Officials look to Iran for help on AIDS

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Officials look to Iran for help on AIDS By MARIA CHENG

The Associated Press Tuesday, April 27, 2010; 9:14 AM

LIVERPOOL, England -- Health experts are holding up a perhaps unlikely country

as a model for fighting AIDS in drug users: Iran.

Experts at an international AIDS conference this week are studying how the

hardline Islamic republic's methadone clinics and needle exchange programs may

be a model for other countries, including some in the West.

Being right next to Afghanistan's opium fields, Iran has long struggled with

large numbers of drug addicts.

When AIDS arrived in Iran, the virus first hit the country's heroin users. To

curb the outbreak and prevent it from spilling into the general population,

Iranian leaders adopted an approach that appeared surprisingly progressive for

an authoritarian regime.

" It might be seen as socially liberal, but from a public health point of view,

it's just pragmatic, " said Joumana Hermez, an AIDS expert at the World Health

Organization's office in Cairo. On Tuesday, Hermez and other officials were

addressing how the Middle East has responded to the disease at the International

Harm Reduction Association's 2010 conference in Liverpool.

For years, Iran had a hard-line drug policy, and it still executes people for

certain drug trafficking crimes.

Experts say attitudes began to shift about a decade ago when doctors and

academics managed to convince religious and governmental authorities that unless

they helped drug users kick the habit, Iran would face a much bigger AIDS

epidemic.

" They began to understand it was better to have a (drug) addiction problem than

an addiction problem with HIV, " said Dr. Seyed Ramin Radfar, an executive

manager at an Iranian non-governmental organization that runs methadone clinics

and needle exchange projects throughout the country.

Religious leaders issued fatwas declaring that drug users shouldn't be

prosecuted if they sought help. In 2005, Iran's top judge decreed initiatives to

combat the spread of AIDS were aimed at protecting society and should not be

blocked.

That led to a change in how addicts were treated. " If drug users agreed to

accept treatment, then they could be viewed as patients, not criminals, " said

Radfar.

Methadone clinics to help wean addicts off heroin and provide clean needles

first started in Iranian prisons where drug abuse is rampant. The clinics only

popped up in regular communities when authorities realized released prisoners

had nowhere to continue their treatment. The government has since set up more

than 200 methadone clinics and there are more than 1,000 private clinics.

Even in countries like Australia, Canada and the U.S., it is hard for prisoners

to get methadone or clean needles. Until recently, the U.S. refused to fund

needle exchange programs - in which addicts get clean needles in exchange for

used ones - as part of foreign aid.

" Iran is absolutely a model for the world in certain respects, " said Susie

McLean, a senior adviser in HIV and drug abuse at the International AIDS

Alliance. " No one ever would have thought they would make delivering services to

junkies a priority. "

Still, McLean said the country is far from perfect and the initiatives still

need to be rolled out on a much bigger scale.

There are also occasional problems with the methadone supply and services across

the country can be patchy.

Though officials are still conducting surveys to find out how many people are

infected with HIV in Iran, they say the country's policies have probably made a

dent in the virus' transmission. Still, the number of people infected is growing

and in 2008, the health ministry estimated there were from 70,000 to 100,000

people with HIV in Iran.

With more cases now being picked up beyond drug users, experts say it is time

for Iran to fight the virus in other vulnerable groups: gay men and prostitutes.

So far, Iran has made no attempt to protect them, and homosexuality, adultery

and prostitution remain illegal. Condoms are distributed in prison, but only for

conjugal visits. President Mahmoud Ahmadinejad once declared there were no gay

people in the country, and there are no AIDS initiatives aimed at gay men or sex

workers.

If Iran is to stop AIDS, that may be the next frontier.

" There are a lot of contradictory things happening in Iran, but they seem to get

around it for controlling HIV, " said Gerry Stimson, executive director of the

International Harm Reduction Association.

Stimson has visited a methadone clinic inside an Iranian prison close to Tehran.

He was impressed with the prison's cleanliness, Iranian carpets and free

condoms, but admitted he was probably shown the facility's best parts.

" They have made some good progress on things we never would have expected, "

Stimson said. " But I still wouldn't want to be inside an Iranian prison. "

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