Mental health and substance use risks intersect in Vietnam’s nightlife

Women frequenting social environments characterized by sex work, alcohol and substance use are vulnerable to substance use and mental health problems, particularly in settings where these behaviors are stigmatized and criminalized. To assess the mental health and substance use risks of women who frequent venues characterized by alcohol consumption, substance use and transactional sex in Haiphong, Vietnam. Between October 2025 and February 2026, we adapted the Priorities for Local AIDS Control Efforts (PLACE) method to reach this population. The process included (1) identifying priority areas through 4 workshops with peer outreach workers and their existing female clients of whom many were women who use drugs and female sex workers; (2) identifying potential venues through interviews with 151 community informants; (3) verifying 128 venues through observation and interviews with venue informants; and (4) conducting a cross-sectional survey among women present at accessible venues. Symptoms of psychological distress were assessed using the 21-item Depression, Anxiety and Stress Scale (DASS-21) and substance use risks were measured using Alcohol, Smoking and Substance Involvement Screening Tool - Lite (ASSIST-Lite). We used descriptive statistics, univariable logistic regression, and Firth penalized multivariable logistic regression to examine sociodemographic and substance-related factors associated with moderate or greater symptom severity of any psychological distress. We recruited 298 women from 62 accessible venues, primarily hotels/motels and karaoke bars (72%), with a mean age of 36.6 years (SD 9.4). Overall, 28% exhibited moderate or greater symptom severity of depression, anxiety or stress. About one third were current tobacco smokers and 32% reported past 3-month illicit drug use. Alcohol, methamphetamine, sedatives, and cannabis were the most commonly reported substances (35%, 17%, 15%, and 14%, respectively). Moderate or greater symptom severity of depression, anxiety or stress was independently associated with current smoking (aOR = 3.4, 95% CI: 1.8-6.4, p < 0.001), moderate/high-risk alcohol consumption (aOR = 7.7, 95% CI: 1.6-37.1, p = 0.011), moderate/high-risk methamphetamine use (aOR = 8.4, 95% CI: 2.6-26.6, p < 0.001) and moderate/high-risk sedative use (aOR = 3.7, 95% CI: 1.1-12.4, p = 0.034). No sociodemographic factors were significant. The adapted PLACE method reached an underserved population of women who frequent high-risk venues in Haiphong. Women identified through this approach experienced substantial and intersecting burdens of psychological distress and substance use. Community-based, low-threshold models that integrate both mental health and polysubstance use interventions, delivered through peer outreach workers and venue-based strategies would help meet the needs of this population, especially in unfavorable policy environments.