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FEATURE |
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| IRAN: HIV/AIDS and Intravenous
Drug Usage |
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Public awareness is critical |
Tehran, 29 Nov 2002 (IRIN)
- Iran enjoys a low prevalence of HIV/AIDS, but as the
number of injecting drug users increases, so too will
the government's need to enhance prevention efforts. The
country is a major transit route for narcotics coming
from neighbouring Afghanistan and Pakistan, destined for
Europe, Central Asia, as well as the Gulf region.
"Intravenous drug usage remains the key challenge
to combating the spread of HIV/AIDS in Iran today,"
Dr Mitra Motamedi, the director of Iran's department of
AIDS and hepatitis in the Ministry of Health, told IRIN
in the capital, Tehran. The vast majority of Iran's AIDS
sufferers - 65 percent - were men who contracted the disease
through contaminated needles, she said. |
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| According to official estimates, infection was 12 percent
through sexual contact, nine percent through blood transfusion,
one percent mother-to-child transmission and 13 percent unknown. |
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| The first reported AIDS case in Iran dates back
to 1987, when a six-year-old haemophiliac child was diagnosed
to have been infected, resulting in the establishment of the
National Committee to fight AIDS and its executive and technical
committees. Since then, there have been 4,237 reported cases
of HIV/AIDS. Of this number, 626 have developed full-blown AIDS
and 585 have died. |
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| But health officials, most notably in the government,
acknowledge that the real numbers are much higher. "These
are only reported cases. A more accurate estimate would be around
20,000," Motamedi said. |
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| Sharing her concern was head of infectious diseases
at the Ayatollah Khomeini Hospital and one of the leading experts
on AIDS in Iran, Dr Minoo Mohraz. "The threat is increasing.
We have not stopped it," she told IRIN. "It's not
under control." |
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| Her warning is not new. Just two years ago, former
Health Minister Mohammad Farhadi described HIV/AIDS at a conference
ahead of World AIDS Day in Tehran as a "time bomb"
waiting to go off. "There is a time bomb ticking in Iran
and we have to take it seriously," he reportedly said. |
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| But what concerns experts most in this state
of 70 million is the increasing number of intravenous drug users.
Of the two million addicts estimated to be in the country, according
to a recent government study, some 136,000 were injecting drug
users. Others fear the number could be far higher. |
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| In many ways, the rise in intravenous drug usage
is a product of the Taliban ban on the cultivation of opium
in Afghanistan in 2000. This in turn has also resulted in a
change in the categorisation of drug users. |
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| "Most of the drug users here use opium,
and the method of use is through smoking/inhalation," Fariba
Soltani, an expert on drug demand reduction at the United Nations
International Drug Control Programme (UNDCP) in Tehran, told
IRIN. "However, as a result of that opium ban, there was
a reduction in the opium supply, so the prices increased dramatically.
This in turn resulted in the drug users either going into treatment
- wherever possible - or they switched to heroin, and injecting
drug use increased." she explained. |
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| According to the expert, drug usage had a long
history in Iran, but what had changed were the categorisation
of users. "Before it was elderly people, men using drugs,
smoking opium in a traditional sort of setting - a social sort
of activity," she said. "Now it's moving to the younger
generations." |
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| The tendency towards heroin abuse also grew stronger.
"This is the worrying factor and why all these harm-reduction
committees have been formed," she said, noting that about
70 percent of the country's population was below the age of
30. |
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| In short, drug usage is increasing far faster
than earlier expected, and officials are alarmed. |
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| In October, Reza Sarami, who heads the anti-addiction
programme of the national anti-narcotics trafficking body, reportedly
said drug use was rising by eight percent annually. Given the
existing numbers, Iran could be counting nine million addicts,
or some one-seventh of the total population, and undoubtedly
even more injecting drug users, within the next 20 years unless
drastic action was taken. |
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| However, it is addiction problem within the prisons
system that remains the main source of concern seven years after
a major HIV outbreak was reported in the western Kermanshahan
Province in 1995. One former government official told IRIN that
of the 400 inmates tested for HIV/AIDS, a startling 146 of them
tested HIV-positive. Due to a rise in crime and addiction and
deteriorating economic conditions, Iran has a large and growing
prison population. |
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| "Prisons are the main source of HIV,"
Mohraz said. As the population increased, so too would addiction
and the number of men who have sex with men, she explained.
