Abstract
Background: Healthy and satisfying sex life is one of the important elements of well-being and quality of life in women.
Objectives: This study aimed to investigate the effect of sexual counseling on self-efficacy, assertive sexual communication, self-awareness, sexual attitude, awareness of sexually transmitted diseases, and HIV in addicted women in mandatory drug treatment camps.
Material and Methods: The present study was conducted on 68 women in two groups (intervention = 34, control = 34). The intervention group received the counseling program. The control group received routine services from the rehabilitation center.
Results: The results showed that in the intervention group, 31 (100) before the intervention and 26 (86.7) 4 weeks after intervention (p = 0.05), had heard the name of STDs (p = 0.28). Moreover, 12 (38.7) participants in the intervention group and 12 (38.7) in the control group could name 4 symptoms of STDs in women 4 weeks after intervention (p = 0.001).
Additionally, the sexual attitude was 44.64 ± 4.21 and 45.38 ± 4.09 in the intervention group and 40.66 ± 4.50 and 39.93 ± 4.71 in the control group 4 and 8 weeks after the intervention, respectively. (p = 0.01). Moreover, the obtained results showed that the mean score of sexual knowledge was 40.25 ± 3.62, 41.74 ± 3.44 and 36.36 ± 5.37 in the intervention group 4 and 8 weeks after the intervention, showing a significant difference (p = 0.02).
Conclusion: The findings of this study showed that sexual knowledge, sexual attitude and selfefficacy, and sexual assertiveness could be improved through interventions based on skills and empowerment. In addition, by presenting knowledge on STDs, condom use for safe sex in addicted women can be increased.
Keywords: Women, Condom, Sexual Negotiation, Addiction, Reproductive health, sexually transmitted diseases.
Graphical Abstract
[1]
Seyed, A.Z.N.; Chizari, M.; Vakilian, K.; Ranjbaran, M. Predictors of female sexual self-disclosure in Tehran. JMUMS, 2017, 26(144), 357-361.
[2]
Soltani, F.; Azizi, R.; Sourinegad, H.; Shayan, A.; Mohammadi, Y.; Khodakarami, B. Sexual knowledge and attitude as predictors of female sexual satisfaction. Biomed. Res. Ther., 2017, 4(12), 1874-1884.
[http://dx.doi.org/10.15419/bmrat.v4i12.398]
[http://dx.doi.org/10.15419/bmrat.v4i12.398]
[3]
Armstrong, J.; Thorpe, S.; Williams, D. Sexual attitudes, religious commitment, and sexual risk behaviours among college-aged women. J. Gend. Stud., 2021, 30(8), 875-886.
[4]
Sung, S.C.; Huang, H.C.; Lin, M.H. Relationship between the knowledge, attitude, and self-efficacy on sexual health care for nursing students. J. Prof. Nurs., 2015, 31(3), 254-261.
[http://dx.doi.org/10.1016/j.profnurs.2014.11.001] [PMID: 25999199]
[http://dx.doi.org/10.1016/j.profnurs.2014.11.001] [PMID: 25999199]
[5]
Mousavi, A.; Keramat, A.; Vakilian, K. Esmaeili Vardanjani, SA Development and adaptation of Iranian youth reproductive health questionnaire. ISRN Obstet. Gynecol., 2013, 950278, 1-7.
[http://dx.doi.org/10.1155/2013/950278]
[http://dx.doi.org/10.1155/2013/950278]
[6]
Vakilian, K.; Keramat, A.; Seyyed Abbas, M. The necessity of developing AIDS and reproductive health indicators for Iranian adolescents in the national health system; The evaluation of indicators among 18-24 year old university students of shahroud, Iran: A cross-sectional study. Open Public Health J., 2018, 11(1), 339-347.
[http://dx.doi.org/10.2174/1874944501811010339]
[http://dx.doi.org/10.2174/1874944501811010339]
[7]
Keramat, A.; Vakilian, K.; Mousavi, S. Barriers to youths’ use of reproductive health services in Iran. Life Sci. J., 2013, 10, 943-949.
