Trust, Stigma and Voice: What Draws Vulnerable Iranian Teens into NGO HIV Prevention Services

Reaching adolescents who engage in high-risk behaviors with effective HIV prevention has long been one of public health’s most stubborn challenges. A new qualitative study from Iran, published in BMC Public Health, offers a detailed map of why teenagers do or do not walk through the doors of non-governmental organizations offering HIV/AIDS prevention services. Researchers from Tehran University of Medical Sciences, working with colleagues at Iran’s Ministry of Health and Medical Education, examined the experiences of Adolescent Well-being Clubs, NGO-run centers established specifically to draw vulnerable teenagers into prevention, testing, and counseling programs. Their central finding is deceptively simple: participation is not driven by a single barrier or a single incentive, but by a tangled interplay of individual development, structural access, social stigma, and the internal culture of the organizations themselves.

The research team adopted an interpretive and constructivist paradigm, a qualitative framework that treats the lived experiences of participants as the primary source of knowledge rather than treating behavior as something that can be fully captured by surveys or counts. Between October and December 2020, they conducted four focus group discussions involving 26 teenagers and 17 in-depth interviews. In total, 36 adolescents with high-risk behaviors and 7 managers of the Adolescent Well-being Clubs took part. Adolescents in Tehran were interviewed in person at the clubs, while participants in other cities joined remotely via Skype, a logistical adaptation that reflected the constraints of the period. Sampling for the adolescents was purposeful, deliberately seeking out young people with direct experience of risk, while all club managers were included through a census-based approach. The transcripts were then analyzed using conventional content analysis, a method in which themes emerge from the data itself rather than from a pre-existing theoretical framework.

From this analysis, four major themes crystallized. The first combined individual and structural factors, encompassing the developmental stage of adolescence with its attendant challenges, and the practical question of whether health and social services were physically and financially accessible. The second theme captured social factors, dominated by stigma and discrimination, forces that operate outside the clinic walls but shape every decision a teenager makes about seeking care. The remaining two themes were organizational: one concerned trust and collaboration together with genuine engagement and participation, and the other focused on the quality of services and the environment, alongside whether staff demonstrated real understanding and respect for adolescents. Each of these dimensions, the authors argue, can either pull young people toward services or push them away.

The developmental dimension deserves particular attention. Adolescence is a period of profound neurological, emotional, and social change, marked by identity formation, heightened sensitivity to peer judgment, and a natural drive toward autonomy. Services designed for adults, or designed for adolescents without their input, frequently miss this developmental reality. The study suggests that when programs fail to account for the specific challenges teenagers face, from navigating family expectations to managing the risks in their social environments, the services feel irrelevant or even threatening. Conversely, when organizations demonstrate understanding and respect for adolescents as capable individuals rather than passive recipients of advice, teenagers are far more willing to engage, return, and participate actively in the programs on offer.

Access emerges as the structural half of the first theme. Even the best-designed prevention program is useless if a teenager cannot physically reach it, afford it, or fit it into a life already constrained by school, work, or family obligations. In the Iranian context, where formal health services may be perceived as judgmental or where adolescents fear that seeking information about HIV could expose them to consequences at home or school, NGOs occupy a critical intermediary position. Their relative independence from the state apparatus can make them feel safer, but only if their locations, hours, and outreach strategies align with the realities of adolescent life. The study’s findings imply that access must be understood broadly, not merely as geographic proximity but as the total friction a young person experiences between deciding to seek help and actually receiving it.

Stigma and discrimination form the social core of the analysis, and the researchers treat them as among the most powerful determinants of participation. HIV carries a heavy social burden in many settings, and adolescents, who are acutely attuned to social standing and peer perception, may avoid services simply because being seen entering them carries reputational risk. The fear is not abstract: disclosure of risk behavior or HIV status can lead to exclusion from family, school, and community. The study underscores that NGOs must actively work to create environments where confidentiality is not just promised but visibly practiced, and where the physical and social design of the service minimizes the chance that a visit itself becomes a marker of stigma. Culturally sensitive approaches, the authors note, are essential for sustainable prevention among high-risk adolescent populations.

On the organizational side, trust stands out as the currency on which everything else depends. Adolescents with high-risk behaviors have often experienced judgment from institutions, and they extend trust cautiously. The study found that collaboration between organizations, and between organizations and the adolescents themselves, builds the credibility needed for engagement. When teenagers are invited into genuine participation, contributing to program design, decision-making, and the running of activities, they develop ownership of the services. This participatory approach, the researchers conclude, is not merely a courtesy but a mechanism that directly enhances service utilization. Empowering adolescents through active involvement transforms them from clients into stakeholders, and stakeholders return.

The quality of services and the environment in which they are delivered forms the second organizational pillar. Teenagers, like all service users, respond to whether staff are trained, whether facilities are welcoming, whether waiting times are reasonable, and whether the atmosphere communicates respect. The study highlights that understanding and respect for adolescents must permeate the organizational culture, from the front desk to the counseling room. Managers of the Adolescent Well-being Clubs who succeeded in attracting sustained participation were those who treated adolescents as partners whose feedback shaped the program, rather than as problems to be managed. This finding aligns with a broader international literature on adolescent-friendly health services, which consistently identifies provider attitudes as a decisive factor in whether young people return after a first visit.

The implications of the study extend well beyond Iran. Adolescents worldwide remain disproportionately underserved by HIV prevention efforts, and the global response has repeatedly struggled to translate adult-oriented interventions into formats that work for young people. The Iranian experience with NGO-run clubs offers a model in which civil society organizations act as trusted bridges between vulnerable youth and the formal health system. The authors emphasize that such strategies must be inclusive and trust-based, and that NGOs are particularly well positioned to lead them because of their flexibility, community embeddedness, and perceived neutrality. For policymakers, the message is that funding and regulatory frameworks should support, rather than constrain, the participatory and adolescent-centered practices that the evidence shows are effective.

Ultimately, the study reframes adolescent participation in HIV prevention as a systems problem rather than an individual failing. A teenager’s decision to engage with prevention services is shaped simultaneously by their developmental needs, the accessibility of services, the stigma they risk, and the trustworthiness and quality of the organizations offering help. Intervening on any one of these dimensions alone is unlikely to succeed. The researchers’ call for culturally sensitive, inclusive, and trust-based strategies, with adolescents themselves involved in design and decision-making, provides a concrete roadmap. As HIV prevention efforts continue to evolve globally, the voices of the 36 Iranian adolescents and 7 club managers captured in this research offer a reminder that the most effective programs are those built with young people, not merely for them.

Subject of Research: Adolescent participation in NGO-provided HIV/AIDS prevention services in Iran

Article Title: Factors affecting adolescent participation in HIV/AIDS prevention services provided by Non-Governmental Organizations in Iran

Article References: Ghadirian, L., Sayarifard, A., Sajadi, H. S., Rostamigooran, N., Majdzadeh, R., Loori, N., Moghaddam, M. S., & Rajabi, F. (2026). Factors affecting adolescent participation in HIV/AIDS prevention services provided by Non-Governmental Organizations in Iran. BMC Public Health. https://doi.org/10.1186/s12889-026-29838-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29838-0

Keywords: HIV/AIDS, adolescents, prevention services, non-governmental organizations, Iran, qualitative research, stigma, public health, adolescent participation, trust, BMC Public Health, Factors