Turning to the size of the facilities, she noted that a prison
which might have a capacity of 2,000, could have as many as
10,000 or more inmates. Moreover, until recently, new prisoners
were often mixed with inmates who were addicted and potentially
HIV infected, only to have those prisoners become HIV infected
as well. She observed that many of her patients, most of whom
were addicts, had left prisons HIV positive. |
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| "Sharing of needles is very popular within
the prison system. The way to prevent that is through harm-reduction
programmes such as methadone treatment," she said. But
given conservative attitudes, that is easier said than done.
Although the government has recently accepted methadone-maintenance
therapy, which has started as a pilot project, the situation
inside the prisons remains the same. |
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| According to Pejman, a former inmate and intravenous
drug user at the Gezel Hesar prison near Tehran, home to some
10,000 prisoners, getting heroin inside was easy. "If you
want it, you can find it," the 45-year-old told IRIN. |
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| He recalled how after 28 years of addiction,
using up to five grammes of heroin a day, he found himself in
jail under Iran's strict laws on drug abuse. During his incarceration,
things went from bad to worse and, like many other addicts,
he too became HIV positive. |
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| "This was something I did to myself, so
it was easier for me to accept," he said. "However,
the situation for haemophiliacs or people who received it through
sexual transmission by accident is something different." |
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| Currently undergoing anti-retroviral therapy,
he heads a peer-support group for six other HIV infected individuals,
meeting biweekly, at the Shemiranat health centre in the north
of Tehran, one of seven so-called triangular clinics in the
capital, supported by the government, where needle exchange
and condom distribution take place. |
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| "It's a small number, but it's a start.
I'm a positive person and I want other people to be positive
as well," he said. Dedicated now to helping others, he
nevertheless feels the government should be doing more on awareness
and support. "Of course I think more needs to be done.
That's why I'm here." |
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| Mohraz couldn't agree more. Experts have called
for a more moderate approach to the growing number of addicts
in order to curb the spread of drug-related AIDS, most notably
by way of the free distribution of syringes to avoid contamination. |
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| But according to the health expert, existing
bureaucracy remains a major hurdle to the HIV campaign. "As
addiction is a crime, they cannot provide methadone as a treatment,
but we have the acceptance of the justice ministry that treating
addicted people is not a crime or against the law - as it was
before," she said, noting the importance of harm reduction
efforts. "There needs to be a change of rules and policies
in order to start using methadone in the prisons. The attitude
towards AIDS is not very positive and there are some who view
methadone like heroin," she explained. |
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| However, officials in Iran are far from complacent.
The government has established a national harm-reduction committee
meeting biweekly, and has also accepted the National AIDS Prevention
Committee's comprehensive strategic plan. |
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| "Acceptance of this is a solid step towards
implementation," Motamedi said, recalling the government's
recent acceptance of methadone therapy as a pilot project. Moreover,
the ministry of education has recently accepted the inclusion
of education material on sexually transmitted diseases and HIV
in the national curriculum, as well as the education of soldiers
and those serving in the armed forces, she added. |
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| While admitting there was much work ahead, she
stressed that "the political commitment towards this challenge
is excellent". |
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| Fariba added that Iran had demonstrated some
very progressive efforts in containing the virus spread. She
noted that anti-retroviral treatment had been paid for by the
Ministry of Health and that just recently the government had
called for the protection of HIV-infected people's rights in
the workplace. |
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| Although once a taboo subject, given the past
few years of growing awareness, she maintained that "things
are changing. It's gradual. You can't expect things to change
overnight, but it is happening." |
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| This feature is sourced with permission
from IRIN, a UN humanitarian information unit, but may not necessarily
reflect the views of the United Nations or its agencies. If
you re-print, copy, archive or re-post this feature, please
retain the credit and disclaimer. Quotations or extracts should
include attribution to the original sources. The copyright is
with UN Office for the Coordination of Humanitarian Affairs. |
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| IRIN (Integrated Regional Information
Networks) is part of the UN Office for the Coordination of Humanitarian
Affairs (OCHA). Born out of the 1994 crisis in the Great Lakes
region of central Africa, IRIN pioneered the use of e-mail and
web technology to deliver and receive information to and from
some of the most remote and underdeveloped places in Africa.
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