https://orcid.org/0000-0002-8310-5160
ABSTRACT
This paper attempts to assess the knowledge and attitude on HIV/AIDS among school students of Iran. The following data sources were searched for eligible studies: Medline, Science Direct, CINAHL, Scopus, Web of Science, SID, ISC, Magiran, and Google Scholar from 1990 to the end of 2016. The quality of the studies was evaluated using the 22-item STROBE checklist. The highest level of awareness belonged to sharing clothes (93.15) and blood transfusion, respectively (86.31), while the lowest level of awareness was related to transmitting HIV from mother to child (42.05). The study identified a substantial gap in the knowledge, negative attitude towards HIV/AIDS and its transmission among Iranian school students. Accordingly, schools should be regarded as one of the main focuses of activities in the strategies of AIDS risk reduction, and education of school students about all aspects of HIV/AIDS has to be considered seriously by the education policymakers.
Background
The acquired immune deficiency syndrome (HIV/AIDS) is still considered the main challenge despite the advances in diagnosis, treatment and prevention of the disease (Alwafi et al., Citation2018; HIV/AIDS, Citation2016). According to the latest reports by the World Health Organization (WHO) (2018), 9.36 million people are afflicted with HIV worldwide (Zakher, Blazina, & Chou, Citation2014). Although the prevalence of this disease is still lower in Iran than the global rate and that of Eastern Mediterranean countries, the rate has been recently on the growth in Iran (Zarei, Khabiri, Tajvar, & Nosratnejad, Citation2018). As reported by WHO/UNAIDS, the Iranian population with AIDS has grown by three times compared to the year 2000, which has increased from 24,000 cases in 2000 to 73,000 in 2015 (UNAIDS, Citation2018). The current sociocultural conditions in Iran among which are social labelling, discrimination and fear are the main concerns of those affected by AIDS trying to hide their condition which can further increase the chances of transmitting the disease (Heidary & Nasiri, Citation2016). In Iran in 2016, 5,000 new cases of infection, 4,000 AIDS-induced mortalities and 66,000 cases of affliction with the disease were reported (Madeleine, Chan, & Thayala, Citation2011). In a city in Western Azerbaijan, 371 cases of AIDS were reported, 1 case per 10,000 people among whom 91% were male and 9% were female. Unsafe injection and sexual intercourse were the two main ways of transmission (Haghgoo et al., Citation2015). In Hormozgan province in the south of Iran, the number of those afflicted with AIDS rose from 523 in 2004 to 1,361 in 2015 among whom 83% were male and 17% were female. Mutual injection (61%) and unsafe sexual intercourse (26.3%) were the most common ways of disease transmission in this province (Yaghoobi et al., Citation2018). Research has found that about half of the new HIV infections were observed among youngsters and adolescents (Aggleton, Chase, & Rivers, Citation2004; UNAIDS; UNAIDS). It is estimated that 6,000–7,000 teenagers of 15–24 years get afflicted with the disease on a daily basis, 95% of whom live in developing countries (Ibrahim & Sidani, Citation2014). Among them, school students are the main target group in the risk of HIV as they are more prone to developing social relations and mostly deny sexual relationship as they see themselves not vulnerable to such diseases as AIDS (Babazadeh, Zibaee, Shabani, & Moradi, Citation2015; Hajian Motlaq et al., Citation2004). Students play a key role in preventing HIV. At this age, people are more prone to high-risk behaviours including the first sex experience and drug injection as compared to other age groups (Dehghani, Dehghani, & Dehghani, Citation2017; Madiba, Segobola, & Mokgatle, Citation2015). Therefore, raising students’ awareness of HIV is the most facile and acceptable strategy to prevent the disease (Appiah-Agyekum & Suapim, Citation2013; Gupta, Citation2013 #21). The potential risk of HIV originates from inadequate knowledge of the disease and involvement in high-risk sexual relationships and injections (Shokoohi et al., Citation2016). As students, for different reasons such as curiosity, peer pressure, low awareness and young age, are more subject to the HIV infection and they lack the required sex education at school which leads to more uncontrolled sexual relationships, the age of teenagers at risk is increasing in Iran. The situation is the same for the rate of addiction among youngsters and adolescents highly at risk of AIDS (Arabi, Rakhshi, Heidarzadeh, & Ghahramanian, Citation2013). To the present researcher’s knowledge, no systematic investigation has been conducted so far to explore school students’ awareness and attitude of AIDS. Thus, the present research aimed to explore a body of related literature on students’ awareness and attitude toward this disease.
