Sexual Risk Behaviors and Condom Use Barriers in Iranian Men with Substance Use Disorders

Effat Merghati-Khoei, Zahed Rezaei, Davood Shojaei-Zadeh, Nammam Ali Azadi, Shahnaz Rimaz, Alireza Bayat, Saeedeh Moayedi-Nia, Sanaz Omati, Farahnaz Salimi, Jeffrey Korte, Therese Killeen, Minoo Mohraz

Abstract


Background: We aimed to investigate risky sexual behaviors (RSBs) and condom use barriers in Iranian men with substance use disorders (SUDs).

Methods: Of the total 1800 outpatient drug free (ODF) and methadone maintenance treatment program (MMTP) active centers in Tehran, Iran, six were selected to participate in the current study. Data were collected (n = 300 men) using three questionnaires including a demographic questionnaire, the Risky Sexual Behavior Questionnaire (RSBQ), and the Condom Barriers Scale (CBS). The statistical software R, analysis of variance post hoc and multivariate analysis of variance (MANOVA) logistic regression tests were used in data analysis.

Findings: The majority, (n = 194, 64.7%) reported at least one lifetime episode of RSBs. Compared to married participants (23.1%), 88.5% of single and 87.0% of divorced men had a history of RSB. Generally, the lowest and highest subscale scores of the CBS were related to sexual experience (2.60 ± 0.71) and access/availability structure (3.77 ± 0.54), respectively. The results of MANOVA analysis showed that there was a statistically significant difference between the CSB subscales based on the participants' education and marital status
(P < 0.001). Only the partner barrier subscale had a significant negative relationship (P = 0.003) with RSB.

Conclusion: Sexual dynamic of Iranian men with SUDs is different. Barriers to condom use seem to be socio-culturally determined. Culturally acceptable strategies need to be utilized in Iranian clinical settings reaching beyond simply condom accessibility for this at risk population.

Keywords


Sexual risk behaviors; Condoms; Substance abuse; Sexually transmitted infections; Men

Full Text:

PDF

References


Letourneau EJ, McCart MR, Sheidow AJ, Mauro PM. First evaluation of a contingency management intervention addressing adolescent substance use and sexual risk behaviors: Risk reduction therapy for adolescents. J Subst Abuse Treat 2017; 72: 56-65.

Heerde JA, Hemphill SA. Sexual risk behaviors, sexual offenses, and sexual victimization among homeless youth: a systematic review of associations with substance use. Trauma Violence Abuse 2016; 17(5): 468-89.

Dembo R, Krupa J, Wareham J, Schmeidler J, DiClemente RJ. A multigroup, longitudinal study of truant youths, marijuana use, depression, and Std-associated sexual risk behavior. J Child Adolesc Subst Abuse 2017; 26(3): 192-204.

Fairbairn N, Hayashi K, Milloy MJ, Nolan S, Nguyen P, Wood E, et al. Hazardous alcohol use associated with increased sexual risk behaviors among people who inject drugs. Alcohol Clin Exp Res 2016; 40(11): 2394-400.

Heerde JA, Scholes-Balog KE, Hemphill SA. Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: A systematic literature review. Arch Sex Behav 2015; 44(1): 181-212.

Feaster DJ, Parish CL, Gooden L, Matheson T, Castellon PC, Duan R, et al. Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug Alcohol Depend 2016; 169: 171-9.

Rockville M. The NSDUH Report: HIV/AIDS and substance use [Online]. [cited 2010]; Available from: URL: https://www.samhsa.gov/sites/default/files/hiv-aids-and-substance-use.pdf

Booth RE, Kwiatkowski CF, Chitwood DD. Sex related HIV risk behaviors: Differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug Alcohol Depend 2000; 58(3): 219-26.

Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: Review and meta-analysis. J Acquir Immune Defic Syndr 2009; 52(2): 180-202.

Raj A, Saitz R, Cheng DM, Winter M, Samet JH. Associations between alcohol, heroin, and cocaine use and high risk sexual behaviors among detoxification patients. Am J Drug Alcohol Abuse 2007; 33(1): 169-78.

Volkow ND, Wang GJ, Fowler JS, Telang F, Jayne M, Wong C. Stimulant-induced enhanced sexual desire as a potential contributing factor in HIV transmission. Am J Psychiatry 2007; 164(1): 157-60.

Logan TK, Leukefeld C. Sexual and drug use behaviors among female crack users: A multi-site sample. Drug Alcohol Depend 2000; 58(3): 237-45.

Nadeau L, Truchon M, Biron C. High-risk sexual behaviors in a context of substance abuse: A focus group approach. J Subst Abuse Treat 2000; 19(4): 319-28.

Tortu S, McMahon J, Hamid R, Neaigus A. Drug-using women's sexual risk: An event analysis. AIDS Behav 2000; 4(4): 329-40.

Wingood GM, DiClemente RJ. The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior. Am J Prev Med 1998; 15(1): 54-9.

Wood E, Kerr T, Tyndall MW, Montaner JS. A review of barriers and facilitators of HIV treatment among injection drug users. AIDS 2008; 22(11): 1247-56.

Haghdoost AA, Mostafavi E, Mirzazadeh A, Navadeh S, Feizzadeh A, Fahimfar N, et al. Modelling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res 2011; 3(12): 231-9.

