital sexual relations married men engage in. Kight of the nine men in our study who reported having engaged in extramarital sexual relations said they had liaisons with sex workers. This type of liaison was considered preferable to taking a lover because visiting a sex worker is "finite, temporary" and need not require a large commitment of time and money. A young married man employed at a tourist company explained his visits to sex workers in Hai Phong as follows:
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.
More than a decade after promulgation of the Happy Family campaign, the Women's Union[50] has begun to recognize that the sex industry poses a danger to the Happy Family campaign and ideal, in particular, the risk of HIV infection. To counter the pull of the sex market, the Women's Union encourages women to remain sexually alluring to their spouses to keep them faithful.[51] One man (aged 47 years) echoed this message, "A woman should look very pretty so her husband will value her." This notion is also reflected in market developments. Beauty parlors, beauty contests, aerobics, dancing and fitness clubs, and fancy clothing stores, including sexy lingerie shops, have sprung up throughout Hanoi to cater to women's new concerns about body image and their ability to keep their husbands faithful.
We found that this strategy, which places the responsibility on wives to remain sexually attractive, renders women ideologically and structurally inferior to their husbands. This makes wives more likely to acquiesce to their husbands' infidelities and perhaps less likely to employ risk reduction strategies such as initiating condom use or discussing HIV risk. Many of our male and female informants spoke of a husband's right to seek sexual intercourse outside marriage if his wife could not satisfy him. A xe om driver said that he would go outside the home for sexual intercourse when his wife was menstruating or pregnant. He chuckled that sometimes when he left the house, she would joke, "Don't bring anything home." By failing to address men's responsibility for engaging in risky sexual intercourse, the government and society have allowed men to continue conceptualizing their marital fidelity in economic rather than sexual terms.
The lack of focus on men's responsibility might explain our informants' inconsistent condom use with sex workers and lovers. If men used condoms with these extramarital sexual partners, there would be no inherent relation between these patterns of extramarital sexual intercourse and married women's HIV risk. However, men do not use condoms consistently. Men we interviewed who engaged in extramarital sexual intercourse typically said they used condoms with sex workers. Yet, behavioral studies of sex workers and their clients in Hanoi have indicated that condom use is low.[52] In addition, the extremely high abortion rate in Vietnam indicates that many men are not using condoms to protect against pregnancy or sexually transmitted diseases.[53] One divorced man said that there is no need to use a condom with high-class sex workers because they are clean, implying that they are disease-free. None of the men we interviewed felt it was necessary to use a condom with a girlfriend or a wife. Should he do so, both women would be suspicious that he was having sexual intercourse with someone else. The risk of HIV transmission was most evident in the behavior of a driver (aged 51 years) who insisted on "kicking barefoot." He did not use condoms with his lover, his wife, or the sex worker.
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.
In contrast with the prior era, when migration was limited by the state, the opening of the economy has been accompanied by an increasingly mobile workforce. White-collar Hanoi residents frequently travel to other parts of Vietnam or overseas for work or educational purposes, leaving their families behind for extended stays. Large numbers of migrants seeking economic opportunity have moved to the cities, dramatically changing the-urban landscape and the social dynamics of city life.[56] Among these migrants are young women from rural areas who have come to Hanoi to seek employment in the sex industry. The state's passive accommodation of this industry has led to a dramatic increase in the number of sex workers in Hanoi and in men's opportunities for extramarital sexual relations.[57]
The Vietnamese government also lifted restrictions on foreign visitors and foreign residents. Hanoi has become a much more diversified and open society. Describing the change, one Hanoi native (man aged 50 years) said,
It used to be a small town: we knew everyone and everyone knew what
we were doing. Now you don't even know the person living next to
you; the social connections between people are looser. As a result,
you can pretty much do anything you want and no one will know.
This anonymity, coupled with the ability to make furtive atrangements by cell phone and to get across town quickly via motorbike, has contributed to men's and women's ability to engage in affairs unbeknownst to their friends, neighbors, and spouses.[58] For instance, a xe om driver showed me how easy it was for a man with a motorbike to locate sex workers around the city, and also told me about the ease with which he maintained relations with an old lover who lived on the outskirts of Hanoi. His wife, on the other hand, did not leave home as frequently; she was occupied with the children and with selling pho out of their house.
New forms of geographic mobility and labor migration have provided men with frequent access to extramarital sexual relations. According to our findings, professions that provide men the most opportunities for extramarital sexual relations were white-collar jobs (state and private enterprises) and the entertainment, hotel, and transportation industries.[59] What men in these industries have in common is mobility in a manner and to an extent that their wives do not share.