Methods
The present systematic review investigated school students’ awareness of and attitude towards HIV and its transmission. The context could be either inside or outside school.
Search strategy
A systematic review of the following databases led us to find the target articles: Medline (via PubMed), Science Direct, CINAHL, CINAHL (EBSCO), Scopus, Web of Science, SID, ISC, Magiran, and Google Scholar. The key terms searched were: Student, School Student, Secondary school, Kids, Youth, pupils, Adolescents, High school, HIV, AIDS, Iran, Knowledge, Attitude, Awareness, Teenage, and Child. The search was done in two languages, English and Persian. The operators used were AND, NOT, OR which led us to find related articles.
Inclusion and exclusion criteria
Regarding the inclusion criteria, the studies should have been: published after January 1990 to the end of 2016; relevant to the research purpose (knowledge, attitude of school students in Iran); performed on human; related to school student’s (12–17 years); related to HIV/AIDS and sexual health; single publication of a particular article in English or Persian; and quantitative (cross-sectional). They could also be related to young men or women or both. On the other hand, editorial letters, case studies and interventional studies, as well as quality studies, were excluded.
Screening
The search process was conducted by two researchers independently. The articles perused were those investigating Iranian school students’ awareness of and attitude towards HIV/AIDS. In the first stage, to select the articles, their titles and abstracts were analysed. In the second stage, the full texts were independently examined by two researchers. Then, in order to reach a consensus, a third researcher was also consulted with. In the primary search, 182 articles were found, but once the repeated articles were excluded, 93 articles finally remained. With further exclusion of articles which did not meet the inclusion criteria, the data of 13 local and national studies which had been conducted in Iranian provinces entered the study. The details of the selection procedure are presented in . The awareness and attitude of school students have been reported according to different criteria.
Figure 1. The flow diagram of the sample selection procedure
Quality assessment
Quality assessment of the included studies was performed using the 22-item ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) checklist (Von Elm et al., Citation2014). The studies were classified as good (scores within the range of 17–22), medium (8–16) and poor (1–7) quality studies.
Data extraction
Data extraction involved extracting the name of the author(s), publication year, research variables (awareness and attitude), sample size, type of research and the main findings. The analysis methods consisted of rating score of the quality of each study. Subsequently, the researchers entered the existing data into Excel based on the items mentioned in the data extraction section.
Classification of knowledge and attitude
The awareness findings, as extracted from the results of every single study, were reported at two levels (according to correct response); appropriate; correct answers to 60–100% of questions of knowledge and Inappropriate; less than 60% correct answers to the questions of knowledge. Further, the attitude-related information about AIDS and the afflicted patients were reported at three levels including positive, negative, and neutral in percentages.
Risk of bias in individual studies
In order to minimize the publication bias, a comprehensive search was conducted in a variety of databases. Moreover, in order to evaluate the heterogeneity, the present researchers analysed all the articles in terms of participants and results.
