Informal sexual relationship-associated factors among young adult smartphone users in South of Iran: a cross-sectional study.

BACKGROUND: With the unprecedented pace of modernization, risky sexual behaviors have become more frequent in developing countries, such as Iran. We aimed to assess the prevalence of informal sexual relationship (ISR) and factors associated with having ISR in young adult in Iran. METHODS: This cross-sectional study was conducted on 414 young adult smartphone users in Iran, in 2019. Data was collected through an online questionnaire (including: ISR, socio-demographic variables, their use of social network, religious beliefs, personality, and loneliness). Logistic regression model was used to determine factors related to ISR. RESULTS: A total of 152 (36.7%; 95% CI 32.1-45.6) participants reported having ISR. Finding an opposite-sex friend through a mobile app (OR = 2.59, 95% CI 1.34, 5.01), being currently sexually active (OR = 2.39, 95% CI 1.26, 4.56), higher scores of extroverted personality (OR = 1.13, 95% CI 1.01, 1.27), and closer relationship with parents (OR = 3.17, 95% CI 2.25, 8.02) were found to be associated with having ISR. Additionally, living in small cities rather than the provincial capital (OR = 0.23, 95% CI 0.10, 0.49) had a reverse association with having ISR. CONCLUSIONS: This study illustrated the high prevalence of ISR and its association with increased duration of internet and mobile app use. Innovative and multidisciplinary approaches could be recommended in this regard.

Three Decades of Healthcare System Reform in Iran from the Perspective of Universal Health Coverage: A Macro-Qualitative Study.

Background: The healthcare system in Iran has undergone several reforms to achieve the objectives of universal health coverage (UHC). Some reforms have delivered positive benefits, however, still many challenges remain. Hence, the current study assessed the progress and outcomes of these reforms over the past three decades. Methods: The present nationwide macro-qualitative study was conducted in Iran during 2016-2017. Data were collected through 32 in-depth interviews with 30 high-ranking policymakers and healthcare providers at the national and provincial levels to identify their experiences and perceptions of the reforms. The data were analyzed using the constant comparative analysis method. Results: Analysis of the interview data resulted in two main themes, six categories, and 18 sub-categories. The extracted themes were adverse situational context and the chaotic healthcare system. The results showed that the Iranian healthcare system reforms could be characterized as incoherent and passive, and that these were the main reasons for not achieving the objectives of UHC reforms. It was revealed that the implemented reforms lacked a comprehensive approach and at times were counterproductive. Moreover, the situational context adversely hindered the successful implementation of the reforms. Conclusion: Despite many efforts to improve the Iranian healthcare system through reforms, the situational context and organizational factors have prevented achieving the main objectives. Iran's health policymakers should consider a phased implementation of small-scale reforms based on a comprehensive master plan that takes social, political, and economic factors into account. This approach would minimize potential risks and encourages the cooperation of the main stakeholders.

An Online Investigation of Knowledge and Preventive Practices in Regard to COVID-19 in Iran.

BACKGROUND: Until now, there was no available study on the knowledge and practice of the people of Iran with regard to the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: This study aimed to investigate the knowledge and preventive practices of Iranians toward the COVID-19 pandemic. METHODS: This is a cross-sectional study of 925 people who completed an online questionnaire in March 2020. The study used 21 and 14 questions, respectively, to assess the knowledge and preventive practices of the population in regard to COVID-19. Cronbach's alpha was 0.75 for the knowledge scale and 0.71 for the practice scale. To determine the importance of each independent variable in explaining the participant's practice, a multiple regression model was applied. KEY RESULTS: The results indicated a moderate level of knowledge and preventive practices in regard to COVID-19 in most of the respondents (56.8% and 56.5%, respectively). According to the multiple regression analysis, knowledge showed the highest effect on the practice of the participants (ß = 0.479). The determination coefficient for the model (R2 = 0.509) also showed approximately 51% of the variance in practice was explained by gender, occupational status, knowledge, cost of hand sanitizer, and the belief in the effectiveness of using such necessities. CONCLUSIONS: Acceptable rates of knowledge and practice were observed in most Iranians. However, approximately 10% of the participants were unaware of the effective measures for preventing the infection, which can cause active transmission of the virus. In addition to considering the importance of high community awareness in prevention and isolation measures, the government should provide disinfectants and other materials at a low price to reduce the transmission, as this may lead to effective practice to break the chain of transmission of COVID-19. [HLRP: Health Literacy Research and Practice. 2021;5(1):e15-e23.] PLAIN LANGUAGE SUMMARY: This study sought to evaluate the knowledge and preventive practices of Iranians toward the coronavirus disease 2019 pandemic. Findings of this research demonstrate acceptable rates of knowledge and practice in most Iranians; however, about 10% of them were unaware of the true prevention practices, which can cause active transmission of the virus.

