Reasons for Not Using Condoms by People Who Inject Drugs in Iran; Results from a Conventional Content Analysis in 2018

This qualitative study was conducted to identify reasons for not using condoms by people who inject drugs (PWID) in Iran.
 

Purposeful sampling was applied to recruit four groups [male PWID (n = 14), female PWID (n=6), service providers (n=8), and HIV/Addiction experts (n = 9)] into a qualitative study. Data were collected through focus group discussions (FGDs) or individual in-depth interviews. Data were analyzed using conventional content analysis.
 

The mean age was 44.0 years for male and 38.2 for female PWID. Qualitative analysis showed 16 themes for not using a condom, which were grouped in three main categories, including knowledge (3 themes), accessibility (4 themes), and individual barriers to use condoms (9 themes). Poor knowledge included low perceived level of risk, insufficient training, and misconceptions. Lack of access to condoms resulted from the country's new policy for population growth control and decrease in the number of pharmacies and harm reduction centers and prisons where condoms were previously distributed free of charge. Common reported individual barriers to condom use were poverty, homelessness, depression, low self-care, and low self-esteem, less pleasure, having sex under the influence of drugs, and stigma.
 

Both structural and individual factors may play a role as barriers to condom use among PWID.