Results
Description of included studies
The findings of this systematic review are summarized in and the results are reported in terms of attitude and awareness. Interpretation of the results indicated that 13 articles had explored school students’ awareness of HIV/AIDS (Abdeyazdan & Sadeghi, Citation2008; Behjati & Ayatollahi, Citation2005; Fadaei, Saneei, & Khosravi, Citation2010; Ghojavand, Einali, & Ghaeliniya, Citation2013; Gholamitabar, Moslemi, & Malak, Citation2013; Hadi & Mirzaei, Citation2004; Mazloumi & Abbasi, Citation2006; Movahed & Shoaa, Citation2010; Nasab, Citation2015; Sarahroodi1, Sefidi, & Sarahroodi, Citation2009; Sayede Sani, Citation2009; Tavoosi, Zaferani, Enzevaei, Tajik, & Ahmadinezhad, Citation2004; Yazdi et al., Citation2006). All the studies except for one were cross-sectional in type. The majority of the studies had been done at high schools. They were also conducted on an urban scale. According to the analysis results, less than half of the school students enjoyed adequate levels of awareness. Moreover, among the 9 studies concerned with attitude (Abdeyazdan & Sadeghi, Citation2008; Fadaei et al., Citation2010; Ghojavand et al., Citation2013; Gholamitabar et al., Citation2013; Mazloumi & Abbasi, Citation2006; Movahed & Shoaa, Citation2010; Sayede Sani, Citation2009; Tavoosi et al., Citation2004; Yazdi et al., Citation2006), 49% reported a positive attitude towards AIDS ().
Table 1. Analysis of the literature on school students’ awareness and attitude
Figure 2. Students’ different levels of awareness and attitude of AIDS in the results of the related literature
Synthesis of results related to HIV and its transmission
Interpretation of the results indicated that concerning the awareness of how HIV is transmitted, the highest frequency belonged to sexual relationship and transmission from mother to child. The percentage of all responses to each variable and the mean scores of rating of the whole literature are indicated in . Accordingly, the highest levels of awareness belonged, respectively, to wearing mutual clothes (93.15) (the attitude that sharing clothes does not transmit HIV) and blood transfusion (86.31) (Blood transfusion can transmit HIV). They were followed by sharing toothbrush (84.53) and syringe (84.4). In addition, the lowest level of awareness was that of transmitting HIV from mother to child (42.05) ().
Table 2. Modes transmission as reported by the studies (%). response to the question by which of the following ways can HIV*/AIDS** be transmitted?
Figure 3. Flow chart of modes transmission as reported by the studies (per cent choosing the correct answer)
Discussion
The present review article aimed to investigate Iranian school students’ awareness of and attitude towards HIV/AIDS.
Interpretation of the reviewed results revealed that less than half of the school students (41%) enjoyed an appropriate level of awareness. Also, the attitude of half of the school students towards HIV/AIDS proved to be positive. In their research, Nubed et al. reported that 62.1% of the school students enjoyed a good level of awareness (Nubed & Akoachere, Citation2016). In some other research, Savaser et al. reported the awareness of their high-school student subjects to be 59.15%. Al-Rabee et al. estimated that 58.5% of their school student subjects had an acceptable level of awareness while 41.5% suffered a misconception of how HIV could be transmitted. These results indicated that schools had not been adequately provided with preventive plans in this population. In their research, Price et al. found that schools played the least effective role in promoting school students’ awareness. In some other research in Brazil, the contribution of teachers was estimated as small as 9.9% (Price, Desmond, & Kukulka, Citation1985). However, in another investigation by Bhattacharye et al. in America, contrary to other investigations, the school was found to play a key role in awareness-raising (Bhattacharya, Cleland, & Holland, Citation2000). Therefore, policymakers, school administrators, and other stakeholders should consider the school setting as a place to provide HIV prevention education for school students. Also, there is a need for school teachers to be trained adequately and provided with a structured educational program to follow in order to enhance school students’ awareness of and attitude towards HIV/AIDS.
