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— 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."
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