Academic journal article Journal of School Health

Correlates of the Intention to Remain Sexually Inactive among Male Adolescents in an Islamic Country: Case of the Republic of Iran

Academic journal article Journal of School Health

Correlates of the Intention to Remain Sexually Inactive among Male Adolescents in an Islamic Country: Case of the Republic of Iran

Article excerpt

In Iran, the first case of human immunodeficiency virus (HIV) was reported in 1987, followed by a rapid increase in the number of cases. In 2007, there were officially 15,587 Iranians living with HIV/ acquired immunodeficiency syndrome (AIDS), 14,702 (94.3%) of whom were males and 885 (5.7%) of whom were females. While only 10% of AIDS patients in Iran have been infected as a result of sexual contact, (1,2) sexually transmitted HIV infection is rapidly increasing, which represents a shift in the mode of transmission from drug use to sexual behavior. (3-5)

The Iranian population is extremely young. Of the approximately 68 million people living in Iran, approximately 18 million (27%) are adolescents. (6) There is some evidence that sexual activity, particularly unprotected sexual contact, among adolescents is increasing. A 2002 study of males aged 15-18 years revealed that approximately 28% of the study sample reported premarital sexual contact and of this percentage, almost 3 out of 4 had more than one sexual partner. (7) Notably, studies among male adolescents have shown that while most of them reported high levels of knowledge about HIV, many did not perceive themselves to be at risk of HIV infection and continued to engage in high-risk behaviors, including unprotected sex, sex with multiple partners, and sex with commercial sex workers. (8) It appears that male adolescents are at an increased risk for contracting HIV as knowledge alone does not protect them from engaging in risky sexual behavior. Additionally, the increasing period between achievement of sexual maturity and marriage may be characterized by increased social pressure to reject traditional religion-based values that praise abstinence before marriage. (9)

There are very few studies that have examined Iranian adolescents' sexual intentions or behavior, and none has employed a theoretical framework. (7,9) In fact, to date, no study has examined abstinence intention/ behavior in Iran. The present study employed a modified Health Belief Model (HBM) theoretical framework and delineated a set of motivational and attitudinal correlates of the intention to remain sexually inactive among Iranian high school students in south east Tehran. The HBM is one of the most widely used conceptual frameworks in adolescent health research for the past decade. (10) The HBM has been internationally used to investigate safer sex behaviors, HIV-related sexual risk taking, and safer sex intentions such as abstinence, condom use, having a steady partner, and other sexual behaviors among adolescents. (11-22) The HBM suggests that health behaviors are a result of a set of core beliefs. (23,24) The original model focused on two themes: threat perception, which depends on perception of susceptibility to the illness, severity of the illness; and behavioral evaluation, which consists of barriers to performing the behavior and the benefits of carrying out the behavior. More recently, self-efficacy has been added to the model.

One of the limitations of the HBM is that the model does not incorporate the influence of subjective norms and peer influences on people's decisions regarding their health behaviors (an important point to consider especially when working with adolescents and sexual behavior). (25) To address this limitation, this study adapted the concept of subjective norms from the Theory of Reasoned Action, which states that behavioral intention is influenced by the individual's perception of social pressure to perform a particular behavior (subjective norm). (26) Specifically, this study examined the interrelationship between the intention to remain sexually inactive and these six elements: knowledge of sexually transmitted diseases, perceived susceptibility and severity of HIV infection, perceived benefits and self-efficacy in exercising abstinence, and subjective peer norms to engage in a sexual behavior.

METHODS

Sample

This cross-sectional study was performed with a non-probability sample of 314 adolescents recruited from three all-boys high schools in 1 of 19 school districts in Tehran, Iran. …

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