The findings of the present research revealed that the overall awareness of Iranian school students of AIDS was satisfactory. The highest awareness of school students of the ways HIV was transmitted was related to sharing clothes (no transmission), blood transfusion, and sharing syringe or toothbrush, while the lowest level of awareness was transmission from mother to child. What further confirmed the present findings were the results obtained by Al Khenji et al. from school students in Qatar. They showed to be highly aware of the transmission of HIV through blood transfusion and infected tools (Al Khenji, Al Kuwari, Khal, Latif, & Al Thani, Citation2012). There were also some other studies with similar findings (Appiah-Agyekum & Suapim, Citation2013; Gupta et al., Citation2013; Wong, Chin, Low, & Jaafar, Citation2008). On the other hand, the present findings showed that school students’ awareness of how HIV could be transmitted from mother to child was low. This has been confirmed by Shinde, Trivedi, Shinde, and Mishra (Citation2017) who found that school students’ awareness of how HIV was transmitted from mother to fetus was low (Shinde et al., Citation2017). In Israel, Baytner-Zamir reported school students’ low awareness of HIV transmission to child through breastfeeding (Baytner-Zamir, Lorber, & Hermoni, Citation2014). Park’s investigation on Korean dentistry school students indicated that only 28% of the subjects were aware of the fact that HIV could be transmitted through breastfeeding [46]. Similarly, Agrawal’s findings were indicative of misconceptions of how HIV could be transmitted among school students (Agrawal, Rao, Chandrashekar, & Coulter, Citation1999; DiClemente, Lanier, Horan, & Lodico, Citation1991; Haroun et al., Citation2016). These findings were mostly consistent with the present research. On the contrary, in investigating school students in Qatar, Al-Khenji reported a high awareness of how HIV could be transmitted from mother to the fetus (Al Khenji et al., Citation2012). There has been a body of research reporting school students’ high awareness of this issue, which is incongruent with the present research (Mansoor, Fungladda, Kaewkungwal, & Wongwit, Citation2008; Subbarao & Akhilesh, Citation2017). Such divergences can be partly due to the governing educational and cultural rules of the countries as well as different research populations. In the present research, the target population consisted of school students, while in some of the above-mentioned studies, the subjects were university students. Naturally, university students who are academically more advanced than school students have been more exposed to information on AIDS than their school counterparts.
The present results revealed that a lower percentage of school students reported sexual relationship as one of the ways of HIV transmission. However, Al Khenji reported that the majority of students in his research were aware of the hazard of HIV transmission through sexual intercourse (Al Khenji et al., Citation2012). There have been other studies also reporting students’ higher awareness of how HIV could be transmitted through sexual relationship (Amu & Adegun, Citation2015; Subbarao & Akhilesh, Citation2017). This difference can be partially explained by the cultural constraints in countries such as Iran since in Iranian educational centres, sexual issues are hardly ever discussed. In this regard, Subbarao and Akhilesh (Citation2017) maintained that parents rarely discuss sexual issues with children, as they are considered taboos (Subbarao & Akhilesh, Citation2017). Similarly, Hoga, in the Brazilian context, drew attention to the necessity of considering moral aspects and religious perspectives in discussing sexual issues (Hoga, Tiburcio, Borges, Zoboli, & Chavez-Alvarez, Citation2010). Hence, due to the global significance of AIDS and as school students are among the main age group at risk in Iran, authorities are recommended to take the issue into account seriously and pay special attention to this group. Thus, to improve the existing conditions and raise students’ awareness of the ways of HIV transmission, certain strategies are recommended: implementation of health education programs as a priority in schools for proper sex education and HIV transmission, implementation of educational health interventions, and adopting a more active role by the mass media especially TV to address this concern.
Limitations
This systematic review had limitations. Only English and Persian language studies were included. Also, all studies depended on the self-reported questionnaire and had been conducted quantitatively (cross-sectional). As this review only covered school students in Iran, it may not be generalized to other school students from a different setting. Also, the results were not synthesized and therefore there is little interpretation of what the results mean for further action in Iran. Most of the interpreted studies merely examined the awareness and attitudes associated with HIV/AIDS. Therefore, there is a sparse interpretation of what the results mean for further action in Iran. This can reduce the quality of this research and can be one of the limitations of the study.
Conclusion
The study identified a substantial gap in the knowledge, negative attitude towards HIV/AIDS, and its transmission among Iranian school students. So, it is recommended that schools be regarded as one of the main focuses of activities in the strategies of AIDS risk reduction. Also, education of school students about all aspects of HIV/AIDS should be seriously considered by the education policymakers. Also, extensive health education campaigns should be provided to school students (as one of the vulnerable groups) for controlling HIV/AIDS. Finally, mass education about HIV/AIDS among the school students is urgently needed.
