Sexually transmitted infection knowledge and attitudes among Muslim women worldwide: a systematic review

Sexual health beliefs and prevention of sexually transmitted infections among cisgender women sex workers in Colombia

INTRODUCTION

The stigma and social discrimination against cisgender women sex workers lead many of them to live in conditions characterized by social inequality, marginalization, persecution, and limited opportunities for sexual health literacy. Consequently, they are often compelled to establish a framework of preventive beliefs with little scientific validity, which they use to identify, mitigate, or avoid sexual health risks arising from their interactions with clients. This study investigates the sexual health beliefs that influence self-care practices aimed at preventing sexually transmitted infections among cisgender women sex workers in Colombia.

METHODS

We conducted a qualitative study framed in Hermeneutic Phenomenology. In-depth interviews and discussion groups were conducted with 34 cisgender women sex workers over 18 years of age in the center of the cities of Bogotá and Barranquilla in Colombia.

RESULTS

Seven themes emerged from the reflective and inductive thematic analysis of the narratives: (1) popular habits for the prevention of contagion, (2) ocular assessment of genitals, (3) condom lubrication, (4) suspicion of a hidden infection in the client, (5) saliva and oral contact as a source of contagion, (6) avoidance of semen contact, (7) and trust in God as protection.

CONCLUSIONS

The findings reflect the need for health and social professionals to promote participatory and inclusive cooperation with sex workers to update the framework of preventive beliefs that help them guide sexual health self-care with autonomy and self-efficacy, strengthening favorable beliefs and negotiating unfavorable ones. It is also essential to have a sex worker-informed sexual health policy that guides the promotion of sexual health that is sensitive to the needs and consistent with the risks of sex work and ensures friendly and non-oppressive preventive care environments for sex workers.

Efficacy of mobile-based educational intervention using Instructional Systems Design in promoting preventive behaviors for sexually transmitted infections among Iranian women: a randomized controlled trial

BACKGROUND

Women who are sexually active are at risk of sexually transmitted infections (STIs), which can cause serious difficulties for their reproductive health. However, despite the high global burden of STIs, most infections are preventable with education for behavioral change. The purpose of this study is to investigate the Efficacy of Mobile-Based Educational Intervention Using Instructional Systems Design in Promoting Preventive Behaviors for Sexually Transmitted Infections among Iranian Women.

METHODS

This randomized controlled trial aimed at promoting preventive behaviors related to STIs in Iranian women with an educational intervention based on the Instructional Systems Design (ISD) in 2022. The participants in this study were recruited from a single center, specifically the Health House No. 3 located in District 11 of Tehran Municipality. Two instruments were used in the present study: a) a valid scale titled: "Four-Scale of STI Preventive Behaviors", and b) a researcher-made Questionnaire titled: "Social perception affecting sexually transmitted infections (SOPESTI)". These tools contain 8 demographic items and specific questions with a total of 68 five-point Likert scales. The intervention comprised three phases: a pre-test (baseline), a training program, and two follow-up assessments (4 and 12 weeks after the start of the training program). The experimental group received education through a mobile app, while the control group received no intervention. SPSS v.26 was used, with a significance level of P < 0.05. The chi-square test, Fisher's exact test, independent t-tests, analysis of covariance (ANCOVA), and repeated measures ANOVA were used to analyze the data.

RESULTS

A total of 80 women, with a mean age of 36.524 ± 6.91 (experiment group) and 34.78 ± 8.20 (control group), respectively, participated in the trial. The study revealed a statistically significant difference in the mean score for eight domains, including STIs Knowledge, STIs Vulnerability, STIs Preventive Self-efficacy, STIs Prevention intentions, STIs Perceived social exclusion, STIs Perceived cognitive barriers, STIs Perceived social support, and STIs Perceived risks in the experiment group following the intervention compared to before the intervention (p < 0.05).

CONCLUSION

The results of this study showed that a mobile-based educational intervention based on the ISD model had a significant effect on the preventive behaviors of STIs in Iranian women. These results highlight the potential benefit of mobile health in enhancing reproductive health.

TRIAL REGISTRATION

ClinicalTrials.gov IRCT20200602047638N1. Registered on 22 May 2021 with the IRCTID, V1.0. https://www.irct.ir/trial/55632.

Testing for sexually transmitted infection: who and where? A data linkage study using population and provider data in the Rotterdam area, the Netherlands

BACKGROUND

In the Netherlands, insight into sexually transmitted infection (STI) testing and characteristics of those tested by general practitioners (GPs) and sexual health centres (SHC) is limited. This is partly due to lacking registration of socio-demographics at GPs. We aimed to fill this gap by linking different registers.

