Gender gaps, gender traps: sexual identity and vulnerability to sexually transmitted diseases among women in Vietnam.

We conducted a qualitative study to explore the pathways by which traditional gender roles may ultimately affect Vietnamese women's interpretation of sexually transmitted disease (STD) symptoms and health-seeking strategies. Data on gender roles, perceptions of types of sexual relationships, perceptions of persons with STDs, and STD patient experiences were gathered through in-depth interviews and focus groups with 18 men and 18 women in the general population of northern Vietnam. A framework integrating Andersen's behavioral model of health services use and Zurayk's multi-layered model was used to conceptualize women's health-seeking behavior for STD symptoms. Both men and women noted clear gender differences in sexual roles and expectations. According to participants, a woman's primary roles in northern Vietnam are socially constructed as that of a wife and mother-and in these roles, she is expected to behave in a faithful and obedient manner vis à vis her husband. It emerged that men's marital and sexual roles are less clearly defined by traditional norms and are more permissive in their tolerance of premarital and extramarital sex. For women, however, these activities are socially condemned. Finally, since STDs are associated with sexual promiscuity, both men and women expressed anxiety about telling their partners about an STD; women's expressions were characterized more by fear of social and physical consequences, whereas men expressed embarrassment. Community level interventions that work towards disassociating STDs from traditional social norms may enable Vietnamese women to report possible STD symptoms and promote diagnosis and care for STDs.