[8]
Ngwena, C.G.; Brookman-Amissah, E.; Skuster, P. Human rights advances in women’s reproductive health in Africa. Int. J. Gynaecol. Obstet., 2015, 129(2), 184-187.
[http://dx.doi.org/10.1016/j.ijgo.2015.02.001] [PMID: 25712778]
[http://dx.doi.org/10.1016/j.ijgo.2015.02.001] [PMID: 25712778]
[9]
Norris, A.L.; Rich, C.; Krieger, N.; Guthrie, K.M.; Kaplan, C.; Carey, K.B.; Carey, M.P. Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic. BMC Womens Health, 2019, 19(1), 15.
[http://dx.doi.org/10.1186/s12905-019-0709-2] [PMID: 30665343]
[http://dx.doi.org/10.1186/s12905-019-0709-2] [PMID: 30665343]
[10]
Glasier, A.; Gülmezoglu, A.M.; Schmid, G.P.; Moreno, C.G.; Van Look, P.F. Sexual and reproductive health: A matter of life and death. Lancet, 2006, 368(9547), 1595-1607.
[http://dx.doi.org/10.1016/S0140-6736(06)69478-6] [PMID: 17084760]
[http://dx.doi.org/10.1016/S0140-6736(06)69478-6] [PMID: 17084760]
[11]
Jamshidimanesh, M.; Mousavi, S.A.; Merghati-Khoei, E.; Emamian, M.H.; 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), 157-169.
[PMID: 28496954]
[PMID: 28496954]
[12]
MacAfee, L.K.; Harfmann, R.F.; Cannon, L.M.; Kolenic, G.; Kusunoki, Y.; Terplan, M.; Dalton, V.K. Sexual and reproductive health characteristics of women in substance use treatment in Michigan. Obstet. Gynecol., 2020, 135(2), 361-369.
[http://dx.doi.org/10.1097/AOG.0000000000003666] [PMID: 31923070]
[http://dx.doi.org/10.1097/AOG.0000000000003666] [PMID: 31923070]
[13]
Myers, B.; Carney, T.; Browne, F.A.; Wechsberg, W.M. Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women. Patient Prefer. Adherence, 2018, 12, 1997-2006.
[http://dx.doi.org/10.2147/PPA.S175852] [PMID: 30323569]
[http://dx.doi.org/10.2147/PPA.S175852] [PMID: 30323569]
[14]
Wilson, S.R.; Rodda, S.; Lubman, D.I.; Manning, V.; Yap, M.B.H. How online counselling can support partners of individuals with problem alcohol or other drug use. Patient Prefer. Adherence, 2017, 78, 56-62.
[http://dx.doi.org/10.1016/j.jsat.2017.04.009] [PMID: 28554604]
[http://dx.doi.org/10.1016/j.jsat.2017.04.009] [PMID: 28554604]
[15]
Najmabadi, K.M.; Sharifi, F. Sexual education and women empowerment in health: A review of the literature. Int Women’s Health Reprod. Sci., 2019, 7(2), 150-155.
[http://dx.doi.org/10.15296/ijwhr.2019.25]
[http://dx.doi.org/10.15296/ijwhr.2019.25]
[16]
Closson, K.; Dietrich, J.J.; Lachowsky, N.J.; Nkala, B.; Palmer, A.; Cui, Z.; Beksinska, M.; Smit, J.A.; Hogg, R.S.; Gray, G.; Miller, C.L.; Kaida, A. Sexual self-efficacy and gender: A review of condom use and sexual negotiation among young men and women in Sub-Saharan Africa. J. Sex Res., 2018, 55(4-5), 522-539.
[http://dx.doi.org/10.1080/00224499.2017.1421607] [PMID: 29466024]
[http://dx.doi.org/10.1080/00224499.2017.1421607] [PMID: 29466024]
[17]
Grose, R.G.; Grabe, S.; Kohfeldt, D. Sexual education, gender ideology, and youth sexual empowerment. J. Sex Res., 2014, 51(7), 742-753.
