title: Barrier and Facilitators of HIV Related Risky Sexual Behavior.
abstract: BACKGROUND
  This study was conducted to identify the determinants of protective behavior in relation to HIV transmission. Since the risk of transmission is higher among those who have extramarital intercourse, the study sample constituted of such people.
  
  
  METHODS
  We started this study in 2010 and finished it in 2011. Participants were divided into low-risk and high-risk groups. High-risk people included sex workers and those who presented at drop-in centers. Interviewees were 18 men and women in the low-risk group and 12 men and women in the high-risk group. Data were collected through in-depth interviews and were analyzed using the thematic framework method.
  
  
  RESULTS
  In both groups, protective behavior was influenced by willingness to protect, intention or decision to protect, and personal, social, and environmental barriers and facilitators. In terms of willingness, behavior was influenced to preserve sexual pleasure by avoiding condoms. In terms of barriers and facilitators, trust in partner, misperceptions, condom inaccessibility, unplanned sex, fear of contracting the disease, partner's wish, ethical commitments were mentioned by both groups, stigma of condom possession by the low-risk group, and partner's force was mentioned by the high-risk group.
  
  
  CONCLUSIONS
  Educational programs need to focus on changing the concept that "condoms reduce sexual pleasure". In addition, interventional programs to strengthen factors such as self-efficacy, ethical commitments, faithfulness, and correct beliefs such as undue trust in partner, misconception of being safe, unplanned sex, and the stigma of possessing condoms can be very effective in changing high-risk sexual behavior.
authors.affiliation: International Campus, Tehran University of Medical Sciences, Iran.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Shahnazi
authors.affiliation: Social Determinants of Health Research Centre, Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Ameneh Setareh
authors.initials: AS
authors.lastname: Forouzan
authors.affiliation: Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saharnaz
authors.initials: S
authors.lastname: Nedjat
authors.affiliation: International Campus, Tehran University of Medical Sciences, Iran.
authors.forename: Soheila
authors.initials: S
authors.lastname: Asgari
authors.affiliation: Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Community Based Participatory Research Center (CBPR), Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
keywords: Barrier; Facilitator; HIV; Iran; Sexual behavior