Acknowledgements
This research was part of a project coded as 1397/70366 approved by the Student Research Committee of the Shahid Beheshti University of Medical Sciences in Tehran, Iran. We are grateful to the Student Research Committee and the Research and Technology Chancellor in the target university for their financial support.
Disclosure statement
No potential conflict of interest was reported by the authors.
Additional information
Funding
Notes on contributors
Sakineh Dadipoor
Sakineh Dadipoor is a Ph.D. student in health education and health promotion. His recent research is on women’s behavior.
Saeideh Shahsavari
Saeideh Shahsavari is an MD. His recent research is on women’s behavior.
Mohtasham Ghaffari
Mohtasham Ghaffari is associate Professor of Health Education and Health Promotion in Shahid Beheshti University of Medical Sciences, Tehran, Iran. He is working on subjects related to health education and behavior.
Sakineh Rakhshanderou
Sakineh Rakhshanderou is assistant Professor of Health Education & Health Promotion. He is working on subjects related to behavior and also Structural equation modeling (SEM).
Ali Safari-Moradabadi
Ali Safari-Moradabadi is a Ph.D. student in health education and health promotion. The main focus is on change behavior. His research is about lifestyle related behaviors
Related Research Data
References
- Abdeyazdan, Z., & Sadeghi, N. (2008). Knowledge and attitude toward AIDS/HIV among senior school students in Isfahan. Archives of Clinical Infectious Diseases, 3(2), 93–98.
- Aggleton, P., Chase, E., & Rivers, K. (2004). HIV/AIDS prevention and care among especially vulnerable young people: A framework for action.
- Agrawal, H., Rao, R., Chandrashekar, S., & Coulter, J. (1999). Knowledge of and attitudes to HIV/AIDS of senior secondary school pupils and trainee teachers in Udupi District, Karnataka, India. Annals of Tropical Paediatrics, 19(2), 143–149.
- Al Khenji, A. H., Al Kuwari, M., Khal, A., Latif, A., & Al Thani, A. (2012). University Students‘ Knowledge and Attitude toward HIV/AIDS in Qatar.
- Alwafi, H. A., Meer, A. M., Shabkah, A., Mehdawi, F. S., El-Haddad, H., Bahabri, N., & Almoallim, H. (2018). Knowledge and attitudes toward HIV/AIDS among the general population of Jeddah, Saudi Arabia. Journal of Infection and Public Health, 11(1), 80–84.
- Amu, E., & Adegun, P. (2015). Awareness and knowledge of sexually transmitted infections among secondary school adolescents in Ado Ekiti, South Western Nigeria. Journal of Sexually Transmitted Diseases, 2015, 1–7.
- Appiah-Agyekum, N. N., & Suapim, R. H. (2013). Knowledge and awareness of HIV/AIDS among high school girls in Ghana. HIV/AIDS (Auckland, NZ), 5, 137.
- Arabi, M., Rakhshi, M., Heidarzadeh, M., & Ghahramanian, A. (2013). Knowledge and attitude of female high school students in relation to AIDS in Bonab. Journal of Holistic Nursing and Midwifery, 23(1), 45–53.
- Babazadeh, T., Zibaee, N., Shabani, L., & Moradi, F. (2015). Educational intervention and knowledge, attitude and behavioral intention related to hiv/aids in high school female students of tehran, iran. Journal of Education and Community Health, 2(3), 19–27.
- Baytner-Zamir, R., Lorber, M., & Hermoni, D. (2014). Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel. BMC Research Notes, 7(1), 168.
- Behjati, M., & Ayatollahi, J. (2005). Knowledge of high schools students in Yazd city about AIDS. Iranian Journal of Pediatrics, 15(4), 321–326.
- Bhattacharya, G., Cleland, C., & Holland, S. (2000). Knowledge about HIV/AIDS, the perceived risks of infection and sources of information of Asian-Indian adolescents born in the USA. AIDS Care, 12(2), 203–209.