Estimating the Visibility Rate of Alcohol Consumption: A Case Study in Shiraz, Iran.

BACKGROUND: Network Scale Up (NSU) is applied in many settings to estimate the size of hidden populations. The visibility of alcohol consumption - as a hidden behavior - in Iran has not been yet set. Our aim is to estimate the visibility factor (VF) of alcohol consumption in Iran which is an Islamic country in the Middle East. METHODS: Ninety persons who had a history of alcohol consumption were recruited. Relationships in network were aligned in three main subgroups: immediate family, extended family, and non-family. According to the game of contact methodology, participants answered questions about total and aware number of persons they know in each relationship category. VF was calculated by dividing total number of people aware about the respondent's alcohol consumption by total number of respondent's social network. The 95% confidence intervals (CIs) were computed through bootstrapping. FINDINGS: The mean and standard deviation (SD) of participants' age was 32.9 ± 10.2, the sex ratio was 3. Overall VF (95% CI) was 40% (33% to 47%). VF was estimated at 44% and 23% among men and women's network, respectively. The immediate family was the highest informed group, followed by non-family and extended family members. CONCLUSION: The visibility of alcohol consumption in Iran was not high. This is due to religious and legal prohibitions around it.

High risky behavior and HIV/AIDS knowledge amongst street children in Shiraz, Iran.

Background: Street children around the world are accompanying a wide range of risky behaviors. The most common ones include risky sexual behavior, substance and alcohol abuse, and violence. This study aimed to assess risk behaviors and HIV knowledge of street children in Shiraz. Methods: A total of 329 street children (7-18 years of age who spend days or nights on streets with or without their family for earning money) were interviewed through 2014-2016 in Shiraz. Data were collected through a structured interview about high-risk behaviors and HIV/AIDS Knowledge based on a form and questionnaire. Street children were asked to identify HIV/AIDS mode of transmission. All correct answers were scored as one (1), and incorrect, "don't know" responses and no responses scored as zero. The data were analyzed by SPSS software 16 (SPSS, Inc. Chicago, USA) using the Independent t-test and chi-square test, and Pearson's correlation test. P value< 0.05 was considered as statistically significant Results: The mean ± SD age was 13.46±3.09. A total of 86.6% of them were boys. A total of 97.6% of them reported staying with their parents. Street children reported sleeping place as follow: with their parents (n=312, 94.8%), sharing accommodation with other kids (n=13, %4), sleeping in parks (n=2, 7%), and one with relatives. The frequency of smoking, alcohol drinking, and drug abuse were 35 (10.6%), 47 (14. 3%), and 6 (1.8%) respectively. A total of 43 (13.1%) street children reported sexual activity, among them 30 (9.1%) had sexual activity without a condom. Mean ± SD HIV/AIDS knowledge scoring of street children was, 4.1±3.9. Conclusion: Special programs should be implemented in order to reduce high-risk behavior among street children. Intervention should include increasing awareness about alcohol and drug abuse, HIV/AIDS knowledge, sexual and verbal abuse through an organized system with the help of peer education.

Women's Cancer Care in Iran.