Of the 9 men in our marital case studies who had extramarital sexual relationships, 4 were in the transportation business. One informant (aged 68 years) who drove a passenger car for a private company described how his boss always provided food, drink, and women for his work associates when they were traveling out of town; the driver was included in these "business meetings" when he wished. We were also told about a truck driver who transported goods down south and had developed a relationship with a woman whom he visited regularly when on business trips. The employee of the local tourist company showed me a couple of nondescript nghi tam (bath rest houses) 50 km outside Hanoi on a fairly major travel route. A nghi tam provides traveling men with the opportunity to rest, shower, and enjoy the company of a woman if they wish. Married women, then, are at risk for HIV infection by virtue of their husband's mobility.
In addition to increased mobility, many of our informants attributed men's extramarital sexual relations to the influence of ideas and images accessible through foreign media that portray alternative ideas of sexuality, intimacy, and marital relations. One male informant (aged 40 years), when answering my question about the impact of media on extramarital sexual relations, said, "They stimulate desire for so many things. Not everyone can gain access to material goods, but they can have access to sex because it does not cost a lot." Despite ongoing efforts to control the Internet and domestic publishing, the state has lost the level of control over imported commodities that it had until the early 1990s when most large consumer goods were purchased in governmental department stores or out of the country.[60] Although a couple of our informants were experimenting with new types of sexuality with their spouse as a result of seeing new ideas in the media, many men were choosing to experiment outside marriage, putting themselves and their wives at risk of HIV infection.
The state also no longer has direct control over what kinds of activities take place in Hanoi.[61] The nightly tours of downtown Hanoi I took guided by my xe om driver revealed the ubiquity and openness with which men of different ages and socioeconomic backgrounds looked for sex workers in clubs, restaurants, on the street, and in neighborhood parks. Ironically, a well-known place to find prostitutes at night is across from the Hanoi Women's Union. Almost all of our older informants commented on the ease with which men were able to engage in extramarital sexual relations today. This is remarkable given that prostitution remains illegal.[62] Prior to Doi Moi, state employees who engaged in extramarital sexual relations put themselves at risk socially, economically, and politically.[63] Now the state turns a blind eye to such behavior (despite the occasional reprimand of an uncouth official) and society accepts it. so men are able to engage in extramarital sexual relations with relative impunity.[64] Although there have been discussions about shutting down karaoke bars, the state has yet to do so.
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 factore 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.
TABLE 1 — Key Characteristics of 15 Informants Who Provided Specialized Knowledge Pertinent to the Study of Doi Moi and the Political Economy of Men's Extramarital Sexual Relations and Marital HIV Risk: Hanoi, Vietnam, 2004
Legend for Chart:
A - Formal Key Informants' Occupations (Gender)
B - Topics Addressed
A
B
Economist (female)
Women, family, gender
Women's Union official (female)
Public Policy, development
Lawyer for Women's Union (female)
Law, legal changes
District commune official (female)
Drug use, HIV/AIDS, community response
Two sociologists (1 male, 1 female)
Public health, family, HIV/AIDS, marriage, sexuality, men's and
women's extramarital sexual relationships
Project officer with Vietnamese nongovernmental HIV/AIDS organization
(male)
Community outreach efforts regarding HIV/AIDS
Hotel manager and xe om[a] driver (male)
Economic organization of commercial sexual intercourse, men's
extramarital sexual relations
Two gay men-apparel buyer and writer (males)
Men having sex with men, emerging visibility of gay men, coming out
to family and friends, gay men's social networks
Cook, housekeeper (female)
Gendered norms of family life
Journalist (female)
Historical perspective on rapid cultural changes in Hanoi,
pressures on men to have extramarital sexual relations
Three health professionals (2 female, 1 male)
HIV/AIDS programs, policy, interventions
1 Motorcycle taxi.
TABLE 2 — Participant Observation for Understanding the Gendered Organization of Social and Private Life In the Study of Doi Moi and the Political Economy of Men's Extramarital Sexual Relations and Marital HIV Risk: Hanoi, Vietnam, 2004
Legend for Chart:
A - Location
B - Observations
A
B
Dance clubs, night clubs
Nightly social activities, male leisure activities, male
homosociality, sexualized consumer practices
Parks, lakes, swimming pools, ice cream shops
Family, courting couples, youths socializing
House doorsteps, corner fruit stand, alley noodle soup and tea stands
Gendered interaction and routines of daily life, household division
of labor
Wedding and bridal gown shops
Modern marriage-changing consumer practices around marriage
Cafés, tea shops, reataraunts, street-side stalls, bia hoi[a]
Gendered sociality, modern consumer practices
Markets, shopping mall, stores[b]
Sexualization of advertising, consumer items
Birthday parties, stores that cater to children
Celebration of the individual, new consumer practices with regard
to children
Sidewalk street vendors
Street-side socializing
Mia nghi,[c] nghi tam,[d] garden cafés, fishing huts, mini
hotels, karaoke, calé om,[e] cruising for street-side and
park-based sex workers
Venues for intimacy and sexual intimacy, infrastructure of sex
industry
Women's Union monthly neighborhood meetings
Women's Union activities at the neighborhood level
Note. Participant observation is the gathering of cultural
information by observing people's behaviors in public and private
spaces and participating in their lives.