METHODS

Individual STI testing data of GPs and SHC were linked to population register data (aged ≥15 years, Rotterdam area, 2015-2019). We reported population-specific STI positivity, proportion STI tested, and GP-SHC testing rate comparison using negative binomial generalised additive models. Factors associated with STI testing were determined by the provider using logistic regression analyses with generalised estimating equations.

RESULTS

The proportion of STI tested was 2.8% for all residents and up to 9.8% for younger and defined migrant groups. STI positivity differed greatly by subgroup and provider (3.0-35.3%). Overall, GPs performed 3 times more STI tests than the SHC. The smallest difference in GP-SHC testing rate was for 20-24-year-olds (SHC key group). Younger age, non-western migratory background, lower household income, living more urbanised, and closer to a testing site were associated with STI testing by either GP or SHC. GPs and SHC partly test different groups: GPs test women and lower-educated more often, the SHC men and middle/higher educated.

CONCLUSIONS

This study highlights GPs' important role in STI testing. The GPs' role in the prevention, diagnosis, and treatment of STIs needs continued support and strengthening. Inter-professional exchange and collaboration between GP and SHC is warranted to reach vulnerable groups.

The Knowledge and Determinants of Sexual Health and Sexual Transmitted Infections Among Women in Saudi Arabia: A Nationwide Survey

Background

Sexual health is a necessary part of any society because it significantly influences the quality of life. Women's knowledge regarding STIs and safe sex practices in Saudi Arabia has not been thoroughly investigated; therefore, this study aims to investigate and measure the knowledge and the determinants of sexual health and STIs among women in Saudi Arabia.

Methods

This study is a nationwide cross-sectional survey conducted through phone interviews in Saudi Arabia in 2021. This study included 1334 female participants aged 18 years or older.

Results

The study's results collectively show that women in Saudi Arabia have limited knowledge of sexual health and STIs. The primary causes are the lack of knowledge of different STIs-communicability, symptoms, and an overall lack of technical proficiency in the subject. The study analyzed factors associated with participants' knowledge of sexual health and sexually transmitted infections. Significant associations were found between knowledge and age, region, educational level, and family income. In the multivariable analysis, participants aged 20-29 had higher knowledge compared to those aged >60. Participants in the Eastern region had higher knowledge than those in the Southern region. Participants with less than a bachelor's degree had lower knowledge than those with a bachelor's degree or higher. Participants earning an average of 16,000 SAR to 19,999 SAR had higher knowledge than those with unstable monthly income.

Conclusion

The study found that women's understanding of sexual health and STIs in Saudi Arabia is low due to a lack of knowledge and awareness. Knowledge levels were correlated with educational levels; therefore, targeted health promotion initiatives are needed to increase understanding, particularly regarding condom use for HIV and STI prevention.

Muslim women's perspectives on the barriers to sexually transmitted infections testing and diagnosis in Saudi Arabia

Background

Muslim women are especially vulnerable to sexually transmitted infections (STI) and are at higher risk of under-detection. Evidence on the unique barriers to STI testing and diagnosis among Muslim communities is severely lacking. Understanding the complexity of accessing STI testing and diagnosis in Muslim communities is an area that requires further exploration. We aimed to explore the multilevel barriers to STI testing and diagnosis among Muslim women.

Methods

We conducted qualitative semi-structured interviews informed by the ecological model of health. This study took place in Riyadh Saudi Arabia in 2019 with women aged over 18. Data were analysed using reflexive thematic analysis.

Results

Twenty-eight women were interviewed from different ages, marital status, employment, and educational levels. Muslim women's perceived barriers to STI testing and diagnosis included personal, socio-cultural, and service-level barriers. Lack of knowledge about STIs, denial, and underestimating the seriousness of infection and symptoms were among the many individual barriers to STIs testing and diagnosis. Religious views towards extramarital sex and negative views of people with STIs is a significant barrier to STI testing and diagnosis. Lack of patient confidentiality and providers' judgement and mistreatment were also cited as barriers to seeking healthcare.

Conclusion

Barriers to STI testing and diagnosis exist on many levels including personal, socio-cultural, religious, and healthcare services, and at policy level. Multilevel interventions are needed to reduce the stigma of STIs and facilitate access to sexual health services among Muslims. It is our recommendation that policy and research efforts are directed to enhance trust in the doctor-patient relationship through better clinical training as well as implementing stricter regulations to protect patients' confidentiality in healthcare settings.

Public Awareness About Sexually Transmitted Diseases in Taif, Saudi Arabia

INTRODUCTION

Islamic culture does not tolerate homosexuality and extramarital sex. This may result in ignorance of safe sex practices and a lack of proper public health education by the authorities and parents; this includes knowledge and awareness about sexually transmitted diseases (STDs), modes of transmission, protection methods, and sources of information about STDs.

