HIV/AIDS is a global infectious disease that affects many people around the world, with men being more vulnerable to acquire the disease than their female counterparts (Piot et al. 2001). The truth is, AIDs pandemic continues to devastate many communities and economies especially in the underdeveloped nations around the world. According to a report released by the United Nations Programme on HIV/AIDS, for example, more than 1.5 million people in different regions of the world died of the disease in the year 2013, and another 2.1 million were infected (United National Programme on HIV/AIDS, 2014).Unfortunately, most of the individuals with the disease are not aware that they have it and, therefore, most of them end up dying of depression and delayed treatment. Reports from the UNAIDS indicate the most vulnerable people to acquire the infectious disease in the developing nations are the women because they lack knowledge about the disease (Quinn & Overbaugh, 2005). A higher prevalence of the virus among the female population can also be attributed to social pressures and the inequality they face.
It’s worth noting that the prevalence if the AIDS pandemic varies from one region to another due to the difference in the driving factor. The most affected regions in the world include Sub-Saharan Africa, Middle East, United States and South East Asia (Piot et al. 2001). In the Sub-Saharan Africa, for example, there were over 22 million cases of HIV and more than 1 million AIDS-related in the year 2010 (UNAIDS, 2014). In the Middle East and North Africa (MENA), the number of HIV-infected individuals dramatically increased by 73% between the year 2001 and 2012 (Gokengin, Doroudi, Tohme, Collins & Madani, 2016). Reports released by the UNAIDS also show that the number of deaths related to the epidemic in the MENA region continues to increase compared to other affected regions mainly due to the reduced supply of antiretroviral drugs (Gokengin et al. 2016; Mumtaz et al. 2011). Medications and treatment are inadequate especially to the children and women. According to the United Nations Programme on AIDs, most of the individuals living with the disease in Middle East region are drug users who inject themselves, female commercial sex workers and gay men (Mumtaz et al. 2011). Iran is one country in the Middle East with a large population infected with AIDS (Fallahzadeh, 2009). Despite the availability of drugs and treatment methods in Iran, the prevalence of the disease in the country continues to increase at an alarming rate. In fact, Iranians are more vulnerable to acquire the disease than other people in the same region. The following paper will explore the population living with AIDS in Iran and then discuss some of the factors that have led to the increased prevalence if the disease in the country. It will also outline some of the treatments that are working and those that have proven not to be effective in dealing with the disease. The paper will also outline some of the intervention measures to reduce the prevalence of the disease in the country.
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Population living with AIDS
Based on data published by Center for Disease Control and the Ministry of Health and Medical Education on the 22nd of June the year 2006, the Iranian population is composed of 18 million adolescents (this constitutes to 27% of the total population in the country). The number of AIDS cases in the year 2004 was estimated as 30, 000: 94.5 % were men and women were only 5.5%. Reports from the ministry also show that people under the age group of 25 and 34 years are the most affected and the least number of affected people are those between the age group of 0-4 years (Fallahzadeh, 2009). This is a clear indication that transmission of the virus from mother to child during birth is very rare in Iran. The HIV virus is mostly transmitted through the following ways: Injecting drug abuse (64%), sexual transmission (7.4%), mother to child (0.5%) and unknown transmission routes account for 26.3 % (Fallahzadeh, 2009). The high rate of HIV transmission in Iran is attributed to increased drug abuse. According to the Global AIDS Report of the year 2013 released by Iranian authorities, more the total number of people living with the virus have acquired it through drug injecting. Therefore, the infect drug users are more likely to infect their marital partners. When incarcerated, these users are likely to have unsafe sexual intercourse with other inmates hence infecting them with the virus (Fallahzadeh, 2009).
Since the year 2000, the Iran government has demonstrated its commitment to fighting the infectious disease. For instance, it has been allocating funds and establishing government-sponsored clinics to prevent further occurrence of the disease. Despite the government commitment in the war against HIV/AIDS, there are some activists and infected Iranians who believe that effort to manage the infectious disease is still faced with many challenges. The setback in controlling the epidemic is attributed to not only weakening economy but also unclear information about the prevalence of the disease in the country (Haghdoost et al. 2011). Due to lack of information of the prevalence of the disease, the government is likely to provide insufficient resources that would address their needs accordingly. In fact, most of the HIV- infected Iranians complain that the government has failed to provide them with enough health insurance covers. Therefore, knowing the number of Iranians infected or living with the disease is important because it would help the government to put into place effective intervention measures that would be of help to the victims.