a Beer gardens.
b Lingerie, motorcycle, cell phones, maternity, television, DVD,
video.
c Rest houses.
d Bath rest houses outside Hanoi.
e "Hugging cafes" — cafes that may provide some privacy for
customers, such as seating behind plants or dividers.
[
References
1.
Women und 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/FSCAP/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%5fen nglish_final.pdf (accessed September 5, 2000); 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.
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.
3.
Dang Nguyen Arm and Le Bach Duong, Issues of Sexuality and Gender in Vietnam: Myths and Realities of Penile Implants and Sexual Stimulants (Hanoi: Institute of Sociology, n.d.); Marie-Ewe Blanc, "Sex Education for Vietnamese Adolescents in the Context of the HIV/AIDS Epidemic: The NGOs, the School, the Family and the Civil Society," in Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London: RoutledgeCurzon, 2004), 241-262; Donn Colby, Nghia Huu Cao, and Serge Doussantousse, "Men Who Have Sex With Men and HIV in Vietnam: a Review," AIDS Education and Prevention 16 (2004): 45-54; Le Bach Duong, Sexuality Research in Vietnam: A Review of the Literature (Hanoi: Ford Foundation, 2001); S. Ghnman et al., "Continuity and Change in Premarital Sex in Vietnam," International Studies in Family Planning 32 (2006): 166-174; VF Go el al., "Gender Gaps, Gender Traps: Sexual Identity and Vulnerability to Sexually Transmitted Diseases Among Women in Vietnam," Social Science & Mediane 55 (2002): 467-401; N.T. Hoa et al., Behind the Pleasure: Sexual Decision Making Among High-Risk Men in Urban Vietnam (Hanoi: Family Health International Working Paper on HIV Prevention, Care, and Treatment in Vietnam, 2007); Khuat Thu Hong, "Study on Sexuality in Vietnam: The Known and Unknown Issues" (Hanoi: Population Council South and Fast Asia Regional Working Paper, 1998); Khual Thi Hai Oanh, How Do Vietnamese Youth Learn About Sexuality in the Family? (Hanoi: Institute for Social Development Studies, 2004); Nguyen Minh Thang, Vu Thu Huong, and Marie-live Blanc. "Sexual Behavior Related to HIV/AIDS: Commercial Sex and Condom Use in Hanoi, Vietnam." Asia-Pacific Population Journal 17 (2002): 41-52; N.T.T. Thny et al., "Sexual Risk Behavior of Women in Entertainment Services, Vietnam." AIDS and Behavior 4 (2000): 93-101: Tran, "Drug Use, Sexual Behaviors"; Ha Vu. The Harmony of Family and the Silence of Women: Sexual Behavior Among Married Women in Two Northern Rural Areas in Vietnam (New York: Columbia University of New York Research Track — SMS, 2002).
4.
For articles that do discuss the intersection of HIV infection and Doi Moi policies, see Hoa, Behind the Pleasure; Paula-Frances Kelly "What Is Known About Gender, the Constructs of Sexuality and Dictates of Behavior in Vietnam as a Confucian and Socialist Society and Their Impact on the Risk of HIV/AIDS Epidemic," in Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London: RoutledgeCurzon, 2004), 98-126; Evelyne Micollier, "Social Significance of Commercial Sex Work: Implicitly Shaping a Sexual Culture?" in Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London: RoutledgeCurzon, 2004), 3-21; Thu-Huong Nguyen-Vo, "Governing Sex: Medicine and Governmental Intervention in Prostitution," in Gender, Household, State: Doi Moi in Vietnam, ed. Jayne Werner and Daniele Belanger (Ithaca, NY: Southeast Asia Program Publications, 2002).
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).
6.
