Abstract: (53 Views)
Introduction: In recent decades, Iran has undergone significant social shifts, particularly in youth interactions and sexual activity. International communications, and social media have influencved social norms and value systems, increasing premarital sexual relationships. However, Iran's health systems lack adequate sexual and reproductive health policies. Policymakers promote "virginity" as a health strategy, neglecting risks such as Human Papillomavirus (HPV), a sexually transmitted infection leading to cervical cancer- the fourth most common cancer among women globally. In Iran’s HPV incidence aligns with global statistics, with rapid growth expected. Despite the availability of vaccines and screenings, sanctions, high vaccine costs, lack of insurance, and taboos hinder adequate access.
Objectives: This study explores the experiences of women diagnosed or suspected HPV, focusing on their access to care within Iran's health system. Methods: Using a qualitative methodology and thematic analysis, Snowball purposive sampling identified10 sexually active Iranian women (18+), from 8 provinces, who agreed to share their experiences via Semi-structured interviews.
Findings: Three main themes and eight sub-themes emerged: “Encountering the virus" encompasses three sub-themes: 1. “emotional and psychological reactions": Women experienced intense distress, fear, anxiety, obsessive behaviors, anger, self-destructive tendencies, and shame upon diagnosis or suspicion 2. “Managing Emotions”: Coping with negative emotions included religioon, realism, and seeking support from close circles and doctors 3. "Challenges Ahead": women’s concerns stemmed more from social pressures, than biological factors. They expressed fear of judgment, rejection, loss of social value, dishonor, the possibility of honor-related violence, financial burdens, and stigma.
Plus, two multi-level subthemes emerged under “Awaiting challenges”: 1."The Role of Cultural Taboos”: Gender-based taboos create significant barriers to sexual health services and HPV prevention. Shame, imposed by close circles and healthcare providers, contributed to feelings of isolation. Religion further reinforces the feelings of shame, with the broader social order using religious principles to suppress discussions around sexual health. Participants highlighted how internalized cultural taboos shows up in times of crisis like an HPV diagnosis, emphasizing that sex is a forbidden topic. .2. “The Reaction of Significant Others”: The women encountered mixed responses from their social circles, including support, labeling, suppression and humiliation, rejection, ridicule, shame, and isolation.
“Encountering Healthcare System” encompass three subthemes:1. “The Patient as a Money Bag”: The high costs for Pap smears, HPV tests, and vaccines, alongside the lack of financial support, inefficient healthcare policies, and tax evasion, pose critical obstacles for women seeking care. 2.“Inadequate laws and policies”: The differences in the type of tests for virgin women, the criminalization of hymen damage, especially for specialists who perform the test, and biased policies regarding the distribution and easy access to the vaccine present significant challenges. These biased policies were stated as a strategy since women believed that easy access was considered an encouragement to have premarital sexual relationships by policymakers. Social class and geographic location were also highlighted as factors influencing women's ability to obtain the vaccine.3.”Rare Vaccines”: Obtaining a reliable vaccine is challenging due to importation issues, storage concerns and scarcity. Women often purchase all three doses at once, at a high cost, to avoid missing further doses, while urban areas experience even greater shortages.
The theme “Encountering the Virtual Space” highlights dual role of online platforms in providing and distorting information. While these platforms offer a wealth of information, they can also spread misinformation and exploitation. Some individuals may take advantage of vulnerable patients by promoting misleading health solutions. Nevertheless, some social networks enable collective action and healthcare advocacy, but women also experience labeling and stigmatization when seeking vaccines or discussing their infection.
Discussion: This study explored the experiences of women diagnosed with or suspected of HPV and their access to care within Iran's health system. The findings revealed that the taboo surrounding HPV negatively impacts emotional and psychological responses. The study highlighted that social and cultural factors shape women's perceptions of sexual health.societal norms influence women’s views of their bodies, leading to negative reactions Additionally, the lack of reliable information made virtual spaces influential, serving both as sources of awareness and platforms for misinformation and exploitation. This study highlights the need for HPV destigmatization and accessible vaccination. Current health policies require revision to enhance vaccination accessibility, including affordable vaccines and government insurance coverage.