METHODS

This is a cross-sectional study, a Quick Response (QR)-code-based survey. A standard web-based questionnaire was electronically delivered to our enlisted sample. The statistical analysis started by transferring data from the Excel spreadsheet (Microsoft Corporation, Redmond, Washington, United States) to the SPSS software program. We used one-way ANOVA to compare mean scores between the various groups. And we used the Pearson correlation coefficient to assess the association of age with the score. Significance was established at a p-value of 0.05 or less with a 95% confidence interval. All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States).

RESULTS

The study analysed the sociodemographic characteristics and STD knowledge of 608 participants. Findings revealed a balanced gender distribution, 52.8% male and 47.2% female, the majority being single (72.0%) and with a university education (72.0%). Knowledge gaps were identified, such as confusion between genital herpes and HIV, limited understanding of chlamydia transmission, and misconceptions about human papillomavirus (HPV) and HIV. No significant differences were found based on sex, age, marital status, or father's education. However, higher education of mother correlated with significantly higher knowledge scores (p < 0.0001).

CONCLUSION

This study shed light on the limited knowledge and misconceptions surrounding STDs in Taif city. The findings highlighted knowledge gaps, including confusion between different STDs and misconceptions about transmission modes. The results revealed a positive correlation between higher maternal education and increased knowledge scores. These findings underscore the urgency for health authorities to develop awareness campaigns and educational initiatives to promote accurate information and foster healthier attitudes toward sexual activity in these regions.

Muslim women's knowledge, views, and attitudes towards sexually transmitted infections in Saudi Arabia: A qualitative study

BACKGROUND

The cultural sensitivity surrounding sexuality in Islamic communities has an impact on awareness and prevention of sexually transmitted infections (STIs). This study explores Muslim women's knowledge, views, and attitudes towards STIs and people living with HIV/AIDs in Saudi Arabia.

METHODS

We conducted qualitative semi-structured interviews with Muslim women from Saudi Arabia. Interviews took place in a public hospital in Riyadh, Saudi Arabia in 2019. Data were transcribed, coded, and analysed using a reflexive thematic analysis.

RESULTS

Twenty-eight women were interviewed, the majority were college educated and employed. Participants lacked knowledge about STIs, and there were significant misconceptions. The majority of women expressed extremely negative attitudes towards STIs, particularly towards people living with HIV/AIDS. Participants believed that judgemental attitudes and stigmatisation of people with HIV/AIDS were justified if an infection was transmitted through extramarital sex. Men were believed to be the source of STIs, and STIs were viewed as punishment from God for extramarital sexual relations that are forbidden in Islam. Protection against STIs was believed to be achieved by strengthening religious beliefs.

CONCLUSION

Attitudes towards people with STIs, HIV/AIDS in particular, were highly influenced by religious views towards extramarital sex, as well as lack of knowledge and misconceptions. There is an urgent need for accurate information and improved awareness of sexual health including STIs among Muslims in Saudi Arabia. Public health efforts should be directed towards reducing stigma and discrimination against people living with HIV/AIDS in Saudi Arabia and other Islamic communities.

Sexual knowledge based on Islamic values and sexual risk behaviors of HIV/STIs among Thai Muslim army conscripts: A cross-sectional study

BACKGROUND

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are commonly associated with conflict areas. In Thailand, conflict situations have occurred from 2004 until the present in three Muslim-majority southernmost provinces, including Yala, Pattani, and Narathiwat. However, Islam provides strict guidelines on sexuality. Therefore, those who strictly practice Islam will have lower sexual risk behavior.

OBJECTIVE

This study aimed to examine the relationship between Islamic values-based sexual knowledge, sociodemographic factors, and risk for HIV/STIs among Thai Muslim army conscripts in the unrest situation area.

METHODS

A cross-sectional study was conducted between May and July 2020. Data were collected using a validated questionnaire among 421 participants. Descriptive statistics and Chi-square were used to examine the association among variables.

RESULTS

57.5% of Muslim army conscripts had poor sexual knowledge based on Islamic aspects, and the participants showed high-risk profiles for HIV/STIs (32.5%). Marital status, hometown, smoking and drinking status, and Islamic values-based sexual knowledge were significantly associated with the risk of HIV/STIs (p <0.05).

CONCLUSION

Participants with poor sexual knowledge according to Islamic values, smokers, single-status, alcoholic drinkers, and non-three southernmost provinces' hometowns had higher risks of HIV/STIs. Thus, it is suggested that nurses and public health professionals implement sexual health promotion and prevention for HIV/STIs. In addition, misperceptions of Islamic aspects toward sexual behavior should receive immediate adjustments.