Micollier, "Social Significance of Commercial Sex Work", Helle Rydstrom, "Sexual Desires and 'Social Evils': Young Women in Rural Vietnam," Gender, Place and Culture 13 (2006): 283-301; Harriet Phinney, "Asking for the (Essential Child: Revolutionary Transformations in Reproductive Space in Northern Vietnam" (Ph.D. dissertation. University of Washington, 2003); Harriet Phinney "Asking for a Child: The Refashioning of Reproductive Space in Post-War Northern Vietnam," The Asia Pacific Journal of Anthropology 6 (2005): 215-230; Jayne Werner, "Gender. Household, and Slate: Renovation (Doi Moi) as Social Process in Vietnam," in Gender. Household. State Doi Moi in Vietnam, ed. Jayne Werner and Daniele Belanger (Ithaca, NY: Cornell University Southeast Asia Program Publications, 2002), 29-48; Thu-Huong Nguyen-Vo, "Governing Sex: Medicine and Governmental Intervention in Prostitution, Process in Vietnam," in Gender, Household, State: Doi Moi in Vietnam, ed. Jayne Werner and Daniele Belanger (Ithaca, NY: Cornell University Southeast Asia Program Publications, 2002), 129-152; Kristin Pelzer, "Socio-cultural Dimensions of Renovation in Vietnam: Doi Moi as Dialogue and Transformation in Gender Relations," in Keinventing Vietnamese Socialism, ed. William S. Turley and Mark Seiden (Toronto: York University, Centre for South East Asian Studies, 1993), 310-336; Le Thi Quy, "Social Policies to Prevent and Contain Prostitution in Vietnam," in Ten Years of progress: 0Vietnamese Women From 1985 to 1995, ed. Le Thi and Do Thi Binh (Hanoi: Hanoi Women's Publishing House, 1999), 297-311.
7
This research was grounded in previous qualitative research I have conducted on gender, sexuality, reproduction, and Vietnamese kinship ideology since 1993, including archival data collection of literature and magazines dating back to 1986 and discussion with Vietnamese folklorists, social scientists, Women's Union officials, and women and men living in the Red River Delta. See Phinney, "Asking for the Essential Child."
8.
Ethical approval to conduct the research was obtained from the institutional review board at the University of Washington and at Hanoi Institute of Sociology in Vietnam.
9.
Four of the wives chose not to participate in the study. I made the decision to hire Vietnamese researchers to conduct the formal marital case studies for the following reasons: (1) As a foreign researcher, I would have been accompanied by a member of the Hanoi Women's Union, a member of the city district's People's Committee, or by another researcher. Given the private nature of the interview. I felt we would achieve better results if I person conducted the formal marital case studies. (2) If I had conducted the marital case studies and if we had followed the protocol initially formulated, we would have been introduced to our informants through the Hanoi Women s Union or the People s Committee of each city district This would have determined the types of marriages we would learn about given the Hanoi Women s Union and People's Committee's penchant for representing their districts in the best light. Instead, the Vietnamese researchers worked on their own to find informants. As a result, they were able to locate individuals without interference and conduct interviews on their own. I conducted informal interviews as part of my participant observation.
10.
Participant observation became important for our understanding of how the organization of different kinds of spaces facilitated men's opportunities for extramarital sexual relations.
11.
Ministry of Health/Family Health International, "HIV/AIDS Estimates and Projections 2005-2010."
12.
United Nations Programme on HIV/AIDS Vietnam. "Key Messages."
13.
The Vietnamese government first responded to the growing prevalence of HIV/AIDS in 1993. In the early 1990s, the government also launched a Social Evils Prevention Campaign to stop people from engaging in harmful practices such as drug use and prostitution. Because the HIV/AIDS epidemic emerged coincident with increased drug use and prostitution, the Social Evils legislation developed in tandem with HIV/AIDS legislation. The state currently is making a concerted effort to negate the association between the campaign and HIV/AIDS, having recently recognized its detrimental effects on the prevention and control of the spread of HIV/AIDS. Mass organizations such as the Women's Union and the Youth Union. Buddhist organizations, and People Living With AIDS organizations provide information and education on preventing HIV transmission, maintaining a healthy lifestyle, and eradicating stereotypical images of HIV-positive people.
14.
Hong, "Study on Sexuality in Vietnam"; Phinney, "Asking for the Essential Child."
15.
A recent study by Family Health International slated that "Married male respondents estimated that bused on personal experience, 70-90% of men they know had sex outside of marriage" (Hoa, Behind the Pleasure, 15). Our study focused on men s heterosexual sexual intercourse. However, our research in addition to other research has suggested that gay men are becoming more outspoken and visible in the demonstration of their sexual preferences. Given that many men who have sexual intercourse with other men are married and keep their homosexual behavior a secret because of social stigmatization combined with their increased risk of HIV infection, they may well be placing their wives at risk of HIV. See Colby. "Men Who Have Sex With Men."
