Guest: Marjan Hezareh

Guest: Marjan Hezareh
Date : 2005-06-06
www.irandokht.com

This interview is intended for our website viewers and was not conducted for television.

EmdAde AIDS (www.aids-ir.org) is an independent, non-profit organization devoted to providing information about HIV/AIDS for Persian-speaking communities. In addition to increasing the level of awareness, EmdAde AIDS also provides support for HIV-positive people while seeking to reduce the taboos and stigma of HIV/AIDS in Iranian society.

It currently has 9 members, one of whom is Dr. Marjan Hezareh -- Scientific Director at the AIDS Research Alliance in Los Angeles. Other participants include Dr. Leila Mirhagani, founder and director of HIV/AIDS clinic in Teheran until 2004. Currently, Dr. Mirhagani is a member of the advisory committee at the International Institute of Health Studies ( IIHS) and is a member of EMDAdeAIDS website.

Pari Esfandiari: How big of a problem is AIDS in Iran? What is the most common means of infection?

Marjan Hezareh: The first case of HIV/AIDS in Iran was reported in 1982 in a 6-year-old child with hemophilia. The infection was due to the use of imported blood products contaminated with the virus. Since 1982, the number of HIV infections increased exponentially. From 1982 until 1989 the main route of infection was through blood products. Since 1989, it’s been mandatory to perform an HIV test (among other tests) on all blood and related products at the Center of Blood Transfusion. Thereafter, the main route of infection is known to be intravenous drug use.

In Iran, drug use and transmission of HIV are closely intertwined, as the majority of HIV positive patients have contracted the disease by sharing needles. However HIV infection is rising through other means such as sexual transmission among heterosexuals and homosexuals. Since most studies were concentrated on HIV infection in drug users there is no available statistics on transmission through other routes of infection. The latest report of UNAIDS estimated that 30,000 people are HIV positive in Iran. We believe that in the case of HIV/AIDS we are just looking at the tip of the iceberg, the problem is much more profound and advanced.


Pari: In what direction is HIV infection transmitted and by what professions of people?
Marjan: The HIV surveillance program in Iran indicates a high prevalence of HIV infection among injecting drug users and prisoners in selected provinces. However, further analysis demonstrated that the epidemic is shifting from drug users to their sex partners (bridge group) and to their children through Mother-to-Child Transmission (MCT).

Even if there are no valuable statistics on the prevalence of HIV infection among prostitutes in Iran, because of the increasing number of prostitute and the lack of information about HIV/AIDS, we suspect a rising number of infections in this profession too.

Pari: How is the Iranian medical/scientific community responding?
Leila: Current estimates in Iran indicate that about two-thirds of HIV infections are due to sharing needles among injection drug users. In response to the escalating number of HIV infection in this community, the Center for Disease Control in Iran has established clinics called “Triangular Clinics”. These centers are using an innovative approach combining the delivery of HIV care, treatment of Sexually Transmitted Diseases (STDs) and treatment of drug dependence. The mission of Triangular Clinics is: to defeat stigma and discrimination by offering user-friendly services; to serve the marginalized and the poor; to tailor services to the needs of the each individual; to integrate HIV prevention and care, and to coordinate various services to ensure continuum of care.

These centers offer a wide range of services that include HIV testing and counseling, provision of syringes, condoms, referral to specialists and inpatient treatment of drug dependence and other diseases. They also organize support groups for HIV positive patients and their families. To this date, fourteen Triangular Clinics have been established around the country. However, these clinics offer their services only to a small proportion of the injecting drug users and the challenge is to scale up the program in order to reach the majority of drug users in Iran.


Pari: Are the Iranians “HIV-aware”? Do they understand how they get infected or how high the rate of infection in Iran is?
Leila: There is an increase in awareness among Iranians about HIV/AIDS. Until 4 years ago media didn’t play a great role in AIDS awareness but recently they have started to talk about HIV infection and the Iranian television shows clips on prevention. There is a weekly program in a local radio, “Radio Javan”, named “be rang-e- Paeez” in which HIV positive people are interviewed and speak about how they got infected, their lives, their hopes and challenges. The ministry of education has launched an educational program on HIV/AIDS, called “The Health Youth” for high schools around the country.

Despite all these efforts, there is an urgent need to establish aggressive prevention plans to reach every Iranian in the country independent of their economic situation, language and religious belief.

Pari: How does it track with other STDs?
Marjan: Usually the existence of other Sexually Transmitted Diseases (STDs), such as syphilis increases the risk of HIV acquisition. That is why we are planning to inform people about other STDs and their treatment.

