Original Article

Risky Sexual Behaviors and Condom Use Barriers in Iranian Women with Substance Use Disorders


Background: Scant information exists on Iranian women's protective behaviors mainly constant condom use. Inconsistent condom use seems prevalent among women with substance use problems. We aimed to investigate risky sexual behaviors (RSBs) and condom use barriers in Iranian women with substance use disorders (SUDs).

Methods: In our cross-sectional study, we recruited 300 women who sought treatments for their SUDs from the active outpatient drug free (ODF) and Methadone Maintenance Therapy (MMT) centers in Tehran, Iran during 2017-2021. We used three batteries including demographic questionnaire, the Risky Sexual Behavior Questionnaire (RSBQ); and the Condom Barriers Scale (CBS). The statistical software R, analysis of variance post hoc and multivariate analysis of variance (MANOVA) logistic regression tests were used in data analysis

Results: The majority reported at least one lifetime experience of RSBs. Our results show that only 22% of the participants 'always' use condom in their sexual encounters. The lowest and highest subscale scores of the CBS were related to Sexual Experience (SE) (2.47 ± 0.86) and access/availability structure (3.52 ± 0.7), respectively. RSBs had negative significant association with Partner Barrier (PB) subscale scores (OR = 0.4; 95% CI: 0.22 to 0.73) and effect on SE subscale scores (OR= 0.54; 95% CI: 0.31 to 0.94).

Conclusion: RSBs was prevalent among our study population. RSBs and condom use barriers are significantly interwoven. The condom use barriers were highly associated with the types of sexual encounters such as group sex or casual sexual relations than specific mean of sexual performance (i.e. anal sex). Gender-specific RSBs, STIs/HIV/AIDS prevention program is recommended for women with SUDs.


