Star-Telegram | 04/14/2006 | Iran's anti-HIV program serves as a model




TEHRAN, Iran -- It took 30 meetings just to create a slim AIDS-awareness handbook for Iran's conservative high schools. A drawing of a condom disappeared early; a photo of a syringe survived. A mention of sexual transmission was approved, but only with a reminder that sex before marriage is forbidden.
Even after the government's wordsmiths were satisfied, AIDS workers in Tehran had to take the book south to the holy city of Qom, the spiritual center of Iran's all-powerful clergy. To everyone's surprise, the clerics endorsed it.
Iran's fight against the spread of HIV hinges on a delicate give-and-take between activists who talk frankly about sex and drugs, and the ruling ayatollahs, who fiercely protect the Islamic Republic's ultraconservative image. The combination has made Iran the Middle East leader in preventing HIV and AIDS.
The country's program, which melds deep-rooted religious values with cutting-edge research, is being exported to Afghanistan, Iraq, Lebanon, Pakistan, Sudan, Syria and other Muslim nations.
"I told my colleagues in the United Arab Emirates, 'You're not more rigid than us. We're the only country in the world where it's the law to wear a head scarf, where it's a pure Islamic government, where you can't drink,'" said Dr. Arash Alaei, one of Iran's most respected AIDS researchers. "'If we have a prevention program, why don't you?'"
In a region where other Muslim governments ignore the epidemic, quarantine HIV-infected people or preach abstinence as the only solution, Iran's approach is especially remarkable.
It still doles out floggings to Iranians caught with alcohol, but it gives clean syringes and methadone treatment to heroin addicts. Health workers pass out condoms to prostitutes. Government clinics in every region offer free HIV testing, counseling and treatment. A state-backed magazine just began a monthly column that profiles HIV-positive Iranians, and last year the postal service unveiled a stamp emblazoned with a red ribbon for AIDS awareness. This year, the government will devote about $30 million to the program.
One of Iran's most acclaimed advances comes from its notoriously secretive network of prisons, where hundreds of drug-addicted inmates sometimes share the same makeshift syringe to inject heroin smuggled in by guards or visiting relatives. In a startling acknowledgment of sex and drugs even in its most closely guarded quarters, the Tehran administration has made condoms and needles available in detention centers across the country.
"Iran now has one of the best prison programs for HIV in not just the region, but in the world," said Dr. Hamid Setayesh, the coordinator for the U.N. AIDS office in Tehran. "They're passing out condoms and syringes in prisons. This is unbelievable. In the whole world, there aren't more than six or seven countries doing that."
Iran's national response still faces obstacles, especially when it comes to reducing the shame and isolation that HIV-infected Iranians endure. The government reports 12,000 people with HIV; health workers say the real figure is closer to 70,000. Many HIV-positive Iranians are reluctant to tell relatives and co-workers about their diagnosis, fearful that they'll be cast out of their homes or fired from their jobs.
But the program's architects are turning to the clergy for help in combating the stigma of a disease that in the minds of many Muslims is inextricably linked to sex.
A year ago, Setayesh sent questionnaires to the most influential Shiite Muslim clerics to elicit their views on condom use, government's role in AIDS prevention and how society should deal with HIV-infected Iranians. He received 17 handwritten responses, nearly all in favor of the government's efforts. The U.N. AIDS office plans to compile them into a book to distribute at mosques.
Iran's first reported HIV infection was in 1987, when a hemophiliac child tested positive.



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