Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 52 8 2023 08 06 1673 1681 Effat Merghati Khoei 1. Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran 2. Brian and Spinal Cord Injury Research Center, Neuroscince Institution, Tehran University of Medical Sciences, Tehran, Iran Zahed Rezaei 1. Social Determinants of Health Research Center, Gonabad University of Medical sciences, Gonabad, Iran 2. Asadabad School of Medical Sciences, Asadabad, Iran Minoo Mohraz Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran Alireza Bayat Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Ghanbarpour Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran Therese Killeen Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA Jeffrey Korte Department of Public Health Sciences, School of Medicine, Medical University of South Carolina, Charleston, USA 2021 04 30 2022 06 29 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.   https://ijph.tums.ac.ir/index.php/ijph/article/view/24773 https://ijph.tums.ac.ir/index.php/ijph/article/download/24773/8010