National AIDS Committee Secretariat, Ministry of Health and Medical Education. Islamic Republic of Iran: AIDS progress report on monitoring of the United Nations general assembly special session on HIV and AIDS [Online]. [cited 2015]; Available from: URL:

www.unaids.org/sites/default/files/country/.../IRN_narrative_report_2015.pdf

Nejat S, Feyzzadeh A, Asghari Sh, Keshtkar Aa, Heshmat R, Majdzadeh SR. HIV risk factors in iran; systematic review, meta-analysis and generalized impact fraction approaches. Payesh Health Monit 2007; 6(1): 45-54. [In Persian].

Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in Iran. J Res Health Sci 2012; 12(2): 81-7.

Ministry of Health and Medical Education, Center for Disease Management. Current statistics on HIV/AIDS Infection in Islamic Republic of Iran [Online]. [cited 2014]; Available from: URL: www.isv.org.ir/download/news/AIDS93-2.pdf

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. HIV surveillance report [Online]. [cited 2013]; Available from: URL: https://www.cdc.gov/hiv/pdf/statistics_2011_hiv_surveillance_report_vol_23.pdf

Haghdoost AA, Sajadi L, Osooli M, Mostafavi E, Khajehkazemi R, Mirzazadeh A, et al. HIV bio-behavioral surveillance survey among female sex workers I. R. Iran in 2010 [Project]. Kerman, Iran: Center for Communicable Disease Management, Kerman University of Medical Sciences; 2012. [In Persian].

Moayedi-Nia S, Bayat JZ, Esmaeeli DG, Entekhabi F, Bayanolhagh S, Saatian M, et al. HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling. AIDS Care 2016; 28(4): 487-90.

Calsyn D, Doyle S, Hatch-Maillette M, Song Y. Reliability, factor structure and validity of the condom barriers scale for use with men in substance abuse treatment [Online]. [cited 2006]; Available from: http://ctndisseminationlibrary.org/PDF/141.pdf

Keshtkar A, Majdzadeh R, Nedjat S, Gholipour M, Badakhshan A, Qorbani M, et al. Characteristics of high-risk sexual behaviors for human immunodeficiency virus infection among Iranian drug abusers. J Addict Med 2012; 6(2): 153-8.

Moeini B, Hazavehei SM, Mousali AA, Soltanian A, Barati M, Kafami V. Predicting factors in intentional safe sexual behaviors among drug abusing men covered by rehabilitation centers in Hamadan (Iran): Applying the theory of planned behavior. Koomesh 2016; 17(4): 888-94. [In Persian].

Mir Heydari M, Tavafian SS, Montazeri A, Fallahi H. Effect of educational interventions on sexual high risk behavior between drug addicts ex-users based on the Health Belief Model. J Sch Public Health Inst Public Health Res 2014; 12(2): 93-104. [In Persian].

Heidari A, Mirahmadizadeh A, Keshtkaran A, Javanbakht M, Etemad K, Lotfi M. Changes in unprotected sexual behavior and shared syringe use among addicts referring to Methadone Maintenance Treatment (MMT) centers affiliated to Shiraz University of Medical Sciences in Shiraz, Iran: An uncontrolled interventional study. J Sch Public Health Inst Public Health Res 2011; 9(1): 67-76. [In Persian].

Sarkar NN. Barriers to condom use. Eur J Contracept Reprod Health Care 2008; 13(2): 114-22.

Calsyn DA, Peavy M, Wells EA, Campbell AN, Hatch-Maillette MA, Greenfield SF, et al. Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers. Am J Addict 2013; 22(2): 150-7.

Rosengard C, Anderson BJ, Stein MD. Correlates of condom use and reasons for condom non-use among drug users. Am J Drug Alcohol Abuse 2006; 32(4): 637-44.

Campbell AN, Brooks AJ, Pavlicova M, Hu MC, Hatch-Maillette MA, Calsyn DA, et al. Barriers to condom use: results for men and women enrolled in HIV risk reduction trials in outpatient drug treatment. J HIV AIDS Soc Serv 2016; 15(2): 130-46.

Song YS, Calsyn DA, Doyle SR, Dierst-Davies R, Chen T, Sorensen JL. Predictors of condom use among men enrolled in drug treatment programs. AIDS Educ Prev 2009; 21(5): 460-73.

Islam MM, Topp L, Conigrave KM, Haber PS, White A, Day CA. Sexually transmitted infections, sexual risk behaviours and perceived barriers to safe sex among drug users. Aust N Z J Public Health 2013; 37(4): 311-5.

Assari S, Yarmohamadivasel M, Moghani LM, Sehat M, Narenjiha H, Rafiey H, et al. Having multiple sexual partners among Iranian intra-venous drug users. Front Psychiatry 2014; 5: 125.

Assari S, Yarmohmmadi VM, Tavakoli M, Sehat M, Jafari F, Narenjiha H, et al. Inconsistent condom use among Iranian male drug injectors. Front Psychiatry 2013; 4: 181.

Jamshidimanesh M, Mousavi SA, Merghati-Khoei E, Emamian MH, Keramat A. Sexual risk behaviors constructed in iranian women's life with substance use disorders: A new implication of human ecological theory. Addict Health 2016; 8(3): 157-69.




DOI: http://dx.doi.org/10.22122/ahj.v9i1.461

Refbacks

  • There are currently no refbacks.