ASSESSMENT OF ANONYMOUS HIV AND STI- RELATED SEXUAL RISK BEHAVIOURS AND SUBSTANCE USE AMONG IRANIAN UNIVERSITY STUDENTS IN TEHRAN

Author: Banafsheh Moradmand Badie

Moradmand Badie, Banafsheh, 2017 ASSESSMENT OF ANONYMOUS HIV AND STI- RELATED SEXUAL RISK BEHAVIOURS AND SUBSTANCE USE AMONG IRANIAN UNIVERSITY STUDENTS IN TEHRAN, Flinders University, School of Health Sciences

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Abstract

Background: In recent years, a wide range of epidemiological studies have identified high levels of risky behaviours among young people in several developing countries. Knowledge among high school and university students about HIV/STI and the need to be protected from unsafe sex is very low in these countries. There is evidence that sexual activity, particularly unprotected sexual penetration among the young population, is increasing. Iran is in the midst of an HIV and STI epidemic concentrated among the most at risk populations. The university student population is the largest group of young people in Iran. It has been acknowledged that, increasingly, young people in Iran are engaging in high-risk behaviours for STI and HIV infections. Therefore, university students were selected as the target group for our investigation. Objective: To assess the range of HIV and STI risk related behaviours and substance use in students at universities in Tehran, Iran. Methods: This dissertation employed a mixed methods strategy to study Iranian university students. The mixed methods comprised both quantitative and qualitative inquiries to collect data. For the quantitative method, an anonymous quantitative survey was conducted using a self-administrated questionnaire. In this part, respondents were selected from students studying at universities in Tehran. In the qualitative part, thirteen experts with first-hand knowledge of how young people at university behaved were invited to participate in face-to-face semi-structured interviews. The semi-structured interviews were broadly guided by the key questions that included: their viewpoints about estimating the prevalence of illicit drug use, different types of illicit drug use, high-risk sexual behaviours, unsafe sex or unprotected sex, estimating the prevalence of STIs, multi-partnerships and other highly sexual behaviours among university students in Tehran, Iran. Results: Out of 400 students who were invited to the study, 392 (98%) students responded to the questionnaires. The mean age of the participants was 21.98 (range 18-35). A total of 230 (58.7%) were males and 162 (41.3%) were females. Fifty-eight (14.8%) participants had experience of drug use at least once in their lifetimes. The three most commonly used substances were grass 43 (11%), hallucinogens and stimulants 27(6.9%) and cocaine 10 (2.6%). Moreover, 144 (36.7%) of participants had sex within the last 12 months and had experience of sexual behaviours within the past twelve months, of which 103 (26.3%) reported having unsafe sex and 63 (44.1%) reported having had more than one sexual partner. In addition, 17(4.3%) of participants reported having had an STI in the past 12 months. Compared to females, more males had used condoms in their last sexual contact (P<0.005, CI 95%) and more male students had multiple sexual partners compared to female students (P<0.005, CI 95%). Furthermore, 34 (8.7%) of the students surveyed had sex with sex workers (male students) or a person with a multi-partnership background (female students). Twenty (5.1%) participants had been in a group-sex session at least once in the last 12 months. All the experts believed that the prevalence of high-risk sexual behaviours had increased among students, and almost all mentioned that students were unwilling to use condoms. There were different opinions about the prevalence of STIs and, especially, HIV among university students, but nearly all participants were still concerned that the risk of spreading these diseases among students was the same in this population as in the general Iranian population. Almost all participants expressed that there were other high-risk sexual behaviours among university students including: multi-partnerships, sex with commercial sex-workers, homosexuality and bisexuality, and engaging in group-sex. In addition, it was common for male students to have several sexual partners at the same time. According to most participants, having sex with sex workers was becoming very popular among male students. A large number of participants had several clients who had been in a group-sex session or had exchanged their partners with their friends at least once. All participants believed that drug use was common, especially among male university students. The three most commonly-used substances mentioned were cannabis, amphetamine and opium. Conclusions: High-risk behaviours, including unprotected sex, having sex with multiple partners and using illicit substances, were on the rise in university students in Iran. The current study has uncovered a critical situation of HIV and STI infections that may occur among young university students in the near future; therefore, public health strategies needed be developed to prevent a significant emergence of HIV and STIs among university students. These findings have policy and practice implications for the prevention of STIs, including HIV, and the protection of young people in Iran and in other similar settings.

Keywords: Sexual risk behaviour, Substance use, HIV/STI, Mixed method study
Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Health Sciences
Supervisor: Professor Colin McDougall