Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 19;24(1):1433.
doi: 10.1186/s12913-024-11933-w.

Facilitators and barriers of HIV pre-exposure prophylaxis use among four key populations in Iran

Hossein Moameri  1 , Parvin Mangolian Shahrbabaki  2 , Fatemeh Tavakoli  1 , Parya Saberi  3 , Ali Mirzazadeh  4 , Reza Goudarzi  5 , Hamid Sharifi  6   7
Affiliations

Facilitators and barriers of HIV pre-exposure prophylaxis use among four key populations in Iran

Hossein Moameri et al. BMC Health Serv Res. .

Abstract

Background: Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.

Methods: We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.

Results: We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).

Conclusions: We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.

Keywords: Barriers; Facilitators; HIV; Iran; Key populations; Pre-exposure prophylaxis.

PubMed Disclaimer

Conflict of interest statement

Declarations Ethics approval and consent to participate The Ethics committee of Kerman University of Medical Sciences approved the study protocol (Ethics code: IR.KMU.REC.1401.443).Participation in this study was voluntary and anonymous; names or other personal identifiers were not collected as a condition for participation. Participants could refuse to answer any question or stop the interview at any time. Due to the stigma toward HIV and key populations in Iran and the fear of patients signing written documents, verbal informed consent was obtained from all participants in this study. The ethics committee of Kerman University of Medical Sciences approved the procedure for obtaining verbal informed consent. Competing interests The authors declare no competing interests.

References

    1. Collaborators GH. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the global burden of diseases, injuries, and risk factors study 2017. Lancet HIV. 2019;6(12):e831–59. - DOI - PMC - PubMed
    1. UNAIDS. Global HIV & AIDS statistics — fact sheet. 2022. Available from: https://www.unaids.org/en/resources/fact-sheet.
    1. UNAIDS. Country factsheets, Iran (Islamic Republic of). 2022. Available from: https://www.unaids.org/en/regionscountries/countries/islamicrepublicofiran.
    1. Zhenhua D, Shuangfeng F, Rong L, Xueqing W, Yaying S, Zhijun L, et al. Consistently high HIV prevalence among men who have sex with men in Chengdu city from 2009 to 2014. Int J STD AIDS. 2016;27(12):1057–62. - DOI - PubMed
    1. Manathunge A, Barbaric J, Mestrovic T, Beneragama S, Bozicevic I. HIV prevalence, sexual risk behaviours and HIV testing among female sex workers in three cities in Sri Lanka: findings from respondent-driven sampling surveys. PLoS One. 2020;15(10):e0239951. - DOI - PMC - PubMed

Substances