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The prevalence of HIV among men who have sex with men (MSM) in Vietnam’s two largest cities, Hanoi and Ho Chi Minh City, may be above 10%.

The aim of this study was to explore sexual relationship patterns and experiences among MSM in Hanoi, to inform HIV preventive efforts.

Using purposive sampling we recruited 17 MSM in Hanoi, Vietnam, for in-depth interviews.

Interviews were tape-recorded, transcribed verbatim, and translated into English. Almost all men in the study saw their same-sex attraction as part of their "nature".

Many informants had secret but rich social lives within the MSM social circles in Hanoi.

However, poor men had difficulties connecting to these networks.

Lifetime sexual partner numbers ranged from one to 200.

Seven participants had at some point in their lives been in relationships lasting from one to four years.

For several men, relationships were not primarily centered on romantic feelings but instead intimately connected to economic and practical dependence.Sexual relationships varied greatly in terms of emotional attachment, commitment, trust, relationship ideals, sexual satisfaction and exchange of money or gifts.Faithfulness was highly valued but largely seen as unobtainable.Several informants felt strong family pressure to marry a woman and have children.This study contextualizes sexual relationships among MSM in Hanoi and highlights the extent to which HIV prevention activities need to not only consider HIV prevention in the context of casual sexual encounters but also how to adequately target preventive efforts that can reach MSM in relationships. However in order to correctly target preventive measures it is crucial to also acquire a contextualized understanding of the nature of sexual relationships in which these high-risk behaviors occur.In Vietnam as elsewhere in Asia, MSM identities are based not only on whether a man has sex with men or women, but on a man’s gender role, that is the degree to which he perceives himself as male or female.A man may thus have a masculine role in society and perceive himself as a man but nevertheless have sex with other men, without acquiring a homosexual identity.Other MSM, however, see themselves as fully or partly female and seek male sex partners who are masculine [].Identities of MSM in Vietnam are, however, more nuanced and varied than these overarching categories indicate, and Ngo have documented a wide range of terms and categories in use.These include, for example, terms for someone who could be classified as either a man or a woman (].

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