Barriers of condom use among female sex workers in Tehran, a qualitative study

In Iran, HIV prevalence in sex workers is reaching to an epidemic, but still consistent use of condoms is low. This qualitative study aimed to assess barriers to condom use in female sex workers (FSWs). We conducted individual in-depth interviews with 40 FSWs and 12 partners in the year 2010 in Tehran. The FSWs were purposefully selected from four different groups based on the level of socioeconomic status and history of using substance. Findings were extracted and coded manually and the responses of the groups were categorized and compared. Almost all FSWs had not used condoms regularly in the past six months. The main barriers of condom use were: lack of awareness of the modes of transmission of HIV and prognosis of the disease, doubt on the role of condoms in preventing sexually transmitted diseases and HIV, fear of violence or rejection by male customers, reluctance of sexual partners to use condoms due to diminution of sexual pleasure, and believing in health of some customers. Increasing awareness of the FSWs through education about HIV, ways to prevent the disease and empowering them on negotiating skills to use condoms as part of harm reduction programs are recommended.