- Dehghani, A., Dehghani, P., & Dehghani, B. (2017). HIV/AIDS knowledge and attitude among High School students in Shiraz, Iran in 2015. Journal of Midwifery and Reproductive Health, 5(2), 897–903.
- DiClemente, R. J., Lanier, M. M., Horan, P. F., & Lodico, M. (1991). Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco. American Journal of Public Health, 81(5), 628–630.
- Fadaei, M., Saneei, M. E., & Khosravi, S. (2010). Knowledge, attitude, and practice on HIV/AIDS among Chabahar high school students in 2007. Scientific Journal of Iran Blood Transfus Organ, 7(3), 170–177.
- Ghojavand, G., Einali, B., & Ghaeliniya, M. (2013). HIV/AIDS knowledge and attitude of adolescents to prevent aids in Isfahan City. International Journal of Environment, Ecology,Family and Urban Studies, 3(1), 63–70.
- Gholamitabar, T. M., Moslemi, L., & Malak, Z. R. (2013). A comparison of male and female high school students‘awareness, perception, and performance toward aids in Babol. Journal Of Health Breeze, 1(4), 21–28.
- Gupta, P., Anjum, F., Bhardwaj, P., Srivastav, J., & Zaidi, Z. H. (2013). Knowledge about HIV/AIDS among secondary school students. North American Journal of Medical Sciences, 5(2), 119.
- Hadi, N., & Mirzaei, K. (2004). The level of knowledge about HIV/AIDS in high school students of Shiraz in 2004.
- Haghgoo, S. M., Joula, H., Mohammadzadeh, R., Sabour, S., Yousefi, R., Ghahramani, G., & Rahimi, A. A. (2015). Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran. Jundishapur Journal of Microbiology, 8(8).
- Hajian Motlaq, N., Farshi, S., Abdollahi, E., Arvantaj, A., Kordestani, A., Ahmadi Yazdi, S., … Bayat, R. (2004). Savodjbolagh high school students’ knowledge and attitude to HIV & AIDS in Spring 2002. Razi Journal of Medical Sciences, 11(41), 393–399.
- Haroun, D., El Saleh, O., Wood, L., Mechli, R., Al Marzouqi, N., & Anouti, S. (2016). Assessing knowledge of, and attitudes to, HIV/AIDS among University Students in the United Arab Emirates. PloS One, 11(2), e0149920.
- Heidary, M., & Nasiri, M. J. (2016). Why has HIV/AIDS prevalence increased in Iran? Clinical Infectious Diseases, 63(6), 846.
- HIV/AIDS, J. U. N. P. o. (2016). Global AIDS update 2016. Geneva: UNAIDS.
- Hoga, L. A. K., Tiburcio, C. A., Borges, A. L. V., Zoboli, E. L. C. P., & Chavez-Alvarez, R. E. (2010). Counseling regarding sexual and reproductive behavior: Principles and practices of catholic priests. Revista Latino-Americana De Enfermagem, 18(6), 1237–1245.
- Ibrahim, S., & Sidani, S. (2014). Community based HIV prevention intervention in developing countries: A Systematic Review. Advances in Nursing, 2014, 1–11.
- Madeleine, L. R., Chan, M. F., & Thayala, N. V. (2011). A systematic review of the knowledge, attitudes and practice of trained nurses towards patients with HIV/AIDS. JBI Library of Systematic Reviews, 9(51), 2105–2165.
- Madiba, S., Segobola, M., & Mokgatle, M. (2015). Assessing the acceptability and willingness to use HIV self-testing among student nurses in a private nursing college, Gauteng Province, South Africa. World Journal of AIDS, 5(03), 208.
- Mansoor, A. B., Fungladda, W., Kaewkungwal, J., & Wongwit, W. (2008). Gender differences in KAP related to HIV/AIDS among freshmen in Afghan universities.