[http://dx.doi.org/10.1080/00224499.2013.809511] [PMID: 24024546]
[http://dx.doi.org/10.1080/00224499.2013.809511] [PMID: 24024546]
[18]
Vakilian, K.; Abbas Mousavi, S.; Keramat, A.; Chaman, R. Knowledge, attitude, self-efficacy and estimation of frequency of condom use among Iranian students based on a crosswise model. Int. J. Adolesc. Med. Health, 2016, 30(1)
[http://dx.doi.org/10.1515/ijamh-2016-0010] [PMID: 27176740]
[http://dx.doi.org/10.1515/ijamh-2016-0010] [PMID: 27176740]
[19]
Tavakoli, F.; Khezri, M.; Tam, M.; Bazrafshan, A.; Sharifi, H.; Shokoohi, M. Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis. Drug Alcohol Depend., 2021, 221, 108655.
[http://dx.doi.org/10.1016/j.drugalcdep.2021.108655] [PMID: 33689969]
[http://dx.doi.org/10.1016/j.drugalcdep.2021.108655] [PMID: 33689969]
[20]
Karamouzian, M.; Sadeghirad, B.; Sharifi, H.; Sedaghat, A.; Haghdoost, A.A.; Mirzazadeh, A. Consistent condom use with paying and nonpaying partners among female sex workers in Iran: Findings of a national biobehavioral survey. J. Int. Assoc. Provid. AIDS Care, 2017, 16(6), 572-578.
[http://dx.doi.org/10.1177/2325957417732834] [PMID: 28974161]
[http://dx.doi.org/10.1177/2325957417732834] [PMID: 28974161]
[21]
Gangi, M.F.; Karamouzian, M.; Nedjat, S.; Rahimi-Movaghar, A.; Yazdani, K.; Shokoohi, M.; Mirzazadeh, A. HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran. Int. J. Drug Policy, 2020, 84, 102868.
[http://dx.doi.org/10.1016/j.drugpo.2020.102868] [PMID: 32717706]
[http://dx.doi.org/10.1016/j.drugpo.2020.102868] [PMID: 32717706]
[22]
Rahmati Najarkolaie, F.; Khobdel, M.; Ghasemi, M.; Farmanbar, R.; Jafari, M.R. KamliKhah, T. Knowledge and high risk behaviors of newly entered students to Tehran University toward HIV/AIDS. J Holist Nurs Midwifery, 2013, 23(2), 35-44.
[23]
Costa, E.C.; McIntyre, T.; Ferreira, D. Safe-sex knowledge, self-assessed HIV risk, and sexual behaviour of young Portuguese women. Port. J. Public Health, 2018, 36(1), 16-25.
[http://dx.doi.org/10.1159/000486466]
[http://dx.doi.org/10.1159/000486466]
[24]
Mousavi, S.A.; Keramat, A.; Vakilian, K.; Chaman, R. Interpretation of opposite-sex friendship based on social ecology model in Iranian females. Iran. J. Psychiatry. Behav. Sci., 2012, 6(2), 69.
[25]
Funnell, M.M.; Anderson, R.M. Empowerment and self-management of diabetes. Clin. Diabetes, 2004, 22(3), 123-127.
[http://dx.doi.org/10.2337/diaclin.22.3.123]
[http://dx.doi.org/10.2337/diaclin.22.3.123]
[26]
Quijano, R.A.; Faytong, H.M. Maternal sexual empowerment and sexual and reproductive outcomes among female adolescents: Evidence from a cross-sectional study in Ecuador. SSM Popul. Health, 2021, 14, 100782.
[http://dx.doi.org/10.1016/j.ssmph.2021.100782] [PMID: 33912648]
[http://dx.doi.org/10.1016/j.ssmph.2021.100782] [PMID: 33912648]
[27]
Peterson, Z.D. What is sexual empowerment? A multidimensional and process-oriented approach to adolescent girls’ sexual empowerment. Sex Roles, 2010, 62(5), 307-313.
[http://dx.doi.org/10.1007/s11199-009-9725-2]
[http://dx.doi.org/10.1007/s11199-009-9725-2]
[28]
Ebrahimipour, H.; Akerdi, B.J.; Solhi, M.; Esmaeli, H. Effect of educational intervention based on Self- Efficacy Theory (SET) on behavior of prevention of HIV/AIDS in high risk women. IJOGI, 2015, 18(144), 19-27.