16.
Because of the small sample size of male marital case study informants who admitted to having had extramarital sexual relations, it is difficult to make any generalizations regarding the relationship among generation, class, and occupation. Nonetheless, newlywed men in our study appeared to have less extramarital sexual relations than did men who had been married for longer periods of time. This could he attributable to the fact that the younger couples said they talked with their spouse more openly and comfortably about their marital sexual relationships, whereas many of the older women had never done so. The variety of different ages and kinds of men we heard about from our informants or that we saw looking for opportunities for extramarital sexual relations corroborated existing behavioral studies. Sec Thang, "Sexual Behavior Related to HIV/AIDS."
17.
David Craig. Familiar Medicine: Everyday Health Knowledge and Practice in Today's Vietnam (Honolulu: University of Hawnii Press, 2002).
18.
David Marr, "A Passion for Modernity: Intellectuals and the Media." in Post-war Vietnam: Dynamics of a Transforming Society, ed. Hy Van Luong (Lanham, Md: Howman and Littlefield Publishers Inc, 2003), 257-297.
19.
See Catherine Earl, "Leisure and Social Mobility in Ho Chi Minh City." in Social Inequality in Vietnam and the Challenges to Reform, ed. Philip Taylor (Singapore: Institute of Southeast Asian Studies, 2003); and Lisa B.W. Drummond, "Street Scenes: Practices of Public and Private Space in Urban Vietnam," Urban Studies 337 (2000): 2377-2392.
20.
By sexualization, I mean providing sex workers or other women as part of a customers options.
21.
The market also targets women, hut in different ways. Whereas the market provides men with sexual services, the market provides women with products geared toward their appearance and their home (e.g., clothing, jewelry, toys, cribs, strollers). For a discussion on the changing urban environment in Hanoi, see Drummond, "Street Scenes."
22.
This is a marked change from the early Doi Moi era when there were few leisure establishments in Hanoi that required spending money, aside from the circus, the zoo, amusement park rides, tea stalls, bia hoi (fresh beer joints), and an occasional trip to a temple or tourist site. Beginning in the mid-1990s, restaurants, karaoke, and cafes sprung up enticing those with money to come spend their leisure time and money.
23.
Drummond. "Street Scenes," 9.
24.
See Nguyen-Vo, "Governing Sex."
25.
These sexual services could range from hugging, kissing, strip tease, or fondling to sexual intercourse. See livclyne Micollier, "Introduction," in Sexual Cultures in East Asia: The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London, England: RoutledgeCurzon, 2004), xiii-xxv; Micollier, "Social Significance of Commercial Sex Work."
The opportunity to have places to go to he intimate with someone is remarkable, particularly when contrasted to the 1960s and 1970s when, according to one older male informant, it was difficult to kiss and hug your girlfriend because there was no place to go to do it and the Youth Union patrolled the streets keeping a lookout for transgressive behavior. He recounted having been told to go home by a Youth Union cadre while he was sitting on a public bench with his arm around his girlfriend.
27.
Walters provided qualitative and quantitative evidence that demonstrated the economic value of prostitution to the Vietnamese economy at many levels. See Ian Walters. "Dutiful Daughters and Temporary Wives: Economic Dependency on Commercial Sex in Vietnam." in The Social Construction of Sexuality and Sexual Risk in a Time of AIDS, ed. Evelyne Micollier (London, England: RoutledgeCurxon 2004), 76-97
28.
Not all of the sexualized leisure involves sexual intercourse. Rather, it can range from having a particularly attentive waitress to having one who offers to meet a client later at another location. Yet, it is in these spaces where opportunities for engaging in sexual intercourse present themselves.
29.
Nguyen Van Cu Street on the other side of the Chuong Dnong Bridge, which leads out of Hanoi, and the road perpendicular to it running along the Red River are lined with newly built "skinnies," most of which are nha nghi (rest houses) that provide rooms for rent and male and female sex workers. Nguyen Van Cu Street is so infamous, men tease each other with the joke. "Have you been to see Ong Cu [Mr. Cu] yet?"
30.
In the early 1990s, karaoke bars were principally places in which friends could go to sing. Some karaoke became known as karaoke om (hugging karaoke), where waitresses would keep the male singers company. Men would tease each other by asking whether they had "karaoke arm." Gradually some businesses, big and small, began to provide private rooms for their male clients to sing in private with pretty girls. Some Am hoi (fresh beer) establishments became bia om (hugging beer) places, but these were public and not as popular as the karaoke om. At the same time, not all karaoke cater to men who are looking for women.
31.