1. Meredith SE, Rash CJ, Petry NM (2017). Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients. J Subst Abuse Treat, 83:10-14.
2. Liu D, Jiang Z, Xiu C, et al (2017). Sexually transmitted infection prevalence and related risk factors among heterosexual male methamphetamine users in China. Int J STD AIDS, 28(12):1208-1214.
3. Ritchwood TD, Ford H, DeCoster J, et al (2015). Risky sexual behavior and substance use among adolescents: A meta-analysis. Child Youth Serv Rev, 52:74-88.
4. Scott-Sheldon LA, Carey KB, Cunningham K, et al (2016). Alcohol use predicts sexual decision-making: A systematic review and meta-analysis of the experimental literature. AIDS Behav, 20(1):19-39.
5. Pan Y, Metsch LR, Wang W, et al (2017). Gender differences in HIV sexual risk behaviors among clients of substance use disorder treatment programs in the US. Arch Sex Behav, 46(4):1151-1158.
6. Corbin WR, Scott CJ, Treat TA (2016). Sociosexual attitudes, sociosexual behaviors, and alcohol use. J Stud Alcohol Drugs, 77(4):629-37.
7. Rammsayer TH, Borter N, Troche SJ (2017). The effects of sex and gender-role characteristics on facets of sociosexuality in heterosexual young adults. J Sex Res, 54(2):254-263.
8. Jamshidimanesh M, Mousavi SA, Merghati-Khoei E, et al (2016). Sexual risk behaviors constructed in Iranian women’s life with substance use disorders: A new implication of human ecological theory. Addict Health, 8(3):157-169.
9. Feaster DJ, Parish CL, Gooden L, et al (2016). Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug Alcohol Depend, 169:171-179.
10. Raj A, Saitz R, Cheng DM, et al (2007). Associations between alcohol, heroin, and cocaine use and high risk sexual behaviors among detoxification patients. Am J Drug Alcohol Abuse, 33(1):169-78.
11. Ministry of Health and Medical Education (2015).Current Statistics on HIV/AIDS Infection in Islamic Republic of Iran.Center for Disease Management, MOH: Tehran, Iran. Avaiilable from: https://www.unaids.org/sites/default/files/country/documents/IRN_narrative_report_2015
12. Ministry of Health and Medical Education, National AIDS Committee Secretariat (2014). Islamic Republic of Iran Progress Report On Monitoring of the United Nations General Assembly Special Session on HIV and AIDS. Avialable from:
a. https://files.unaids.org/es/dataanalysis/knowyourresponse/countryprogressreports/2014
13. Pettifor A, MacPhail C, Corneli A, et al (2011). Continued high risk sexual behavior following diagnosis with acute HIV infection in South Africa and Malawi: implications for prevention. AIDS Behav, 15(6):1243-50.
14. Rojanapithayakorn W (2006). The 100% condom use programme in Asia. Reprod Health Matters, 14(28):41-52.
15. Merghati-Khoei ES, Rezaei Z, Shojaei-Zadeh D, et al (2017). Sexual risk behaviors and condom use barriers in Iranian men with substance use disorders. Addict Health, 9(1):40-47.
16. Taghizadeh H, Taghizadeh F, Fathi M, et al (2015). Drug use and high-risk sexual behaviors of women at a drop-in center in Mazandaran Province, Iran, 2014. Iran J Psychiatry Behav Sci, 9(2):e1047.
17. Karamouzian M, Mirzazadeh A, Rawat A, et al (2017). Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey. Int J Drug Policy, 44:86-91.
18. Tehrani FR, Malek-Afzali H (2008). Knowledge, attitudes and practices concerning HIV/AIDS among Iranian at-risk sub-populations. East Mediterr Health J, 14(1):142-56.
19. Norris J, Stoner SA, Hessler DM, et al (2009). Cognitive mediation of alcohol's effects on women's in-the-moment sexual decision making. Health Psychol, 28(1):20-28
20. El-Bassel N, Caldeira NA, Ruglass LM, et al (2009). Addressing the unique needs of African American women in HIV prevention. Am J Public Health, 99(6):996-1001.
21. Calsyn DA, Peavy M, Wells EA, et al (2013). Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers. Am J Addict, 22(2):150-157.
22. Moayedi-Nia S, Bayat Jozani Z, Esmaeeli Djavid G, et al (2016). HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling. AIDS Care, 28(4):487-90.
23. Calsyn D, Doyle S, Hatch-Maillette M, et al (2006). Reliability, factor structure and validity of the Condom Barriers Scale for use with men in substance abuse treatment. Poster presented at the APA annual convention, New Orleans. Avialbale from: ctndisseminationlibrary.org/PDF/141.pdf
24. Moeini B, Hazavehei SMM, Mousali AA, et al (2016). Predicting factors in intentional safe sexual behaviors among drug abusing men covered by rehabilitation centers in Hamadan (Iran): applying the theory of planned behavior. Koomesh, 17(4): 888-894.
25. Bagheri P, Faramarzi H (2012). The dispersal of high risk sexual behaviors in different occupations of people referred to council center of shiraz medical university. ZJRMS, 14(2):e93600.
26. Bryan AD, Schmiege SJ, Magnan RE (2012). Marijuana use and risky sexual behavior among high-risk adolescents: trajectories, risk factors, and event-level relationships. Dev Psychol, 48(5):1429-42.
27. Castrucci BC, Martin SL (2002). The association between substance use and risky sexual behaviors among incarcerated adolescents. Matern Child Health J, 6(1):43-7.
28. Romero EG, Teplin LA, McClelland GM, et al (2007). A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community. Pediatrics, 119(5):e1126.
29. Otto-Salaj LL, Gore-Felton C, McGarvey E, et al (2002). Psychiatric functioning and substance use: Factors associated with HIV risk among incarcerated adolescents. Child Psychiatry Hum Dev, 33(2):91-106.
30. Lotfi R, Tehrani FR, Yaghmaei F, et al (2012). Barriers to condom use among women at risk of HIV/AIDS: a qualitative study from Iran. BMC Womens Health, 12(1):1-10.
31. Walters SM, Rivera AV, Reilly KH, Anderson BJ, Bolden B, Wogayehu A, et al (2018). Exchange sex among persons who inject drugs in the New York metropolitan area: The importance of local context, gender and sexual identity. AIDS Behav, 22(9):2773-87.
32. Guimarães RA, de Castro VdOL, Stabile AC, et al (2017). Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry, 17(1):412.
33. Korte JE, Merghati-Khoie E, Rimaz S, et al (2014). Increased condom use with psychological abuse among drug-abusing women in Tehran. Drug Alcohol Depend, 140:e110.
34. Merghati-Khoei E, Rimaz S, Korte JE, et al (2015). Intimate partner violence and risky sexual behaviors among Iranian women with substance use disorders. Med J Islam Repub Iran, 29:174.
35. Lotfi R, Tehrani FR, Khoei EM, et al (2013). How do women at risk of HIV/AIDS in Iran perceive gender norms and gendered power relations in the context of safe sex negotiations?Arch Sex Behav, 42(5):873-81.
36. Allen C, Simon Y, Edwards J, Simeon D (2010). Factors associated with condom use: economic security and positive prevention among people living with HIV/AIDS in the Caribbean. AIDS Care, 22(11):1386-94.
37. Lotfi R, Ramezani TF, Yaghmaei F, et al (2012). Socio-environmental barriers of condom use among women at risk for HIV/AIDS: a qualitative Study. Payesh, 11(5):669-678
38. Campbell AN, Brooks AJ, Pavlicova M, et al (2016). Barriers to condom use: Results for men and women enrolled in HIV risk reduction trials in outpatient drug treatment. J HIV AIDS Soc Serv.15(2):130-146.
IssueVol 52 No 8 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v52i8.13405
Sexual risk behaviors Condoms Substance use disorders Sexually-transmitted infections Women

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How to Cite
Merghati Khoei E, Rezaei Z, Mohraz M, Bayat A, Ghanbarpour F, Killeen T, Korte J. Risky Sexual Behaviors and Condom Use Barriers in Iranian Women with Substance Use Disorders. Iran J Public Health. 2023;52(8):1673-1681.