Pari: How are STDs explained in Islam compared to other religions?
Marjan: The Ministry of Health is trying to get the permission of religious leaders and their cooperation to allow sex education in the media as well as in schools and universities. They have been almost successful, but still advertisements or education about the use of condoms is forbidden. Another issue is the existence of “Sigheh”, which is an acceptable practice by religious groups. This has become a source of income for women in a difficult economic situation. During one day, one woman can be a “Sigeh” to several men and practice unprotected sexual intercourse.

The bottom line is that Islam like other religions is advocating abstinence and being faithful as the only means to stop any STDs including HIV. However, a recent study conducted over several years on 500 people in Uganda showed that the decrease in HIV prevalence in Uganda is only due to an increase in number of people using condoms (50% of men between the ages of 15-45). There was no change in the number of sexual partners. This study does not advocate increasing the number of sexual partners, but emphasizes the importance of using condoms in saving lives.

Pari: Has it reduced women''s freedom?
Leila: In Iran, because of the importance of keeping one’s virginity until marriage, young girls practice unprotected anal sex, which is one of the primary sources of HIV transmission. In addition, women are also less likely to seek treatment for sexually transmitted diseases or get information about safer sex. It is noteworthy that the increasing number of HIV infection among women is not only a threat to the health of women but also leads to an increase in the number of mother-to-child transmissions.

Pari: What do you and your colleagues do & how are you helping HIV patients in Iran? What is the website''s advocacy status?
Marjan: Our goals are
1. To provide accurate information on the nature of the virus and its routes of transmission to prevent the emergence of new infections and also decrease stigma and taboos.

2. To provide accurate information on patient’s care and available treatment options for HIV and related diseases to HIV-positive people, their friends and families, health care providers and physicians.

In order to emphasize the importance of protected sex we have a comprehensive and complete section about the use of both male and female condoms. We are also addressing separately, gender specific issues associated with various aspects of HIV.

We have an online consulting section where people can anonymously ask questions about HIV/AIDS and its treatment.


Pari: What is its primary audience and goal?
Marjan: Our aim is to provide information on the nature of the disease, the routes of transmission and treatment options to Persian-speaking people around the world. We believe that knowledge of these issues will hopefully stop the propagation of the disease and lessen the discrimination against HIV-positive people in these communities.

Pari: Are religious considerations important for the reporting and discussion of AIDS on the website?
Marjan: We provide information on medical, scientific and social aspects of HIV/AIDS without consideration of any religious, political and cultural beliefs.

Pari: Will it attempt to measure its "success"?
Marjan: We have implemented a system to track the number of people visiting the site. Also, we have our consulting service as a source to measure people’s awareness about HIV/AIDS and also to identify issues that we have not addressed in the site.

Pari: Why have you and your colleagues decided to devote time/effort to this website?
Marjan: After more than 20 years into this pandemic, everyone has observed the devastating effects of HIV/AIDS worldwide, specifically in Africa, China, and India, where the lack of information and political will contributed to one of the largest human disasters.

As we said earlier, the situation of the HIV epidemic in Iran is like seeing the tip of the iceberg and any delay might spell disaster. Therefore we have decided to use the Internet, which is widely used in Iran by young people, to provide information on all aspects of HIV/AIDS in a hope to increase awareness and decrease its prevalence in Iran and other countries.

Pari: What is the website''s source of funding? Are you receiving any financial support from the US and/or Iranian government?
Marjan: We do not receive any support from any government or related grants, though we are in the process of applying for some non-governmental funding. So far, we all work as volunteers. However, since the website is widely used we are in need of people to collaborate with us in different areas such as translations of articles.

Pari: How can other Iranians situated outside of Iran help with the AIDS problem?
Marjan: First of all, by increasing their own awareness about HIV/AIDS so they can pass on this knowledge to their family and friends and contribute to decreasing the level of stigma. Then, due to a lack of treatment and medications, there is an urgent need to support Non-Governmental Organizations (NGOs) and clinics in Iran that specifically help HIV positive people and also provide prevention programs.

Everyone should look at the example of Africa and realize that delay can spell disaster when dealing with AIDS. UNAIDS has reported that life expectancy in nine African countries has dropped to below 40 because of this HIV disease. There are already 11 million orphans because of AIDS, while 6,500 people are dying each day and in 2004, 3.1 million Africans were newly infected. The report concluded:

"If by 2025, millions of African people are still becoming infected with HIV each year, these scenarios suggest that it will not be because there was no choice, it will be because, collectively, there was insufficient political will to change behavior at all levels, from the institution, to the community, to the individual, and halt the forces driving the AIDS epidemic in Africa."