Cafes that serve coffee in the front room may well provide private rooms in the hack for those in the know. Because the clients who visit these private moms are usually married, hut not to each other, an employee or owner of the cafe will turn the patrons' motorcycles around so the license plates cannot be seen from the street, preventing suspicions husbands and wives from finding cheating spouses.
32.
For a detailed description of the different kinds of sex workers in Hanoi, the kind of the establishments they work in. and the range in cost, see Tran. "Drug Use, Sexual Behaviors and Practices."
33.
Through the ethnographic research I conducted in the mid-1990s. I learned that in addition to finding secluded places in a park, another strategy for being alone with a lover was to arrange to go to a friend's house and have the friend sit outside to make sure no one would come in. The difference is that these are not commercial spaces.
34.
For a discussion of this process in Ho Chi Mini: City, sec Earl. "Leisure and Social Mobility."
35.
Our research findings were consistent with those of a recently published study by Family Health International, which found that unmarried men like to go out with one another as a group to have fun. It is within the context of these group situations that men encourage one another to enjoy the company of women. See Hoa, Behind the Pleasure. Our married informants spoke of this same dynamic operating when they went out with their male friends and colleagues. For a discussion on the relationship between homosociality and the construction of masculinity see Anne Allison Sexuality. Pleasure, and Corporate Masculinity in a Tokyo Hostess Club (Chicago: University of Chicago Press, 1994); Grazian. David. "The Girl Hunt: Urban Nightlife and the Performance of Masculinity as Collective Agency." Symbolic Interaction, Vol 30, Issue 2, pp. 221-243. 2007.
36.
One of the reasons his friends enjoyed such trips was because sex workers were willing to engage in sexual acts that men were afraid to introduce to their wives or that their wives were reportedly not interested in performing.
37.
The Vietnamese aphorism, an no, dung mo (eaten one's fill and all stirred up), sums up this comment nicely.
Nguyen Huu Minh Tradition and Change in Vietnamese Marriage Patterns in the Red River Delta" (Ph.D. dissertation, University of Washington, 1998); David Marr, Vietnamese Tradition on Trial 1920-1945 (Berkeley: University of California Press. 1981); Neil Jamieson, Understanding Vietnam (Berkeley: University of California Press, 1993); Tine Gammeltoft, Women's Bodies, Women's Worries: Health and Family Manning in a Vietnamese Rural Community (Surrey, England: Curzon, 1999).
Phinney, "Asking for the Essential Child"; Melissa J. Pashigian, "Conceiving the Happy Family: Infertility and Marital Politics in Northern Vietnam." in Infertility Around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies, ed. Marcia Inhorn and Frank Van Balen (Berkeley: University of California Press, 2002).
40.
Together, the 2 policies represent a significant shift from previous socialist periods in at least 2 ways. First, by promoting women's maternal identity at the expense of other possible subjectivities, the Doi Moi state has reinscribed the traditional gender roles and inequalities of prerevolutionary Vietnam, which also viewed women's maternal and familial responsibilities as foremost. Second, previously, women and men were encouraged to devote their energies to the war effort (they were asked to delay love, marriage, and child-bearing) and later to building the nation (by devoting their energy to the commune or workplace). Now the success of the nation is tied to couples' ability to create an economically successful household largely without the benefit of state aid.
41.
Holly Wardlow and Jennifer S. Hirsch. "Introduction." in Modem Loves: The Anthropology of Romantic Courtship & Companionate Marriage, ed Jennifer S. Hirsch and Holly Wardlow (Ann Arbor: University of Michigan Press. 2000): 4.
42.
The concern for economic stability was especially marked among the older couples who got married during the 1980s. During this time, those couples were also concerned to find someone whose family had a good political standing. This is consonant with my earlier research on postwar marital formation. See Harriet Phinney, "Objects of Affection: Vietnamese Discourses on Love and Emancipation," Positions East Asian Cultures Critique, Special Issue: Taking it to Heart, in press.
The essentialist assumption that men are capable of having sexual intercourse without loving was cited by men and women alike as n reason men are capable of visiting a sex worker without shattering family happiness. This idea also circulates in public opinion. At the same time, not all of our male informants thought men should have sexual relations outside marriage.
44.
The Vietnamese state and family have long asked and expected Vietnamese women to sacrifice their personal desires for the communal good. We also heard about cases in which women were aware that their husbands were having ongoing extramarital sexual relations and refused to divorce their husbands because they wanted to hold on to their social and economic status.
45.
