Brothers, Kamiar and Arash Alaei were imprisoned in Iran in 2008 for their work with HIV. Under a new government, Iran’s health minister, Hassan Hashemi, has blamed “misinformation and unscientific claims” for a dramatic rise in the number of people with HIV. Kamiar Alaei looks at the HIV crisis in Iran and a country facing up to some uncomfortable home truths.
Before 1997 there was a huge stigma attached to HIV/AIDS in Iran. Policy-makers said it was only concentrated in people with blood transfusions, HIV was a western disease and Iran was a Muslim country, that “we don’t have those issues”. But for ten years there was debate between experts and policy-makers and in 1995 they accepted a survey among injecting drug users. They found the rate of HIV in this group was increasing.
Iran has some critical indicators for HIV. About 70% of the general population is under 35. And the majority of them are between about 17 and 27. The age of puberty is around 14 to 15 years old, and the mean age of marriage is about 30 for women and 35 for men. That means that people are also at risk for 15 years for unprotected sex.
Drug use has been treated very harshly. But Iran has one of the highest rates of drug users in the world — major drug trafficking goes through Iran. We also have a high rate of unemployment and some mental health issues. At the same time during the [Mahmoud] Ahmadinejad administration [2005-2013] we didn’t have enough educational material or transparency about safe sex.
One MP, who was a doctor from western Iran, negotiated with parliament and got money in 1996 to have a national AIDS hospital in Kermanshah. But he forgot about the stigma – people realised that patients would be referred to the city and it would be tagged by HIV. Nobody re-elected him. For two years there was a huge silence, not only in Kermanshah but also nationwide.
We’re originally from Kermanshah and we wanted to have that pilot, but with a different strategy to target opposition to HIV: first the high-risk groups such as injecting drug users, and then their families, and then little-by-little to approach the general population.
The reformists got to power after 1997 with Mohammad Khatami. After that the environment was open and there was a window of opportunity. They supported us and had an open mind to develop the idea — that is how Hassan Hashemi [Iran’s health minister] is now. We had visitors from other provinces and were part of a group that developed a proposal for international support. The programme was very progressive. We expanded to Afghanistan, Tajikistan — because we have a common language — and we started to promote these achievements at international conferences.
HIV worse than condoms
The next phase was a religious approach. For example, in Islam, saving life is a first priority and if you save one life it’s equal to everyone’s life. So if you say we want to save a life of a baby — who would say no? Later that you want to save the life of the mother, then the father. And little-by-little you can expand.
Another example is drinking alcohol, which is prohibited in Iran by Sharia law. But if you’re in the desert and you can’t find water you can drink alcohol to save your life — between bad and worse, bad is better. So talking about condoms was bad, but getting HIV was worse. That gave us the opportunity to talk about a bad thing to prevent a worse thing.
Some religious leaders made a fatwa in support of our programme. And, in 2005, the head of the judiciary wrote a letter that the judges, courts, lawyers and enforcement had to be supportive of harm reduction. It was a huge change.
Yet another change
But by September a new government under Ahmadinejad came in that was very conservative. The mentality was exactly like it was before 1997, that we shouldn’t highlight this weakness internationally — because if we talk about HIV and about injecting drugs it’s a weakness. That was why the president said in 2007 we don’t have gays, we don’t have sex workers. Finally in 2011 they removed World Aids day from the calendar, which took several years to put there. It showed that they didn’t want to emphasise or priorise HIV/AIDS.
So on the one side we have all these young people and at the same time a lack of enough or effective material in high schools. We were working with the Red Crescent and the education ministry on some books about HIV for high schools and it was stopped. At university, there was a one-credit course on family planning, and two years ago they removed it from the curriculum. And culturally, HIV stigma is attached particularly to women. But if policy-makers say we don’t have these high-risk groups and harm reduction is immoral, how do you expect those people to come to the clinics?
Because Iran has a good infrastructure and we integrated the triangle clinics we set up into existing primary healthcare settings, when they arrested us they couldn’t close those clinics down.
Life in prison
In 2008, my brother and I were arrested in Iran because of our high-profile work on HIV. We were charged under Article 508 for communicating with an enemy government to overthrow the government of Iran which was because of our work on scientific collaborations with academic institutes in other countries such as the United States. At the beginning we had no access to an attorney and I spent two months in solitary confinement in Tehran’s Evin prison in a cell that was six feet by four feet. Another six months was shared with extra people, but there were blindfolds and no access to fresh air.
After our one-day trial behind closed doors, three independent judges said we didn’t do anything to overthrow the government. But the judiciary system had changed and they didn’t look at the report, so I spent two-and-a-half years in prison. My brother Arash was released in 2011.
It is difficult when you do good things and you get arrested for no reason. We were not political activists. If you’re a political activist you have some expectation that you may get in trouble — everything was transparent and we only focused on health. We continued our work inside the prison by educating prisoners about HIV and addiction at the same time as morning exercise.
Within three days of my release I had to leave the country. I learnt Spanish in prison, so when I got released I went to work in central America. My brother now works with me.
Back on track
Now there is another change in Iran under president Hassan Rouhani. Hashemi has said HIV is increasing and taboo and misinformation stops people from reporting it. He is a top expert in this field and the people he has selected. It shows that they want to address this issue.
If you look at the data that the ministry released — they said around 27,000 HIV cases are registered in Iran. But based on the WHO and UN estimates there are more than 100,000 people with HIV, which means that they don’t know about 73% of HIV cases that could transmit.
In a report last year, more than 30% of reported new cases are through sexual intercourse. It shows that the trend is also changing. We need more education about this kind of at-risk behavior.
It was the right thing to do
Since we left Iran we have developed some projects with the World Health Organisation in countries like El Salvador, including the first training on health and human rights for prisoners. We founded the Global Institute for Health Rights and have set up projects in the Middle East and the pan-America region.
Even though I went through two-and-a-half years in prison, I’d be happy to go back. What I did was not for the government but for my people. It was the right thing to do; to have sympathy, to have empathy. If I had this issue I would expect others to help me so that is my responsibility for them. Our goal is to control HIV in Iran.
I did most of my activities in Iran with my brother as volunteers because the policy-makers didn’t realize it was important. And little-by-little it motivated other people to reach a national agenda. Things can easily change but I hope this momentum now can continue.
Kamiar Alaei is director, Global Institute for Health and Human Rights This article was originally published in The Conversation.