Ethical considerations:
Interviews were conducted with volunteer participants after explaining the study’s objectives and obtaining informed consent. Participants were assured of their rights, anonymity, and the ability to withdraw at any time. Privacy and confidentiality were strictly upheld by using pseudonyms and storing individual data in a secure folder to prevent unauthorized access or disclosure.
Objectives: This study explores the experiences of women diagnosed or suspected HPV, focusing on their access to care within Iran's health system. Methods: Using a qualitative methodology and thematic analysis, Snowball purposive sampling identified10 sexually active Iranian women (18+), from 8 provinces, who agreed to share their experiences via Semi-structured interviews.
Findings: Three main themes and eight sub-themes emerged: “Encountering the virus" encompasses three sub-themes: 1. “emotional and psychological reactions": Women experienced intense distress, fear, anxiety, obsessive behaviors, anger, self-destructive tendencies, and shame upon diagnosis or suspicion 2. “Managing Emotions”: Coping with negative emotions included religioon, realism, and seeking support from close circles and doctors 3. "Challenges Ahead": women’s concerns stemmed more from social pressures, than biological factors. They expressed fear of judgment, rejection, loss of social value, dishonor, the possibility of honor-related violence, financial burdens, and stigma.
Plus, two multi-level subthemes emerged under “Awaiting challenges”: 1."The Role of Cultural Taboos”: Gender-based taboos create significant barriers to sexual health services and HPV prevention. Shame, imposed by close circles and healthcare providers, contributed to feelings of isolation. Religion further reinforces the feelings of shame, with the broader social order using religious principles to suppress discussions around sexual health. Participants highlighted how internalized cultural taboos shows up in times of crisis like an HPV diagnosis, emphasizing that sex is a forbidden topic. .2. “The Reaction of Significant Others”: The women encountered mixed responses from their social circles, including support, labeling, suppression and humiliation, rejection, ridicule, shame, and isolation.
“Encountering Healthcare System” encompass three subthemes:1. “The Patient as a Money Bag”: The high costs for Pap smears, HPV tests, and vaccines, alongside the lack of financial support, inefficient healthcare policies, and tax evasion, pose critical obstacles for women seeking care. 2.“Inadequate laws and policies”: The differences in the type of tests for virgin women, the criminalization of hymen damage, especially for specialists who perform the test, and biased policies regarding the distribution and easy access to the vaccine present significant challenges. These biased policies were stated as a strategy since women believed that easy access was considered an encouragement to have premarital sexual relationships by policymakers. Social class and geographic location were also highlighted as factors influencing women's ability to obtain the vaccine.3.”Rare Vaccines”: Obtaining a reliable vaccine is challenging due to importation issues, storage concerns and scarcity. Women often purchase all three doses at once, at a high cost, to avoid missing further doses, while urban areas experience even greater shortages.
The theme “Encountering the Virtual Space” highlights dual role of online platforms in providing and distorting information. While these platforms offer a wealth of information, they can also spread misinformation and exploitation. Some individuals may take advantage of vulnerable patients by promoting misleading health solutions. Nevertheless, some social networks enable collective action and healthcare advocacy, but women also experience labeling and stigmatization when seeking vaccines or discussing their infection.
Discussion: This study explored the experiences of women diagnosed with or suspected of HPV and their access to care within Iran's health system. The findings revealed that the taboo surrounding HPV negatively impacts emotional and psychological responses. The study highlighted that social and cultural factors shape women's perceptions of sexual health.societal norms influence women’s views of their bodies, leading to negative reactions Additionally, the lack of reliable information made virtual spaces influential, serving both as sources of awareness and platforms for misinformation and exploitation. This study highlights the need for HPV destigmatization and accessible vaccination. Current health policies require revision to enhance vaccination accessibility, including affordable vaccines and government insurance coverage.
Ethical considerations:
Interviews were conducted with volunteer participants after explaining the study’s objectives and obtaining informed consent. Participants were assured of their rights, anonymity, and the ability to withdraw at any time. Privacy and confidentiality were strictly upheld by using pseudonyms and storing individual data in a secure folder to prevent unauthorized access or disclosure.
Article number: 2
Keywords: Women, access to sexual health services, human papillomavirus, vaccination, Sexually transmitted infection
Type of Study: orginal |
Received: 2024/10/27 | Accepted: 2025/04/21
Received: 2024/10/27 | Accepted: 2025/04/21
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Social Welfare Quarterly
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