Despite a continuing stigma about AIDS in Iran, the nation’s health authorities are winning praise globally for their response to the disease and have been more open about the number of cases and the routes of transmission, an Iranian-born American scientist said at AAAS recently.
Navid Madani, a research scientist at the Dana-Farber Cancer Institute in Boston, helped organize an international AIDS meeting in Tehran 22-25 October. Close to 300 people attended, including seven invited speakers from the United States, and there was some unexpectedly frank talk about the disease.
Madani said a highlight was a session that resulted in a spontaneous general discussion on neglected key populations. Madani said her Iranian colleagues were eager to have a session that dealt with sexually transmitted cases of AIDS in the country.
The stigma surrounding HIV/AIDS in Iran is “still quite high,” she explained. But in the past several years, Iranian health officials have provided details on the incidence and causes of HIV/AIDS cases. According to figures released in March by Iran, 24,290 people have been identified as infected with HIV, the virus that causes AIDS; 3455 have been identified with full-blown AIDS; and 4722 have died of the disease. The number of Iranians living with HIV but not identified as such is considerably higher. Madani said an estimated 93,000 Iranians are living with HIV. The population of Iran is about 78 million.
Based on Iran’s Ministry of Health report, the main modes of transmission for AIDS in Iran are intravenous drug use (62.5% of cases), sexual transmission (21.2%) and mother-to-child transmission (3.9%). Among those with HIV/AIDS, 91% are male, 9% female.
Iran’s third national strategic plan on HIV/AIDS, covering the years 2010 to 2014, has acknowledged an increase in the number of cases transmitted by sexual contact. Health authorities have developed comprehensive programs to address the needs of key populations, Madani noted.
She discussed her attendance at the Tehran conference—the “First International and 5th National HIV/AIDS Congress”—in a 19 November talk at AAAS sponsored by the AAAS Center for Science, Technology & Security Policy. Irene Jillson, an assistant professor at Georgetown University’s School of Nursing and Health Studies, also spoke about her experience with both bioethics and drug abuse research in Iran. Norman P. Neureiter, acting director of the AAAS Center, moderated the session.
Norman P. Neureiter
The Tehran conference covered a diverse range of scientific topics, including a general overview of the biochemistry of the HIV virus, testing technologies and viral load detection, metabolic complications of HIV, antiretroviral therapy (ART) in children and pregnant women, and the future of AIDS prevention. Reducing the risk of mother-to-child transmission of the virus was emphasized, including appropriate HIV treatment during pregnancy and alternatives to breast feeding for women who are HIV positive.
Madani said Iran has been “a model for the rest of the region” in its response to AIDS. There has been an expansion in the delivery of HIV/AIDS services throughout the country, including voluntary counseling and testing, free condoms, and free treatment for those infected with the virus. There are 421 centers that distribute free sterile needles and syringes to intravenous drug users, Madani said, and more than 3300 clinics—most of them in the private sector—offer methadone maintenance for treatment of drug users. In addition, there are 14 HIV-positive clubs throughout the country, which provide social support to people who are living with HIV/AIDS and their families. This selection of services and support distinguishes Iran from other countries in the region, Madani noted.
The Iranian Research Center for HIV/AIDS, established in 2006 as an affiliate of the Tehran University Medical School, coordinates AIDS research and clinical activities based in Tehran; the center’s educational services also are available throughout neighboring countries, according to Madani. It is the first academic research center in Iran devoted to basic research on HIV/AIDS and to community-based research on the disease.
Community-centered treatment is at the heart of the Iranian health system. A network of “health houses”—small primary care centers located in rural communities—has responsibility for family health and wellness, public health education, and disease monitoring and control. The houses usually are staffed by local residents who have been trained to provide services and refer patients to hospitals and other facilities if they need more sophisticated services.
The health house system has been credited with reducing child mortality rates in Iran by 70% since 1980 and increasing contraception usage rates to 90%. Madani said the health houses are a good vehicle for HIV/AIDS education and awareness programs as well.
The health house concept has drawn international attention, including efforts by public health specialists in the U.S. state of Mississippi to create a similar system in rural communities throughout the Mississippi Delta.
“We can learn a lot from what Iranians are doing,” said Georgetown’s Irene Jillson. She said that after the revolution in 1979, the new Iranian government recognized that the nation “had huge problems” with infant mortality. Health specialists engaged religious leaders as well as scientists in designing a system to improve primary care in rural and underserved areas.
Jillson, who has extensive experience with bioethics in Iran, said the nation’s health system has done “extraordinary work” to improve reproductive health. That work on reproductive health, she said, provided “a very important foundation on which to build very early work on AIDS prevention.”
The Iranian health system is now under considerable stress, however. According to a 22 November report in The Washington Post, patients suffering from the most serious conditions are increasingly unable to get treatment due to a complex set of circumstances, including Western economic sanctions aimed at forcing Iran to halt its uranium-enrichment program. The sanctions have squeezed Iran’s economy, leading to higher prices for medicines and medical supplies, the report said. Iranians have expressed frustration with their government for failing to control the rising costs in a nation accustomed to highly subsidized health services.
The sanctions had an impact on planning for the HIV/AIDS Congress, Madani said. The Iranian government was unable to pay travel costs for invited speakers from the United States, for example. Madani received a grant from ViiV Healthcare at the last minute to defray travel costs.
The broader impact of the sanctions is worrisome, Madani said. Speakers at the conference talked about the latest medicines and laboratory methods being used in the fight against HIV/AIDS, but Iranian specialists told Madani they are unable to readily obtain medicines, lab supplies, and other equipment from Western suppliers. The impact of the sanctions on Iranian health care “is something that we, as health care professionals, really need to address,” she said.
Despite bureaucratic obstacles in arranging the HIV/AIDS conference, including one requested postponement by Iranian authorities, Madani said the gathering was a success and spotlights the eagerness of leading Iranian scientists and educators to promote scientific exchange and establish a solid research infrastructure in their country. Two Iranian universities want to host follow-up conferences on HIV/AIDS, and individual cooperation by faculty members in Iran with Western colleagues has been growing. There are ample opportunities, Madani said, to build on the groundwork laid at Iran’s first international HIV/AIDS conference.
Learn more about Iran’s First International and 5th National HIV/AIDS Congress.