The HIV AIDS Epidemic in Iran
The Triangular Clinic
Kamiar Alaei is a public service professor in the Department of Public Administration and Policy at the University of Albany and the founding Director of the Global Institute for Health and Human Rights. He is an expert on HIV/AIDS, drug policy and international health and human rights. In addition to WHO/CAIRO, he has served as a consultant or temporary advisor to the World Health Organization in Pan American Region (PAHO) to expand health and human rights training programs in the prison system. He and his brother Arash co-founded the first “Triangular Clinic” for three target groups in Iran. His area of expertise, focusing on HIV/AIDS policy and drug policy through an academic perspective with a concentration on central America, the Middle East and Central Asia.
He earned his degrees from Isfahan Medical University (MD), Tehran Medical University (MPH), Harvard University (MS), and the University of Albany (Ph.D.) Alaei is currently completing his degree in International Human Rights Law at the University of Oxford. Selected publications include: Alaei A; Alaei K. Drug users need more choices at addiction treatment facilities. British Medical Journal (BMJ). 22 March 2013; and Alaei K; Mansoori D; Alaei A. The response to HBV Vaccine in HIV infected patient’s. J of Archives of Iranian Medicine. Oct. 2003.Vol.6; No.4:20-25.
Mandatory Rehabilitation Camps for Drug Users
After Islamic revolution in Iran, the policy of official change and they send drug users to prison for mandatory be free from using drugs. And they call them rehabilitation centers, but they were actually prisons, because they didn’t have access to any healthcare services to get you know supplementary treatment for the addiction, and they had no choice except to you know suffer for a few weeks. And since some of them they were you know drug users that they didn’t have experience of injection. When they got to prison, they may got you know some kind of drugs from other prisoners that they brought inside and they shared needles. And that was the beginning of a history of needle sharing among endocrine drug users inside the prison. So this policy unfortunately continued for almost 20 years, and for 20 years there was no treatment facilities for drug users, and if they arrested any drug users they sent them to these mandatory rehabilitation camps.
And they So if they found any drug user, they pushed them to those mandatory rehabilitation camps, and for 20 years they had this kind of policy. And that was the reason that drug users they had to shift their behaviors, and some of they started injecting drugs and sharing needles while they were in prisons. And when they got released, they may got infected by blood-borne diseases such as HIV/AIDS or hepatitis B or hepatitis C. The first HIV case was detected in Iran in 1986 among a hemophilic case. And after that, for a while policy makers they denied that there was any HIV issue in Iran. They called it this was a western disease and we as a Muslim country we don’t have any kind of those illegal behaviors which put a trace of population to get HIV, except through blood transfusion.
Tracking the Spread of HIV AIDS
At the beginning, the main route of HIV transmission was through blood transfusion from blood that they got from France, because they didn’t have any screening system. So the majority of people that they needed blood they got infected if they needed blood due to surgery or the type of disease that they had like thalassemia or hemophilia. But when they identified that the rate of HIV is increasing among this target population, they started to do screening, and that was after a few years the rate of HIV among this type of group was declined. But for more than a decade that there was a debate between experts and policy makers to have some survey among other high-risk behaviors. Finally, officials accepted to have a pilot survey among drug users, and the best way to find. So the first pilot project was implemented among drug users, and the best way to find them was through prison system. So they had a pilot survey among three main prisons in southwest, southeast, and the western part of Iran.