Clearly not all women remain silent. Divorce is on the increase. Domestic violence and allegations of infidelity and incompatibility have become the most common reasons for divorce. Yet this increase needs to he placed in a larger sociohistorical context recognizing that, prior to Doi Moi, the state limited the number of divorces it granted each year. As implied, divorce is most common among well-educated, white-collar women who do not need to rely on their husband's income. Whether a woman is in a social and economic position to live separately from her husband is an important factor in her decision to divorce.
46.
Robin Sherrif, "Exposing Silence as Cultural Censorship: A Brazilian Case," American Anthropologist 102 (2000): 114-132.
47.
See Vu, The Harmony of Family and the Silence of Women. For a discussion about Vietnamese women's silence with regard to sexual coercion in marriage, see Phan Thi Thu Hien, Sexual Coercion Within Marriage: A Qualitative Study in a Rural Area of Quanh Tri, Vietnam (master's thesis, University of Amsterdam: Faculty of Social Science and Behavior, n.d.).
48.
Women have been laid off from state-sector jobs at a higher rate than men, and women's "work has started to concentrate almost exclusively in the household sector keeping women closer to home than their husbands" (Werner, "Gender, Household, and State," 33).
49.
For studies on the relationship between migration and HIV, sec Catherine Campbell, "Migrancy, Masculine Identities and AIDS: The Psychosocial Context of HIV Transmission on the South African Gold Mines," Social Science and Medicine 45 (1997): 273-281: Jennifer Hirsch, et al., "The Social Constructions of Sexuality: Marital Infidelity and Sexually Transmitted Disease — HIV Risk in a Mexican Migrant Community," American Journal of 92 (2002): 1227-1237.
50.
The Women s Union is a mass governmental organization that has branches at all administrative levels, from the central to the provincial, district, commune, and hamlet levels. The Women's Union works to improve the lives of Vietnamese women, attain gender equality, and to encourage women to participate in the building of Vietnamese society.
51.
When the Hanoi Women's Museum first opened in 1996, it offered women classes in cooking and cosmetics so they would learn how to be good wives. The burden placed on women to keep their husbands faithful is ironic given gendered roles with regard to sexual activity: all of our female and male informants stated that it was the husband's role to initiate sexual activity, not the wife's. It is also problematic for couples (of which there were many) who do not talk about sexual intercourse: most of the middle-aged wives were too embarrassed to talk about it with their husbands or did not think it appropriate to broach a topic not considered polite. It is not surprising that the abortion ratein Vietnam is so high. For an elaboration on the subject of "the eroticized … wile," see Nguyen-Vo, "Governing Sex."
52.
Thang et al.'s survey of university students, factory workers, government officials, businessmen, service providers (including hotel and restaurant workers), and mobile workers (drivers and other mobile laborers) in Hanoi indicated, "A number of men think that having sex with expensive prostitutes, young girls, and girls who live in remote areas is safe" and therefore do not use condoms with those women. Only 36.4% of those surveyed always used condoms (Nguyen Minh Thang el al., "Sexual Behavior Related to HIV/AIDS: Commercial Sex and Condom Use in Hanoi, Vietnam," Asia-Pacific Population Journal [September 2002]: 51). Another study, a small qualitative study of drug use, sexual behaviors, and practices among female sex workers in Hanoi indicated that the client makes the final decision regarding whether to use a condom, and sex workers will frequently agree to not List: a condom if they are offered more money (Tran, "Drug Use, Sexual Behaviors and Practices").
53.
Stanley K. Henshaw, Susheela Singh, and Taylor Haas, "The Incidence of Abortion Worldwide," International Family Planning Perspectives 25 (1999): S30-S38.
54.
According to the folklorist Tran Quoc Vnong, this joke, which I heard frequently from men (in their mid-20s to late 30s). when I was living in Hanoi in the early 1990s and again in 2004, is thought to be a new joke that emerged after the advent of Doi Moi.
55.
The Social Evils campaign mentioned in endnote 13 is part of the government's effort to maintain control over the private lives of its citizens. In the mid-1990s the government periodically raided the music and video collections of bars that catered to foreigners and also tried to limit the number of non-Vietnamese-language signs in Hanoi to control the "negative" influences coming from the West.
56.