Educational interventions to improve women's preventive behavior of sexually transmitted infections (STIs): study protocol for a randomized controlled trial

BACKGROUND

Sexually active women aged 18 to 48 are within the population at risk for acquiring sexually transmitted infections. Some STIs can cause serious complications in women's reproductive health. Accordingly, this practical randomized trial aims to evaluate the effect of an interventional education based on the ISD model on improving preventive behaviors for Iranian women.

METHODS

Women aged 18-48 years that refer to Tehran Municipality Health Houses will be invited to join the study. Recruitment will continue until a sample of 150 women participants. The study will be conducted using a mixed-methods protocol in three phases. In the first phase, women's educational and learning needs about STIs will be identified using a qualitative approach. In the second phase, the results from the qualitative approach will be used to design a training program based on an ISD model. The educational intervention will be performed in the third phase. Participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using STI Four-Scale of Preventive Behaviors at baseline, immediately, 1-month, and 3-month follow-up assessments. The impact of the intervention on the promotion of preventive behaviors from STIs will then be evaluated.

DISCUSSION

This study provides an educational program for empowering and promoting behaviors that prevent STIs. If the designed interventions in the present study are effective, it has practical potential to be generalized for Iranian women at risk of STIs.

TRIAL REGISTRATION

ClinicalTrials.gov IRCT20200602047638N1 . Registered on 22 May 2021 with the IRCTID, V1.0.

Sexual and reproductive health knowledge, perceptions and experiences of women in Saudi Arabia: a qualitative study

BACKGROUND

There is no formal sexual and reproductive health (SRH) education currently offered in Saudi Arabia. Lack of knowledge and misconceptions are evident among Saudi women, which can lead to negative sexual and reproductive experiences. The aim of this study is to explore Saudi women's SRH knowledge, perceptions and experiences.

METHODS

Qualitative semi-structured interviews with Saudi women were conducted. Interviews took place in a public hospital in Riyadh, Saudi Arabia. Interviews were conducted in Arabic, recorded and transcribed verbatim, to allow for thematic analysis of the data. The following themes were identified: experience with menarche, deep-rooted negative views towards sex, difficulty discussing SRH topics, knowledge of sex and reproduction, generational gap, sources of SRH information and the role of the mother.

RESULTS

A total of 28 women, both married and unmarried, aged 20-50 years were interviewed. A profound lack of SRH knowledge was observed among Saudi women which contributed greatly to negative experiences both in childhood and adulthood. Lack of knowledge about menstruation often caused emotional distress for young girls, and menarche was associated with bad memories and negative emotions. Lack of knowledge about sexual intercourse and the deep-rooted negative views towards sex were linked with physical and psychological issues for women. Women rarely received information from their parents or teachers and preferred the internet for their SRH information.

CONCLUSION

There is a substantial unmet need for SRH education for women in Saudi Arabia. It is our recommendation that SRH education should be tailored to meet Saudi women's unique needs, while understanding specific socio-cultural barriers to SRH education and discussions. Research and policy efforts should be directed towards regulating and producing evidence-based health information on the internet, particularly Arabic language websites.

Women empowerment and sexually transmitted infections: Evidence from Bangladesh demographic and health survey 2014

BACKGROUND

Sexually transmitted infections (STIs) among women have led to substantial public health and economic burdens in several low-middle-income countries. However, there is a paucity of scientific knowledge about the relationship between empowerment and symptoms of STIs among married Bangladeshi women. This article aimed to examine the association between women empowerment and symptoms of STIs among currently married Bangladeshi women of reproductive age.

MATERIALS AND METHODS

We extracted data from the Bangladesh Demographic and Health Survey (BDHS), conducted from June 28, 2014, to November 9, 2014. We utilised cross-tabulation, the conceptual framework and multivariable multilevel mixed-effect logistics regression to explore the association between women's empowerment indicators and women's self-reported symptoms of genital sore and abnormal genital discharge. All of the analysis was adjusted using cluster weight.

RESULTS

We found that among 16,858 currently married women, 5.59% and 10.84% experienced genital sores and abnormal genital discharge during the past 12 months, respectively. Women who depended on husbands to make decisions regarding their health care (AOR = 0.75, 95% CI = 0.67-0.84), significant household purchases (AOR = 0.79, 95% CI = 0.71-0.88), and visiting family or relatives (AOR = 0.72, 95% CI = 0.64-0.80) were less likely to report signs of abnormal genital discharge. Women who could make joint healthcare decisions with their husbands were also less likely to report genital sores (AOR = 0.78, 95% CI = 0.67-0.90).

CONCLUSION

Genital sores and abnormal genital discharge were prevalent across all parameters of women empowerment among currently married women in Bangladesh. Our estimates show that the husband plays a significant role in decision-making about sexual and reproductive health. Efforts need to be invested in establishing culturally relevant gender policies which facilitate the involvement of women in joint decision-making.