In this study, high school students' knowledge levels and behaviors in relation to the prevention and transmission of HIV/AIDS were evaluated in a high-risk, less developed region with a circular population on the Persian Gulf border in southern Iran. The results indicated that less than one out of five students had adequate knowledge about HIV/AIDS prevention and transmission. Television and SNI were the most common sources of information for students. Furthermore, less than one-third of the students respected the social rights of PLHIV. Moreover, about 12% of the students reported using condoms during their recent sexual intercourses.
In this study, the ratio of males to females with adequate knowledge was about one to three. The conventionality of masculine perception of high-risk behaviors or a kind of prestige bias to do high-risk behaviors and lack of attention to precautions in low literacy areas may have led to the unwillingness of males with regard to the care training provided in a variety of ways. On the contrary, a similar study in northwestern Iran demonstrated that the ratio of males with high level of knowledge to females was close to seven (17). Significant differences have been obtained in this ratio in different regions of Iran (17). In another similar study conducted in Iraq, the neighbor of Iran, the number of males with high knowledge levels was significantly more in comparison to females (18). However, some studies have reported no gender differences in this regard (19).
Being resident in Bandar-Abbas, especially its non-marginal areas, was directly linked to an increase in the students’ knowledge levels. Inadequacy of educational infrastructures in such underprivileged and less developed regions (with lower rates of literacy and unemployment) might have been associated with the students' behaviors and lower knowledge levels (11, 20). The families' lower SES in deprived areas could be another reason for this finding (21, 22). In a similar study conducted in Iraq, a significant difference was found between the less developed and more developed regions as well as between the families with higher and lower SES with respect to the proportion of people with adequate knowledge levels (18). These findings were in agreement with those of the present investigation. Coincidence of lower levels of knowledge with other risk factors for transmission, including more circular populations in these areas, poor access to healthcare, and poor healthcare utilization, may increase the risk of HIV/AIDS transmission in these areas.
Television, social networks, and the internet were the most common sources of information among the teenagers participating in the current study. Similarly, mass media, including television, were the most important sources of students’ knowledge in other studies conducted in Bangladesh (23), India (24), and Iraq (18). Students who reported SNI as their main sources of information achieved an odd of 1.45 times of having an adequate level of knowledge compared to other students. The significance of this finding is that given the high influence of these networks on Iranians even in deprived areas, these networks can serve as a platform to promote the knowledge of Iranian teenagers (25). As parents were reported as the most important source of information for only 24 students (out of 1194), family-based interventions may not have acceptable effectiveness in such regions.
Although the students' knowledge on the possibility of transmission of HIV through sharing syringes and sharp objects was sufficient, their information on sexual transmission was not sufficient. In this context, only one-third of the students knew that there was at least one effective way to protect themselves from sexual transmission of the disease. This level of awareness was much lower compared to similar studies (9, 11, 19). This might be attributed to the socio-cultural limitations for providing sex education.
In the present study, more than two-thirds of the students did not respect social rights for PLHIV, which could be a representation of social stigma in the region. This proportion was considerably higher in comparison to similar studies (9, 11, 19). Researchers have highlighted the low level of knowledge as the reason of this high level of stigma (19, 26). Therefore, given the lower prevalence of adequate knowledge level in the current study, lack of knowledge among the participants might have caused higher levels of social stigma associated with HIV/AIDS in the study region. At the same time, the socio-cultural constraints and the guilt convictions of sexual intercourse in Iranian adult thoughts, especially in deprived areas, could be a structural factor in this respect (11). On the other hand, a significant proportion of the students stated television, which not only has all sociocultural and religious restrictions on content delivery, but also promotes these restrictions, as a source of information. High levels of social stigma can lead to lack of willingness to carry out HIV testing, thus concealing the infection and increasing the chance of its transmission to others (11). Therefore, efforts should be made to reduce the level of social stigma in such areas.
As to the participants’ behaviors, 12.5% reported using condoms during their recent sexual intercourses. In the studies conducted in New Zealand, Malaysia, the United States, and Iran, about 30–50% of sexually active adolescents used condoms (27–30). Hence, it can be estimated that approximately 24–36% of the students participating in the present study had experienced at least one sexual contact. The proportion of condom users was roughly equivalent to that reported by other studies from similar communities (27, 28). While the marriage age in Iran is about a decade higher than the average age of the study students, most of them had possibly experienced extra-marital sexual relationships. Concealment of extra-marital sexual activities along with the lack of adequate access to and utilization of healthcare services can be a serious risk factor for these adolescents. Therefore, planning and immediate measures are necessary to provide adequate counseling and training for the students living in these areas in order to establish safe sexual contact.
The present study results revealed significantly higher knowledge levels among condom users compared to the others. In other words, the use of condom was greatly associated with the participants' knowledge levels. This was particularly important among the students in Hormuz Island who reported fewer cases of condom use as well as lower levels of knowledge. Similar results were also obtained in some other studies (9). Although females reported a lower proportion of condom use, they had a higher level of knowledge. This low level of condom usage by females might be due to their lower risky behaviors in comparison to males. In general, sexual activity occurs less in female gender in Iran (11).