IRAN: SOCIAL FACTORS INCREASING HIV RATES

S E C R E T SECTION 01 OF 02 IRAN RPO DUBAI 000019

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TAGS: IR PHUM SOCI PGOV TBIO
SUBJECT: IRAN: SOCIAL FACTORS INCREASING HIV RATES

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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
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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
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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

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more defiant as a response to the restrictive lifestyle in Iran.


Shifts in social norms
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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