- Mazloumi, M. S., & Abbasi, S. M. (2006). Knowledge and attitude survey of high school students of Yazd province of Iran about HIV/AIDS. Zahedan Journal Of Research In Medical Sciences, 8(1), 56–63.
- Movahed, M., & Shoaa, S. (2010). On attitude towards HIV/AIDS among Iranian students (case study: High school students in Shiraz City). Pakistan Journal of Biological Sciences, 13(6), 271.
- Nasab, M. B. (2015). The examination of Pre-University School Boys‘ Awareness of HIV prevention, transmission and treatment in Khuzestan Province. International Letters of Social and Humanistic Sciences, 53, 73–77.
- Nubed, C. K., & Akoachere, J.-F. T. K. (2016). Knowledge, attitudes and practices regarding HIV/AIDS among senior secondary school students in Fako division, South West Region, Cameroon. BMC Public Health, 16(1), 847.
- Price, J. H., Desmond, S., & Kukulka, G. (1985). High school students‘ perceptions and misperceptions of AIDS. Journal of School Health, 55(3), 107–109.
- Sarahroodi1, S., Sefidi, F. J., & Sarahroodi, S. (2009). HIV/AIDS Knowledge and attitudes of Southern Iranian students. Electronic Physician, 1, 17–23.
- Sayede Sani, K. (2009). High school students‘ knowledge and attitude about AIDS-Ferdows 2008. Modern Care Journal, 5(1), 40–45.
- Shinde, M., Trivedi, A., Shinde, A., & Mishra, S. K. (2017). A study of awareness regarding HIV/AIDS among secondary school students. International Journal Of Community Medicine And Public Health, 3(6), 1461–1465.
- Shokoohi, M., Karamouzian, M., Mirzazadeh, A., Haghdoost, A., Rafierad, -A.-A., Sedaghat, A., & Sharifi, H. (2016). HIV knowledge, attitudes, and practices of young people in Iran: Findings of a national population-based survey in 2013. PloS One, 11(9), e0161849.
- Subbarao, N. T., & Akhilesh, A. (2017). Knowledge and attitude about sexually transmitted infections other than HIV among college students. Indian Journal of Sexually Transmitted Diseases, 38(1), 10.
- Tavoosi, A., Zaferani, A., Enzevaei, A., Tajik, P., & Ahmadinezhad, Z. (2004). Knowledge and attitude towards HIV/AIDS among Iranian students. BMC Public Health, 4(1), 17.
- UNAIDS. (2018). HIV and AIDS estimates (IRAN). [ cited 2018 March 13]. http://www.unaids.org/en/regionscountries/countries/islamicrepublicofiran.
- Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2014). The strengthening the reporting of observational studies in epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery, 12(12), 1495–1499.
- Wong, L.-P., Chin, C.-K. L., Low, W.-Y., & Jaafar, N. (2008). HIV/AIDS-related knowledge among Malaysian young adults: Findings from a nationwide survey. Journal of the International AIDS Society, 10(6), 148.
- Yaghoobi, H., Ahmadiniya, H., Shabani, Z., Vazirinejad, R., Zolfizadeh, F., & Rezaeian, M. (2018). The epidemiological investigation of patients with HIV/AIDS in bandar abbas behavioral disorders counseling center during 2005–2015. Journal of Rafsanjan University of Medical Sciences, 16(10), 969–982.
- Yazdi, C., Aschbacher, K., Arvantaj, A., Naser, H., Abdollahi, E., Asadi, A., … Nicfallah, F. (2006). Knowledge, attitudes and sources of information regarding HIV/AIDS in Iranian adolescents. AIDS Care, 18(8), 1004–1010.
- Zakher, B., Blazina, I., & Chou, R. (2014). Association between knowledge of HIV-positive status or use of antiretroviral therapy and high-risk transmission behaviors: Systematic review. AIDS Care, 26(4), 514–521.
- Zarei, E., Khabiri, R., Tajvar, M., & Nosratnejad, S. (2018). Knowledge and attitude toward HIV/AIDS among Iranian women. Epidemiology and Health, Epidemiol Health, 40, e2018037.