The average (mean) age of the women studied was 30.2 years old. By the end of the study period, when the data were reviewed, they had been members of a Sunflower group for an average of 13.4 months. In Hanoi, the oldest and first group in the country, the average length of membership was almost double the average, at 21.4 months.

During the period studied, the total number of HIV-positive mothers who were members across the five groups increased from 4 to 557 members. Among the five groups, 80% of the total members had made a PDP by June 2008. Most of these 419 mothers included in the study sample decided to fill in the plan some months after they had joined a group (the average time members selected took to formulate a PDP was 8.4 months). The plan was filled in alone, with help from a fellow member or a representative of an authority supporting the group such as the Red Cross, according to each individual woman’s preference. It was found that in groups where “core members” actively encourage and assist members, almost 90% of the HIV-positive mothers made a PDP, while in groups in which core members are not active and new members have to make the plan alone, just over half of members produce a PDP.

Over a third, 36.8% (154/419), of the mothers reported to be taking ART at the time of the first formalized evaluation of their PDP. Less than half, 43.9% (184/419), were living with HIV-positive male partners of whom just under half, 49.5% (91/184), were also on ART, while 28/419 (6.7%) lived with a partner who was either HIV negative or did not know his status. A total of 27 of the male partners were reportedly actively using drugs; of these, all but one were also HIV-positive.

There were many widows in all the groups, but the highest proportion of widows was found in the groups in Quang Ninh and Cao Bang provinces, possibly partly because in Quang Ninh ART arrived in 2006, a few years later than in Hanoi where small ART programs began in 2001 and PEPFAR scaled up in 2005. In Cao Bang, a mountainous province bordering China, internationally funded ART also arrived later in 2006.

In Hanoi and Cao Bang, most women lived in a more or less traditional multigenerational patrilocal arrangement with their husbands’ families, either within a couple or as a widow. In the other two provinces, the majority of women – both those in a couple and widows – lived separately from the man’s family in a nuclear family, in couples with the husband as the head of the household.

Although the groups are all located in urban areas, including the capital city, farming was found to be the most frequently reported profession of group members. Forty percent of the women (159; 36%) considered themselves farmers, while around 20% (87) reported being housewives and 83 (20%) were small shopkeepers (83) engaged in the sale of groceries, tailoring, food, hairdressing, and other services. Less than 10% (36) considered themselves laborers, around 5% (26) were directly involved in HIV-related work as counselors and peer educators, 14 were jobless, and 12 reported to be salaried and trained professionals such as working as a nurse, teacher, accountant, or government official. Two women did not provide information concerning their profession.

The rapid scale-up and decentralization of ART services over the period studied is illustrated by the range of treatment service utilization at district level and provincial level of women reported by group members. In Hanoi and Thai Nguyen, women were able to access ART at central, provincial, and district levels, with district level the most common source. In Quang Ninh and Cao Bang, most women accessed medicine at provincial level (in Cao Bang treatment was rarely accessed outside of the provincial hospital). Few women (3/158) travelled to national-level facilities in Hanoi to obtain treatment, revealing that women managed to access ART at a local level (Table 14.2).

ART was not necessarily required for all members as it depends on their CD4 count. CD4 count refers to number of functioning CD4 cells that support the immune system. HIV damages the CD4 cells. Women who joined the group would receive a general health examination. If they did not know their CD4 count, they would also be supported to receive a CD4 count test through the health referral system to which the groups were networked. In addition, medical doctors were linked to each group and would visit regularly to discuss health issues such as when ART is required and where it is available. In Thai Nguyen, almost half the women (34/70) who were on treatment were already accessing ART when they entered the group and filled in their first PDP, while the rest received ART after they entered the group, reflecting close relationships between the health services and the support group.

In Hanoi, the group was instrumental in helping women to get access to ART and also provided women who had already access to medicines with adherence support and counseling from their Sunflower peers. In Hanoi, two-thirds of the women on ART accessed treatment after joining the group and stayed the longest in the group, almost 10 months, before getting ART. This suggests that the outreach work in Hanoi was particularly effective in helping women to join a group before they needed treatment and assisting them in accessing treatment at a decentralized level when required. The data suggest a diversity of roles that support groups can play in ART as for some women groups help them to overcome barriers to accessing available treatment and in others, such as in Thai Nguyen where women already were on ART support groups fulfill other needs such as adherence support.

For some women, access to medicines was not a priority defined in their PDP because they were still feeling healthy, while others had already obtained ART in any case. Although health is an obvious concern for all HIV-positive mothers, these members also had other pressing social and economic needs, such as lack of access to micro-credit and/or fears about discrimination of their children in education which they tried to address by means of the linkages which existed between the groups and service providers (Table 14.3).

With both access to health support including free ART and access to a network of social and economic services, one might assume women’s confidence increased and reported stigma, including self-stigma, decreased.

Indeed, data analysis suggests that group membership helped HIV-positive mothers to reduce the stigma they feel from outsiders (Liamputtong et al. 2009; see also Chap.​ 15 in this volume). The sense of being discriminated by neighbors or family and reluctance to go out were found to decrease over time following group membership, but these were small reported concerns compared with women’s perception of themselves. Women who joined the group had great concerns about being useful and suffered a lack of confidence in their own competencies and their contribution to social activities. These concerns diminished a little over time, but most women remained insecure about their ability to contribute or be useful to others. The vast majority (80%) reported having friends whom they felt they could share personal concerns with and these were not just friends who were also HIV-positive. For example, food plays a very central role in Vietnamese family life, and meals are usually shared among several close people (Marquis and Shatenstein 2005; Ochs and Merav 2006). Although 36% women did not share meals with other family members, this was attributed to a large proportion of those living in a nuclear family situation with a husband with an unstable social status and a distinct, complicated, stigmatizing background of IDU. About 90% of the women who were living with their own parents or their husband’s family reported sharing their meals.