Impact of Peer‑Led Education on Sexual Health Outcomes Among Female Sex Workers in Arak, Iran Publisher Pubmed

Summary: Can peer educators improve sexual health knowledge? An Iranian study found better STI knowledge and condom confidence, not safer practices. #SexualHealth #PeerEducation

Navidi I ; Shakibazadeh E ; Akbarpour S ; Raisi F
Source: Scientific Reports Published:2026

Abstract

Female sex workers (FSWs) are among the populations most vulnerable to sexually transmitted infections (STIs) and HIV. Peer-led education has been recognized as a promising approach to improving sexual health literacy and reducing high-risk behaviors in marginalized populations. This quasi-experimental controlled study aimed to evaluate the effectiveness of a peer-led sexual health education intervention among FSWs in Arak, Iran. A total of 68 FSWs were recruited from HIV special care centers in Arak (intervention group; n = 34) and Tehran (control group; n = 34) using random selection from active case files. The intervention comprised five weekly one-hour peer-led group sessions (6–9 participants per session). Data were collected at baseline and three months post-intervention using three validated instruments: a researcher-developed STI Knowledge, Attitude, and Practice (KAP) questionnaire; the Condom Use Self-Efficacy Scale (CUSES); and the HIV Testing Attitude Scale (HTAS). Between-group and within-group comparisons used Mann–Whitney U and Wilcoxon signed-rank tests; multivariate linear regression adjusted for baseline differences and potential confounders including education level, marital status, history of substance use, and history of STIs. Compared with the control group, participants in the intervention group showed significant improvements in STI-related knowledge (P < 0.001), STI-related attitudes (P < 0.001), and condom use self-efficacy (P < 0.001). No significant between-group differences were found in STI-related preventive practices (P = 0.094) or self-reported attitudes toward HIV testing (P = 0.54). Importantly, this study measured attitudinal dispositions toward HIV testing, not actual HIV testing behavior. Attrition was 20.6% in the intervention group (7/34) and 0% in the control group. Intervention effects remained significant after multivariate adjustment for baseline scores, education, marital status, substance use history, and STI history. These findings indicate that peer-led sexual health education is a feasible and effective strategy for improving STI-related knowledge, attitudes, and condom use self-efficacy among FSWs in Iran. The absence of significant change in preventive practices and HIV testing attitudes suggests that longer-term, multi-component interventions may be needed to translate cognitive gains into behavior change. Integrating peer-led approaches into national HIV/STI prevention strategies could enhance community engagement, trust, and psychosocial readiness for safer sexual practices in this highly stigmatized population. © The Author(s) 2026.