Breast cancer (BC) and cervical cancer (CC) are the first and fifth common cancers in Iranian women. Although age-standardized incidence rate of BC and CC in Iran is low, the mortality to incidence ratio is high due to late diagnosis. Except an old and a quite comprehensive cancer registry, women's cancer care encounter many challenges in Iran. Lack of a customized national and inclusive protocol to control cancer care along with the fragmented health system is the first and foremost cancer care challenge. Many high-risk women miss the opportunity of early diagnosis and treatment because of poor knowledge, low accessibility, or affordability to health care, stigma, and spouse negligence. Although the most effective BC screening method is mammography, it is not equally available for all Iranian women. Furthermore, the cost of BC is very high and screening is accompanied by stigmatized sociocultural beliefs. Unfortunately, while Iran has a good primary care system, low coverage of clinical breast examination and poor knowledge of women indicate that this system has not operated effective. Also due to the limited resources, the Pap smear test has not been applied to the majority of Iranian women. Despite the high basic health insurance coverage in Iran, it does not cover diagnostic test and full treatment of cancers which intensified underutilization of cancer care. In conclusion, developing a national policy and guideline for full coverage of early diagnosis of BC or CC should be prioritized. In this regard, health insurance companies should be committed to including BC and CC screening and care for their basic service packages. The second strategy could be training skillful, responsible, and motivated health-care providers. They are able to decrease the stigmatized view of doing mammography. Survivorship care including follow-up care, posttreatment issues, and psychosocial support should also be considered.

Experience of violence among street prostitutes: a qualitative study in Shiraz, Iran.

BACKGROUND: Female Sex workers (FSWs) are a marginalized group. Although some studies have shown various types of violence against sex workers, it is a subject which needs more in-depth knowledge. METHODS: This is a conventional content study conducted on 18 street sex workers in Shiraz, Iran. RESULTS: The present study observed that sex workers had extensive experience in five forms of violence: physical, barbaric, psychological, sexual, deception and robbery. Moreover, violence was deep-rooted in their previous experiences prior to becoming a prostitute, leading to the formation of yet another type of violence, called hidden slavery with male or female pimps. CONCLUSIONS: To improve the general health of this group, it is recommended that they be supported by social institutions and be provided with psychological consultations.

The Impact of Perceived Stigma, Quality of Life, and Spiritual Beliefs on Suicidal Ideations among HIV-Positive Patients.

BACKGROUND: Suicidal ideation is considered a major health problem associated with HIV/AIDS. Suicide rates among people living with HIV/AIDS (PLHA) are more than three times higher in the general population and that is a significant difference. This study aimed at investigating the related factors of suicidal ideations among HIV-positive patients in Southwest Iran. STUDY DESIGN: A cross-sectional study. METHODS: 351 adult volunteer HIV-infected patients that referred to the Voluntary Counseling and Testing (VCT) center in the south of Iran were evaluated based on convenience sampling. Data was collected utilizing a structured questionnaire from March to August 2015. RESULTS: Over the six months prior to the study, 15.4% of the entire sample had been diagnosed with suicidal ideation. There was a significant correlation between the quality of life, spiritual beliefs, perceived stigma, and age with suicidal ideation. Suicidal ideation is significantly different in terms of gender and marital status. Perceived stigma and spiritual beliefs showed the highest effect on suicidal ideations, respectively. CONCLUSIONS: Having religious beliefs due to accelerating psychological adaptation can motivate HIV patients to survive and have also been considered effective in preventing women from suicide. Perceived stigma and quality of life are other factors that should be taken into consideration as key elements in suicide preventive programs.

Prevalence of Tuberculosis in HIV-positive Prisoners: A Systematic Review and Meta-analysis.

