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Ethical approval for this study was obtained from the Research and Ethics Committee, Tehran Faculty of Medical Sciences (IR.TUMS.SPH.REC.1402.281). Given the sensitive nature of the study population, we took extensive measures to uphold ethical standards. Participants were assured that their involvement was entirely voluntary and that their decision to participate or withdraw would not impact their access to healthcare services. To ensure confidentiality, all data were anonymized using unique codes, and no identifying information was recorded. Participants were also informed that their data would remain strictly confidential and would not be shared with law enforcement or judicial authorities. Additional precautions included obtaining verbal informed consent due to the participants\u2019 potential hesitation to provide written consent. The research team emphasized the importance of maintaining empathy and building trust, particularly since many participants may face stigma and discrimination. These steps ensured that participants felt safe and respected throughout the research process.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"2424"}}