In Need of Iran�s Help on HIV?

Efforts to prevent HIV among injecting drug users in Iran were held up as a model worth emulating at the April 25-29 International Harm Reduction Association conference in Liverpool, England. Iran borders Afghanistan, whose poppy fields fuel the global opium trade, and it has long struggled with drug abuse. Heroin users were among Iran's first AIDS cases.

About a decade ago Iranian officials became more receptive to the views of academics and physicians, who predicted that unless the government helped treat IDUs, the country would have a much larger AIDS epidemic. Methadone substitution clinics and syringe access programs to prevent HIV's spread were initially piloted in prisons, where drug abuse is widespread. Religious leaders also issued fatwas that IDUs should not be prosecuted if they sought treatment.

"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 for the World Health Organization in Cairo.

"They began to understand it was better to have a [drug] addiction problem than an addiction problem with HIV," said Sayed Ramin Radfar, a manager for a nongovernmental group that runs methadone clinics and syringe-exchange programs throughout Iran. "If drug addicts agreed to accept treatment, then they could be viewed as patients, not criminals."

Methadone clinics were launched outside prison when authorities realized former inmates had nowhere to continue treatment. In addition to some 200 government-backed clinics, more than 1,000 private clinics offer the treatment.

The initiatives in Iran should be expanded, said Susie McLean, a senior HIV and drug abuse adviser for the International AIDS Alliance. There are occasional methadone supply problems, and services nationally can be hit-or-miss.

Homosexuality, adultery, and sex work remain illegal in Iran, and officials have launched no initiatives to protect persons put at risk by these behaviors.