Tuberculosis (TB) and HIV constitute the main burden of infectious diseases worldwide. Imprisonment is an important risk factor for contracting TB, especially among those living with HIV. This systematic review summarizes the available data on the prevalence of TB among HIV-positive prisoners; which may support improved targeted TB/HIV prevention plans. We electronically examined published studies up to December 2017 with the aim of finding articles that investigated the prevalence of TB in HIV-positive prisoners. MEDLINE, SCOPUS, Embase, and Web of Science electronic databases were searched with no restriction on language or time. A random effects model was used to conduct the meta-analysis and generate a summary estimate for the global prevalence of TB among HIV-positive prisoners; and subgroup estimates by continent. The meta-analysis included 22 studies published from 1992 to 2016. In total, 2,465 articles were retrieved and 22 papers met inclusion criteria. Eligible papers contained 220,101 prisoners, with 1,611 cases of TB in 6,126 HIV-positive subjects. Globally, the pooled prevalence of TB in HIV-positive prisoners was 32.6% [95% confidence interval (CI): 27.5% to 38.2%; p-value for heterogeneity=0.001]. Results of the subgroup analysis by continent were as follows: Africa, 14% (CI: 8% to 24%); North/South America, 37% (CI: 31% to 44%); Asia, 35% (CI: 12% to 68%); and Europe, 25% (CI: 12% to 45%). CONCLUSIONS: The prevalence of TB among HIV-positive prisoners is high worldwide. Screening of TB in this population is essential for the treatment of both diseases. Syndemics of TB and HIV in prisoners during the past three decades have created an alarming situation across the world. Hence, coordinated policies are essential for the early identification and effective treatment of this vulnerable population.

Strategies to Reduce HIV Transmission amongst Prisoners; Lessons Learned From Iran.

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Stigmatized Attitude of Healthcare Providers: A Barrier for Delivering Health Services to HIV Positive Patients.

BACKGROUND: Despite the success of developed countries in preventing the spread of HIV/AIDS, the disease is expanding in developing countries where an unfavorable attitude exists among people, health professionals and employees. This study aimed to assess the stigmatized attitude among health care providers toward people living with HIV (PLWHA). METHODS: The study is a cross-sectional survey. The data were gathered using a structured questionnaire. The study sample included 575 health care providers of public and private hospitals in Shiraz. The data were gathered using a structured questionnaire in spring 2014. Data analysis was carried out using the Statistical Package for Social Sciences, version 21. RESULTS: The most dominant attitude of the health care providers toward HIV/AIDS patients was related to fear (42.42%). According to the results of this study, there was a significant relationship between stigmatized attitude of the health care providers and their religious beliefs, society stigmatized attitude, and knowledge of transmission routes. The relationship between social stigmatized attitude of health care providers and their knowledge of transmission routes, with their willingness to provide services to patients is significant, as well (P<0.05). 39.6% and 46.2% of the respondents preferred not to provide services to the prostitutes and homosexual patients. CONCLUSION: Fear of contamination and social stigmatized attitude are the main impediments to dealing with patients and providing services to them. Hence, it seems that creating an effective knowledge about transmission and correcting the socio-cultural beliefs of health providers are two key strategies to tackle this problem.

Nutrition Transition: An Intergenerational Comparison of Dietary Habits among Women of Shiraz.

BACKGROUND: There is a shift worldwide towards a diet that is high in processed foods and low in fiber, leading to a corresponding increase in degenerative diseases. These diseases are interrelated with lifestyles and especially with diets. The aim of this study was to investigate the eating habit differences between two generations of mothers and daughters and their tendency towards modern foods. METHODS: In this cross-sectional survey, the data were gathered using structured questionnaires. The sample of the study includes 618 women in Shiraz City (309 mothers and 309 daughters) selected through stratified random sampling. Data analysis was carried out using the SPSS software. RESULTS: In the mothers' generation, around 80% showed a traditional nutritional pattern while in the young generation more than 50% had a modern or close to modern pattern of nutrition (P ≤ 0.05). The findings confirmed a significant difference in dietary habits among the two generations. For both generations, nutrition pattern was significantly different in terms of social class, weight control, education, using mass communication, and physical activities (P ≤ 0.05). CONCLUSION: Iran is currently experiencing a nutrition transition. The current inappropriate habits in the lifestyles of the girls' in Shiraz are a health threat for them, and it will increase the risk of non-communicable diseases. Therefore, policy makers have to set new agenda to increase the nutritional knowledge of the population.