[29]
Besharat, M.A.; Ranjbar, K.E. Development and validation of sexual knowledge and attitude scale. Contemp. Psychol. C, 2013, 8(1), 21-32.
[30]
Ziaei, T.; Khoei, E.M.; Salehi, M.; Farajzadegan, Z. Psychometric properties of the Farsi version of modified multidimensional sexual self-concept questionnaire. Iran. J. Nurs. Midwifery Res., 2013, 18(6), 439-445.
[PMID: 24554940]
[PMID: 24554940]
[31]
Heydari, A.; Kabir, M. Knowledge and attitude levels in high risk groups about HIV/AIDS and relation with socioeconomic level indicators in Golestan province. Gorgan Univ. Med. Sci., 2010, 12(2), 63-70. [in persian]
[32]
Lotfi, R.; Ramezani Tehrani, F.; Yaghmaei, F.; Hajizadeh, E. Barriers to condom use among women at risk of HIV/AIDS: A qualitative study from Iran. BMC Womens Health, 2012, 12(1), 13.
[http://dx.doi.org/10.1186/1472-6874-12-13] [PMID: 22624530]
[http://dx.doi.org/10.1186/1472-6874-12-13] [PMID: 22624530]
[33]
Jozani, Z.B.; Seyedalinaghi, S.; Moayedi, N.S.; Behtaj, M.; Shokoohi, M.; Mohraz, M.; Vakili, F.; Dana, H.F. Efficacy of a condom negotiation intervention among high risk Iranian women in Tehran, Iran. J. Transl. Med., 2018, 6(3), 105-112.
[http://dx.doi.org/10.11910/12227-16394.12018.11906.11903.11901]
[http://dx.doi.org/10.11910/12227-16394.12018.11906.11903.11901]
[34]
Kakchapati, S.; Gautam, N.; Kc, K.P.; Rawal, B.B. HIV awareness and safe sexual behaviors among female sex workers in Kathmandu valley of Nepal. HIV AIDS, 2018, 10, 157-166.
[http://dx.doi.org/10.2147/HIV.S163269] [PMID: 30174461]
[http://dx.doi.org/10.2147/HIV.S163269] [PMID: 30174461]
[35]
Shannon, K.; Strathdee, S.A.; Shoveller, J.; Rusch, M.; Kerr, T.; Tyndall, M.W. Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy. Am. J. Public Health, 2009, 99(4), 659-665.
[http://dx.doi.org/10.2105/AJPH.2007.129858] [PMID: 19197086]
[http://dx.doi.org/10.2105/AJPH.2007.129858] [PMID: 19197086]
[36]
Khani Jeihooni, A.; Kouhpayeh, A.; Najafi, S.; Bazrafshan, M-R. Application theory of planned behavior on promotion of safe sexual behaviors among drug users. J. Subst. Use, 2019, 24(3)293-299.doi.org/210.1080/14659891.14652018.11562575
[http://dx.doi.org/10.1080/14659891.2018.1562575]
[http://dx.doi.org/10.1080/14659891.2018.1562575]
[37]
Sadri Damirchi, E.; Poorzor, P.; Esmaili Ghazivaloii, F. Effectiveness of sexual skills education on sexual attitude and knowledge in married women. J. Fam. Psychother., 2017, 6(1), 1-15.
[38]
Dashtestannejad, A.; Eshghi, R.; Afkhami, E. Effectiveness of premarital sex education on sexual dysfunctional beliefs of couples. Isfahan PCNM, 2015, 4(2), 14-22. [in persian]
[39]
Hajinia, A.; Khalatbari, J. The effectiveness of sex therapy on sexual self-efficacy and marital satisfaction of diabetic women. IJPES, 2015, 2(2), 1-10.
[40]
Panjalipour, S.; Bostani Khalesi, Z.; Mirhaghjoo, S.N. Iranian female adolescents’ reproductive health needs: A systematic review. IJWHR, 2018, 6, 226-232.
