IRAN: SOCIAL FACTORS INCREASING HIV RATES

S E C R E T SECTION 01 OF 02 IRAN RPO DUBAI 000019 SIPDIS SIPDIS BERLIN FOR PAETZOLD, LONDON FOR GAYLE, BAKU FOR HAUGEN PARIS FOR WALLER, BAGHDAD FOR GALBRAITH E.O. 12958: DECL: 4/2/2017 TAGS: IR PHUM SOCI PGOV TBIO SUBJECT: IRAN: SOCIAL FACTORS INCREASING HIV RATES RPO DUBAI 00000019 001.2 OF 002 CLASSIFIED BY: Jillian Burns, Director, IRPO, DOS. REASON: 1.4 (d) Iran: Social Factors Increasing HIV Rates 1.(C) Summary: The HIV/AIDS epidemic in Iran is accelerating, mostly due to use of intravenous drugs. Iran's total number of HIV cases has almost doubled in the past two years, and intravenous (IV) drug users account for 63% of the country's total cases. The highest HIV prevalence rates are among IV drug users in large cities and prisons. According to one Iranian expert, however, the disease is spreading rapidly and starting to cross over into the general population, apparently linked to increasing sexual promiscuity. End summary. Concentrated HIV/AIDS epidemic established among Iran's IV drug users -------------- -------------- -------------- 2.(C) The HIV epidemic in Iran is accelerating, according to an Iranian infectious disease doctor, who confirmed the country's official and UN published HIV/AIDS data. The doctor is an AIDS researcher from Iran's primary AIDS Research Center at the University of Tehran, which is partially supported by the office of the Iranian president. UNAIDS (Joint United Nations Program on HIV/AIDS) and the Iranian Ministry of Health estimate that there are 70 thousand HIV/AIDS cases in Iran, although the number of reported cases is under 14 thousand. HIV prevalence in the general population is still low at 0.1%, but this number is increasing quickly. Iran's Ministry of Health and the World Health Organization confirm that HIV/AIDS cases in Iran have almost doubled in the past two years and that localized epidemics exist among IV drug users. IV drug use currently accounts for 63% of Iran's total HIV/AIDS cases, sexual transmission accounts for 7.3%, infected blood products 2% and mother to child transmission 0.4%; transmission routes are unknown in about 30% of cases. HIV prevalence among IV drug users is highest in large cities and prisons; with rates of 23% among IV drug users in Tehran and 25% in Shiraz Prison. 3.(S) The doctor noted that HIV infection rates and incidence in the general population are both on the rise. According to Iran's Ministry of Health and Medical Education, Iran has an estimated 3.7 million drug users, and 137,000 inject drugs. Unofficial estimates for drug use in Iran are as high as 7 million. Prevalence among IV drug users was about 15% in 2004, mainly among low socioeconomic drug users, but now 25% of the injecting drug users examined are infected. The doctor, who previously ran the AIDS research center in a major city, said that the highest HIV/AIDS incidences are among IV users in Kermanshah, Fars, Lorestan, and Tehran. Increase in recreational drug use -------------- 4.(C) According to the Iranian HIV/AIDS expert, one reason for the rise in HIV is a general increase in recreational drug use. Drug use has a long history in Iran and smoking of natural herbs and opiates is traditional in the region, although possession of drugs is forbidden by Iranian law. Several Iranian visa applicants said that smoking hashish and opium is not taken very seriously in Iran, though injecting hard drugs is looked at quite differently. Some Iranians claim that some clerics use opium and two recent contacts claimed that Supreme Leader Khamenei, and former Foreign Minister Velayati smoke opium. What was traditionally a social activity for older males is now spreading to females and youth. At the same time, abuse of other synthetic drugs such as ecstasy and methamphetamines are also increasing. 5.(U) Narcotics reports say that opium, which is traditionally smoked, has become increasingly expensive in Iran. Many drug users are attracted by the cheap prices of synthetic and cut opiates such as heroin, which are extremely addictive and cause people to quickly turn to injection where they can get the same affect with a smaller cheaper dose. According to the Iranian AIDS doctor, a heroin dose is about 2000 tomans or about two dollars. 6.(C) According to two Iranian parents of teenagers, drugs are becoming more accessible for young people, but schools are conducting anti-drug campaigns. Parents are increasingly watchful of this issue, they said, and try to engage their kids in hobbies. One mother said she thinks children are becoming RPO DUBAI 00000019 002.2 OF 002 more defiant as a response to the restrictive lifestyle in Iran. Shifts in social norms -------------- 7.(C) At the same time, Iran's culture as a whole is shifting toward greater sexual activity. Within the sector of drug users, an UNAIDS published behavioral study from 2004 among injecting drug users in a drug treatment center indicated that 41% of the sexually active participants had over six partners, 42% of them had exchanged money for sex, and 50% never used condoms. In the general population, 70% of the country's population is under the age of 30, divorce rates are increasing, and people are getting married later, if at all. Such factors are likely to increases the number of sexual partners people have (including prostitutes),increasing the risk of infection. There is also the practice of "sigheh," which allows for temporary marriages with the blessing of a cleric, even for one night, which some say is used at times to skirt the illegality of prostitution. Some Iranian men who travel in the region reportedly return with HIV and infect their wives, according to several Iranian visa applicants. In a 2005 study published in Middle East and North Africa's 2006 AIDS Epidemic Update, some 28% of 15-18 year old males in Tehran were sexually active, yet about half of this group had never seen a condom or knew they could prevent STDs, despite the availability of free condoms in health clinics. They believed HIV could be transmitted by mosquitoes or acquired in swimming pools. 8.(C) Though little is being done in Iran to monitor HIV among prostitutes, the disease is reportedly increasing among Iran's prostitute communities. According to a study published in the UNAIDS Iran report, one group of women prostitutes in western Tehran had a 6% infection rate. More people are becoming infected through unsafe sex, specifically through prostitution, according to the Iranian AIDS expert. She explained that the overlap between injecting drug use and sex for money facilitates the spread of HIV to the general population, as clients of prostitutes spread the disease to their partners. However, because prostitution is illegal, underground, and stigmatized, it is difficult to survey this group, according to the expert. There is a lack of information on this marginalized group and issues of sex are still too sensitive to address publicly, added the doctor. BURNS