HIV in Iran: onset, responses, and future directions

Abstract

Iran, a country in the Middle East and North Africa (MENA) region, has been actively involved in the fight against HIV/AIDS over the past three decades. The unique features of the HIV epidemic in Iran are reflected by the modes of transmission and its recent changes to improve management and prevention programs. In this review, we recount the initial onset and subsequent spread of HIV infection in Iran, beginning with the first case diagnosed to the ongoing responses and most recent achievements in controlling this epidemic. Although in the MENA region Iran is one of the pioneers in implementing pertinent policies including harm reduction services to decrease HIV incidence, drug injection still continues to be the major risk of infection. In line with other nations, the programs in Iran aim at the UNAIDS 90-90-90 targets 1 and to eliminate mother-to-child HIV transmission. In this article, we discuss the strengths and shortcomings of the current HIV programs and offer suggestions to provide a better perspective to track and respond to the HIV epidemic. More generally, our account of the national religious and cultural circumstances as well as obstacles to the approaches chosen can provide insights for decision-makers in other countries and institutions with comparable settings and infrastructures. KeywordsHIV; Iran; Review 1 UNAIDS 90-90-90 global targets to end the AIDS epidemic by 2020: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.

Social Support Associated with Condom Use Behavior Among Female Sex Workers in Iran

“…A qualitative study in Tehran, Iran, found that the low level of condom use among FSWs is due to a variety of individual, structural, and cultural factors [27]. This study showed that the main individual, structural, and cultural barriers of condom use among FSW in Tehran were [1] lack of knowledge about HIV/AIDS, seeing condom use as a sign of love and loyalty, drug use, fatalism, and disappointment in life with low expectations for the future; [2] sexual partner violence, partner's desire, problems with condom availability, and price; and [3] feeling embarrassed to obtain condoms, following the example of peer sex workers and low condom use among friends [27]. Two studies in the Dominican Republic and in the Philippines showed that FSWs who had fewer intimate relationships and less frequent contact with their peers were less likely to use condoms [28,29].…”

“…Currently, HIV prevention is one of the most important public health concerns and priorities in Iran [1,2]. HIV prevalence is low in the general population (0.08%) in Iran, but high among vulnerable groups, specifically, injecting drug users (13.8%) and sex workers (4.5%) [1,3,4].…”

“…Since 2010, there are over 60 community-based organizations (CBO) in Iran, funded by the Ministry of Health, to provide harm reduction to FSWs (e.g., HIV testing, sexual health education, condoms) [11]. These programs form the basis of past studies about FSWs and help addressing their needs throughout the country [2,11]. Although these efforts in Iran are beneficial for HIV prevention by increasing the access of at-risk groups including FSWs to health care and HIV prevention services [1,14], they do not address how social and contextual factors play a role in HIV prevention and transmission.…”

“…The negative attitudes in Iranian society regarding sex work put FSWs at the risks of violence, refusal of contact, and social isolation. FSWs, being the second largest at-risk group for HIV in Iran [1,2], play a major role in the HIV epidemic due to their HIV risk behaviors such as unsafe sex, drug or alcohol use before or with sex, and having multiple sexual partners. Not only are they at risk themselves for HIV but also their sexual partners are at risk, and these can be a bridge group to transmit HIV to the general population [13].…”

Spatiotemporal epidemiology of HIV between 1997 and 2020 in Kerman, Iran

“…HIV epidemic in Iran is concentrated among key populations including people who inject drug (PWID) (15.2% in 2010, 10.9 in 2014, and 3.6% in 2020) [1][2][3] and partners of PWID (2.8% in 2010), 4 female sex workers (FSW) (2.1% in 2015), 5 and prisoner (1.2% in 2014), 6 but the prevalence of HIV is very low in the general population (0.15%), 7 blood donors (3 per 100,000 donations from 2003 to 2017) 8 and pregnant women (0.04%). 9 The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated 59,314 people living with HIV (PLWH) in Iran in 2019, of whom only 22,054 (37%) were diagnosed and reported to the National HIV Case-Based Surveillance. 10 Among the diagnosed cases, 67% (25% of estimated cases) were under antiretroviral treatment, and 85% of treatment cases (11% of estimated cases) had viral load suppression.…”