[http://dx.doi.org/10.15296/ijwhr.2018.39]
[http://dx.doi.org/10.15296/ijwhr.2018.39]
[41]
Craig, S.L.; Yang, W.; Austin, A. Promoting the sexual self-efficacy of sexual and gender minority youth through a group intervention. Groupwork, 2020, 29(2), 35-57.
[http://dx.doi.org/10.1921/gpwk.v29i2.1213]
[http://dx.doi.org/10.1921/gpwk.v29i2.1213]
[42]
Hassanshahi Raviz, M.; Babazadeh, R.; Bisheh, A.; Esmaily, H. Investigating the effects of education based on the information-motivation-behavioral skills model on sexual self-efficacy in women with high-risk sexual behaviors. EBCJ, 2019, 9(2), 38-43.
[43]
Grayman, J.H.; Nhan, D.T.; Huong, P.T.; Jenkins, R.A.; Carey, J.W.; West, G.R.; Minh, T.T. Factors associated with HIV testing, condom use, and sexually transmitted infections among female sex workers in Nha Trang, Vietnam. AIDS Behav., 2005, 9(1), 41-51.
[http://dx.doi.org/10.1007/s10461-005-1680-5] [PMID: 15812612]
[http://dx.doi.org/10.1007/s10461-005-1680-5] [PMID: 15812612]
[44]
Wong, M.L.; Chan, R.K.; Koh, D.; Wee, S. Factors associated with condom use for oral sex among female brothel-based sex workers in Singapore. Sex. Transm. Dis., 2000, 27(1), 39-45.
[http://dx.doi.org/10.1097/00007435-200001000-00008] [PMID: 10654867]
[http://dx.doi.org/10.1097/00007435-200001000-00008] [PMID: 10654867]
[45]
Latifnejad Roudsari, R.; Javadnoori, M.; Hasanpour, M.; Hazavehei, S.M.M.; Taghipour, A. Socio-cultural challenges to sexual health education for female adolescents in Iran. Iran. J. Reprod. Med., 2013, 11(2), 101-110.
[PMID: 24639734]
[PMID: 24639734]
[46]
Faust, L.; Yaya, S. The effect of HIV educational interventions on HIV-related knowledge, condom use, and HIV incidence in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health, 2018, 18(1), 1254.
[http://dx.doi.org/10.1186/s12889-018-6178-y] [PMID: 30424761]
[http://dx.doi.org/10.1186/s12889-018-6178-y] [PMID: 30424761]
[47]
Marsch, L.A.; Guarino, H.; Grabinski, M.J.; Syckes, C.; Dillingham, E.T.; Xie, H.; Crosier, B.S. Comparative effectiveness of web-based vs. educator-delivered HIV prevention for adolescent substance users: A randomized, controlled trial. J. Subst. Abuse Treat., 2015, 59, 30-37.
[http://dx.doi.org/10.1016/j.jsat.2015.07.003] [PMID: 26293644]
[http://dx.doi.org/10.1016/j.jsat.2015.07.003] [PMID: 26293644]
[48]
Mihailovic, A.; Tobin, K.; Latkin, C. The influence of a peer-based HIV prevention intervention on conversation about HIV prevention among people who inject drugs in Baltimore, Maryland. AIDS Behav., 2015, 19(10), 1792-1800.
[http://dx.doi.org/10.1007/s10461-015-1048-4] [PMID: 25845530]
[http://dx.doi.org/10.1007/s10461-015-1048-4] [PMID: 25845530]
[49]
St Lawrence, J.S.; Jefferson, K.W.; Alleyne, E.; Brasfield, T.L. Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents. J. Consult. Clin. Psychol., 1995, 63(1), 154-157.
[http://dx.doi.org/10.1037/0022-006X.63.1.154] [PMID: 7896983]
[http://dx.doi.org/10.1037/0022-006X.63.1.154] [PMID: 7896983]
[50]
Costa, E.C.; McIntyre, T.; Trovisqueira, A.; Hobfoll, S.E. Comparison of two psycho-educational interventions aimed at preventing HIV and promoting sexual health among Portuguese Women. Int. J. Sex. Health, 2017, 29(3), 258-272.
[http://dx.doi.org/10.1080/19317611.2017.1307300]
[http://dx.doi.org/10.1080/19317611.2017.1307300]
