Officials look to Iran for help on AIDS

(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.”

Doctor sees potential end to AIDS epidemic

A doctor in South Africa is pushing a radical new idea that he believes will wipe out the AIDS epidemic in 40 years.

Brian Williams of the South African Centre for Epidemiological Modeling and Analysis believes that by testing every person at risk of HIV/AIDS and prescribing anti-retroviral treatment (ART) for …

Key AIDS doctor dies at 66

Joel Weisman, who was one of the first doctors to notice the AIDS epidemic, died of heart disease.

Dr. Joel D. Weisman dies at 66; among the first doctors to detect AIDS

Dr. Joel D. Weisman, who was one of the first physicians to detect the AIDS epidemic and who became a national advocate for AIDS research, treatment and prevention, died Saturday at his Westwood home. He was 66.

He had heart disease and had been ill for several months, said Bill Hutton, his domestic partner of 17 years. See Dr. Joel D. Weisman dies at 66; among the first doctors to detect AIDS

Los Angeles Times

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Vatican accuses AIDS groups of intimidation

(Vatican City) The Vatican on Friday denounced the criticisms of the pope’s comments about condoms and AIDS during his trip to Africa, saying they marked an unprecedented attempt to intimidate him into silence.

Pope Benedict XVI said last month that condoms weren’t the answer to Africa’s AIDS epidemic and could make …

Safer or Stupid? Some Gay Men ‘PrEP’ for Sex

More than two decades into the AIDS epidemic, the well-known conundrum of condom burnout among gay men has produced a highly controversial underground practice. “Pre-exposure prophylaxis,” or PrEP, involves taking a comprehensive anti-retroviral drug, usually tenofivir, before having sex.

Some men are actually doing this because they take safer sex seriously indeed. One doctor told me of two patients who took the drug before they had protected sex with strangers as an added preventative in case a condom breaks.

But for the vast majority of gay men, PrEP means a key to not using a condom. That’s what makes it such a hot-button issue among AIDS researchers, doctors and activists. The theory behind is that the anti-retroviral drug prevents HIV from grafting itself onto healthy cells and replicating. When HIV first enters the human body, there isn’t much of it; theoretically, if those few viruses swimming around the bloodstream don’t have anywhere to go, they’ll die out–just as do millions of germs we come across every day that don’t affect us.

One prominent doctor in Boston maintained that PrEP, despite its bad rep, is necessary as one more tool in the arsenal of AIDS fighters. But others see it as an enabler for those men who don’t want to bother using protection. See Safer or Stupid? Some Gay Men ’PrEP’ for Sex

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