Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study

다국어 초록 (Multilingual Abstract)

Objectives: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing.
The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran.
Methods: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis.
Results: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge.
Conclusions: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.

참고문헌 (Reference)

1 Abachi A, "The analysis of stigma impact on quality of life in patients with HIV/AIDS: a phenomenological study" 2 (2): 158-172, 2013

2 Duffy L, "Suffering, shame, and silence: the stigma of HIV/AIDS" 16 (16): 13-20, 2005

3 Carr RL, "Stigma: a health barrier for women with HIV/AIDS" 15 (15): 30-39, 2004

4 Burkholder GJ, "Social stigma, HIV/AIDS knowledge, and sexual risk" 4 (4): 27-44, 1999

5 Rintamaki LS, "Social stigma concerns and HIV medication adherence" 20 (20): 359-368, 2006

6 Pryor JB, "Social psychological perspectives on stigma: advances in theory and research" Routledge 1-3, 2016

7 Bouton RA, "Scales for measuring fear of AIDS and homophobia" 51 (51): 606-614, 1987

8 Shokoohi M, "Remaining gap in HIV testing uptake among female sex workers in Iran" 21 (21): 2401-2411, 2017

9 Brown MJ, "Psychological reactance and HIV-related stigma among women living with HIV" 28 (28): 745-749, 2016

10 Kawichai S, "Profiles of HIV voluntary counseling and testing of clients at a district hospital, Chiang Mai Province, northern Thailand, from 1995 to 1999" 30 (30): 493-502, 2002

11 Najarkolaei FR, "Perception and behaviors of HIV/AIDS patients: a qualitative study" 13 (13): 220-234, 2009

12 Haghdoost AA, "Modelling of HIV/AIDS in Iran up to 2014" 3 (3): 231-239, 2011

13 Fraim NL, "Knowledge levels and misconceptions about HIV/AIDS: what do university students in Turkey really know" 2 (2): 50-58, 2012

14 Ministry of Health and Medical Education, "Islamic Republic of Iran AIDS progress report"

15 UNAIDS, "Islamic Republic of Iran"

16 Merghati-Khoei E, "Intimate partner violence and risky sexual behaviors among Iranian women with substance use disorders" 29 : 174-, 2015

17 Asadi-Ali Abadi M, "High-risk behaviors among regular and casual female sex workers in Iran: a report from Western Asia" 2018

18 Ghahfarokhi SM, "HIV/AIDS related knowledge and attitude among female sex workers in Tehran/Iran" 7 (7): P130-, 2010

19 Ebrahim M, "HIV/AIDS prevention: an Islamic perspective experience from South Africa" Federation of Islamic Medical Associations 91-100, 2007

20 Kawichai S, "HIV voluntary counseling and testing and HIV incidence in male injecting drug users in northern Thailand: evidence of an urgent need for HIV prevention" 41 (41): 186-193, 2006

21 Shokoohi M, "HIV knowledge, attitudes, and practices of young people in Iran: findings of a national population-based survey in 2013" 11 (11): e0161849-, 2016

22 Joint United Nations Programme on HIV/AIDS (UNAIDS), "Global report: UNAIDS report on the global AIDS epidemic 2013"

23 Meiberg AE, "Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa" 5 (5): 49-54, 2008

24 Wang Y, "Factors related to female sex workers' willingness to utilize VCT service: a qualitative study in Jinan city, northern China" 13 (13): 866-872, 2009

25 Teklehaimanot HD, "Factors influencing the uptake of voluntary HIV counseling and testing in rural Ethiopia: a cross sectional study" 16 : 239-, 2016

26 Turan B, "Depression and social isolation mediate effect of HIV stigma on women's ART adherence"

27 Javidan M, "Culture and leadership in Iran: the land of individual achievers, strong family ties, and powerful elite" 17 (17): 127-142, 2003

28 Shokoohi M, "Correlates of HIV testing among female sex workers in Iran: findings of a national bio-behavioural surveillance survey" 11 (11): e0147587-, 2016

29 Thepthien B, "Barriers to VCT for vulnerable and non-vulnerable population at risk of HIV" 7 (7): 552-, 2016

30 Khah Malery Langeroudi Z, "Barriers of condom use among female sex workers in Tehran, a qualitative study" 12 (12): 23-34, 2014

31 Bowen P, "An explanatory model of attitudinal fear of HIV/AIDS testing in the construction industry" 23 (23): 92-112, 2016

32 Bucardo J, "A qualitative exploration of female sex work in Tijuana, Mexico" 33 (33): 343-351, 2004

33 Genberg BL, "A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS" 68 (68): 2279-2287, 2009

34 Karamouzian M, ""I am dead to them": HIV-related stigma experienced by people living with HIV in Kerman, Iran" 26 (26): 46-56, 2015