Migration studies have indicated Dial the majority of migrants are aged between 13 and 33 years. Men migrate in slightly larger numbers than do women. See Michael DiGregorio, A. Terry Rambo, and Masayuki Yanagisawa, "Clean, Green, and Beautiful: Environment and Development Under the Renovation Economy," in Postwar Vietnam: Dynamics of a Transforming Society. ed. H.V. Luong (Lanham, Md: Rowman & Littlefield Publishers. 2003), 171-200. Hanoi currently has a population of 2.5 million phis additional immigrants (300000) from other provinces. As the population of Hanoi has grown, so has its urban land area. In 1960, the land area was 58 km² and by 1998 it had grown to 91 km², and it is expected to grow to 121 km² by 2010 (ibid., 190). For further discussion on urban changes, see M. Douglas et al., The Urban Transition in Vietnam (Hanoi, Vietnam: United Nations Development Programme. 2002). For an in-depth study of female migrants, see Ha Thi Phuong Tien and Ha Quang Ngoc, Female Labour Migration: Rural-Urban (Hanoi: Women's Publishing House, 2001).
57.
For an examination of this process of passive accommodation and the way in which the changing mode of governing contributed to the increase in the sex industry, see Thu-Huong Nguyen-Vo, Governing the Social: Prostitution and Liberal Governance, in Vietnam During Marketization (Ann Arbor, Mich: UMI Dissertations, 1998).
58.
This ease of mobility can he compared to mobility in the early 1990s when bicycling was the dominant mode of transport and there were very few cell phones.
59.
Although we did not conduct any research among men who had migrated into the city, small-scale behavioral studies have indicated that such men do seek the services of sex workers. See Thang, "Sexual Behavior Related to HIV/AIDS." For studies on the relationship between migration and HIV, see Campbell, "Migrancy, Masculine Identities and AIDS"; and Hirsch, "The Social Constructions of Sexuality."
60.
Before Doi Moi, the government dictated what kind of clothing people could buy and made such decisions as what kind of bathing suits were appropriate for women. For a discussion on changes in consumer goods in Hanoi, see Lisa Drummond, "Gender in Post-Doi Moi Vietnam: Women, Desire, and Change," Gender, Place and Culture 13 (2006): 247-250.
61.
Drummond, "Street Scenes."
62.
Prior to 1959, men went to Kham Thien Street (then known as a red light district) in Hanoi's old quarter to find prostitutes. At that time, prostitution and polygamy were legal, but business was principally confined to 1 locality. By contrast, in Hanoi today, men can find and are offered sexual intercourse throughout the city.
63.
From its founding in 1954, the Democratic Republic of Vietnam tried various methods to rein in extramarital sexual activity. In 1959 the government revised the Law on Marriage and the Family to promote marriage based on free will, mutual respect, and love. Prostitution and polygamy already having been outlawed, monogamy could become the locus for satisfying men's sexual and reproductive needs. During and after the Indochina wars, the party enacted punitive measures for party members who transgressed socialist marital ideals. As mentioned, in the mid-1990s, the government launched a Social Evils Prevention campaign to eradicate deviant behaviors by restricting "non-Vietnamese" cultural images and by condemning behaviors such as drug use, pornography, and prostitution. At the same time, at different historical moments, the state has acknowledged the need for some men to engage in extramarital sexual relations (e.g., to help older single women who "asked for a child" or to establish second marriages). See Phinney. "Asking for a Child." In the new Doi Moi era. me state's acceptance, or as others may put it, its inability, to control men's extramarital sexual activity takes on new meaning in an expanding market economy marked by an increase in a gendered social stratification and other forms of inequality.
64.
The increase in the number of commercial spaces has also benefited gay men's abilities to socialize publicly. Since Doi Moi. a few commercial establishments have opened that provide a space for gay men to socialize, these venues are important for making personal connections and provide married men the opportunity to meet men who are also interested in forming intimate sexual relations with other men.
65.
Hirsch, "The Inevitability of Infidelity: Sexual Reputation, Social Geographies, and Marital HIV Risk in Rural Mexico," American Journal of Public Health 97 (2007): 986-996; Shanti Parikh, "Iatrogenic Risk: Marital HIV Risk and the ABC Approach in Uganda," American Journal of Public Health 97 (2007): 1198-1208.
66.
Parikh, "Iatrogenic Risk."
67.
A program called "Inns with condoms" being implemented in Long Bien District of Hanoi is one example of condom provision in spaces where men need to take responsibility for their sexual behavior. It is being run by the group For a Bright Future in Hanoi. See "Group Pledge Condoms as Prevention not Cause." available at: http://english.vietnamnet.vn/reports/2006/07/599976 (accessed July 31, 2006).
68.
The call to rescind the antiprostitution pledge has come from a coalition of international public health organizations. Sec Elisha Dunn-Georgiou, "Special Report. PEFPAR in Vietnam: Are the Prevention Needs of Youth Being Met? Sexuality Information and Education Council of the United States Public Policy Report" (Washington. DC: Sexuality Information and Education Council of the United States, 2007).
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By Harriet M. Phinney, PhD, MPH
