Date Published: March 19, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Khodabakhsh Ahmadi, Majid Rezazade, Mohammad Nafarie, Babak Moazen, Mosaieb Yarmohmmadi Vasel, Shervin Assari.
Purpose. To assess the prevalence and associated factors of unprotected sex with injecting drug users (IDUs) among a sample of female sex workers (FSWs) in Iran. Methods. This cross-sectional study included 144 FSWs who were interviewed as a part of Unhide HIV Risk Study, a national behavioral survey focusing on various high-risk populations, including IDUs, FSWs, and Men who have Sex with Men (MSMs) in 2009. The survey was conducted in eight provinces in Iran using respondent-driven sampling. Participants’ sociodemographic status, HIV knowledge, and HIV attitude were analyzed via logistic regression to determine the predictors of unprotected sex with IDU(s) during the past month. Results. Nineteen percent of FSWs reported at least one occasion of unprotected sex with IDU(s) in the month preceding the study. Higher educational level (OR = −0.653, 95%CI = −1.192 to −0.115), perceived HIV risk (OR = −1.047, 95%CI = −2.076 to −0.019), and perceived family intimacy during childhood (OR = −1.104, 95%CI = −1.957 to −0.251) were all independently associated with lower odds of having unprotected sex with IDU(s) in the month preceding the study. Age, marital status, living condition, HIV knowledge, and perceived behavioral control did not affect the odds of FSWs having sex with IDUs. Conclusion. Perceived HIV risk, which is a modifiable factor, seems to be a promising target for harm reduction interventions amongst Iranian female sex workers. Data presented here may aid in reducing or eliminating the role of sex workers as a bridge for HIV transmission from IDUs to the general population in Iran.
Both its location amid a major regional narcotics transit route and the increasing drug injection rate have made Iran a country with a concentrated epidemic of HIV [1, 2]. Based on data from the Joint United Nations Program on HIV/AIDS (UNAIDS), a total of 92,000 (74,000–120,000) HIV positive people were living in Iran at the end of 2009 .
This cross-sectional study included 144 FSWs who were interviewed as a part of Unhide HIV-Risk Study, a national behavioral survey of different high-risk populations, including IDUs, FSWs, and Men who have Sex with Men (MSMs) in 2009.
Each interview lasted up to 60 minutes. No monetary incentive was offered to the participants. University-trained research assistants interviewed our participants; training for the interviewers was conducted through a series of workshops. All participants received HIV education and free condoms.
Of the 144 female sex workers included in this study, 51% were married, 89% had at least a primary education, 35% were homemakers, and 21.5% reported living with friends. The data indicated that 32.6% of the FSWs reported themselves being exposed to much or too much violence by their family members; 35% reported no or little intimacy between their family members; 41.7% thought that they would never acquire HIV in their lifetime; 97% were eager to know about HIV and its transmission routes; 24% believed they had no HIV knowledge; 38% expressed that radio and television were their main means of acquiring HIV knowledge; 53% had never received face-to-face HIV education (Tables 1 and 2).
About 20% of Iranian noninjecting FSWs reported having sex with at least one IDU during past month. Our findings suggest that a lower tendency toward unprotected sex with an IDU amongst sex workers with higher educational levels increased perceived HIV risk and family intimacy among childhood. HIV knowledge, however, failed to be predictive of sex with IDUs in our study. These findings shed more light on a previously understudied outcome—unprotected sex with IDUs committed by noninjecting Iranian FSWs