Treatment and prevention measures put in place
In the last one decade, the Iran government has established successful programs that would help in addressing the issue of HIV transmission (Dehghan, 2013). More specifically, it has developed programs in care, prevention, and treatment in the society and prisons. Non-Governmental Organizations have also played a significant role in implementing service delivery programs in the country. People have access to antiretroviral treatment which is provided in various VCT centers established by the Prison Organization, Ministry of Health and the Red Crescent, an international humanitarian movement. To address the issue of HIV transmission among injecting drug users, Iran has developed Drug Demand preventive programs. The primary goal of the preventive programs is to reduce incidences of drug abuse in the country by promoting public awareness about drugs and their relation to HIV transmission. One of Iran’s programs for preventing drug abuse especially among the youth is the Colombo Plan Drug Advisory Program (CPDAP) (Zafarghandi, Jadidi & Khalili, 2015).
According to Gary Lewis, head of United Nations Office based in Iran, the government has taken crucial steps in expanding health delivery services for HIV/AIDS at least in every part of the country. Between the year 2008 and the year 2012, for example, the total number of hospitals providing antiretroviral drugs in the country increase from 86 to 290 (Dehghan, 2013). In the year 2013, more than 3, 500 HIV patients were receiving antiretroviral therapy at various health care facilities in the country. What’s more interesting is the fact that patients receive AIDS treatment free of charge. For these reasons, Iran is considered a pioneer nation in AIDS treatment, opium substitution therapies, and HIV prevention. This information is important as it provides an insight of the prevention and treatments plans that are effective and which ones have proven ineffective in addressing the AIDS pandemic in the country. This, in turn, will help the government to identify areas that need improvement to address the problem effectively.
Reasons why HIV infections in Iran continue to increase
Despite the implementation of prevention and treatment programs for HIV/AIDS patients, the number of Iranians infected with the virus continues to increase. Observers have raised questions why HIV infections in the country continue to increase yet the government has put in place appropriate treatment and prevention programs. Government officials like Hassan Hashemi, the health minister, have expressed concerns and worries over the increased prevalence of the HIV/AIDS in the country. In one event in Tehran marking the World Aids Day, the health minister revealed that HIV infections increase by about 80% annually. He complained that taboo in most communities deter or prevent AIDS patients from receiving adequate treatment (Dehghan, 2013). Reports from the ministry of health indicate that most of the individuals living with AIDS are not aware that they are infected if the country fail to pay more attention to issues likes prostitution. For those who are mindful of the fact that they are infected, a majority of them keep it as a secret and do not interact with ordinary people (Dehghan, 2013).
Another reason why the number of HIV infections in Iran continues to increase is related to the fact that the government still concentrates on injecting drug users. Although injecting drug use in Iran contributes to HIV transmission, experts argue that the transmission has now taken the sexual route (Haghdoost et al. 2011; Ahmadi et al. 2012).This means that the risks of the disease have become more generalized and more people are likely to get infected with the virus. Apart from inadequate treatment and prevention plans for AIDS patients, HIV infections in Iran continue to increase due to the lack of education and social support for the victims. The truth is, most of the young Iranians especially those living in rural communities do not have access to education programs and, therefore, remain unaware of the dangers of AIDS and how they can protect themselves. It is important to note that lack of social support increases stigmatization among the people with AIDS. As a result of stigmatization, most of the HIV patients lack self-esteem and confidence to interact with other people and to seek medical help. In fact, some of them quit their jobs and stay hopeless at home or in the streets.
Another challenge facing Iran’s war on AIDS is the reduced HIV/AIDS budget provided by the government. This includes funds for harm reduction, birth-control programs, and delivery of free condoms, especially to the commercial sex workers. HIV/AIDS specialists argue that the country’s fight against the epidemic became less progressive especially under the administration of President Mahmoud Ahmadinejad. Still, as president of Iran, the controversial leader also served as a chairman of a certain council that overlooked the World Aids Day and even removed it from the country’s national calendar in the year 2011. This lack of government support is what specialists believe, has undermined AIDS control in Iran.
Social and economic impacts of HIV/AIDS
HIV/AIDS is a phenomenon that is an obstacle to human progress and has adverse social, economic and cultural consequences on an individual and the entire nation (Bahadori, Babashahy & Hakimzadesh, 2012). One remarkable thing to note is that the epidemic most affects young adults and, therefore, it is perceived as an economic threat. Just like in Iran, HIV infections continue to increase in most developing countries in the world. Critics argue that the AIDS epidemic slows down the economic growth of the affected country and that the gross domestic product decreases further as HIV infection continue to rise (Renani, Akhoondi, Honarvar & Mohammadi, 2014). AIDS is a threat the economy of Iran in the sense that, the government allocates huge funds for the prevention and treatment of AIDS patients thus reducing funds that could be channeled into other sectors that would boost the economy of the country. As a result, the economic growth of the country will tend to lag behind. The epidemic also affects the economy of Iran in the sense that it reduces the labor capital or workforce working in various industries that have a significant contribution to the growth of the nation (Renani et al. 2014).
Major social impacts of the epidemic relate to the burden of care and the demographic changes. In most affected households in Iran, the women and girls are responsible for taking care of their HIV-infected relatives. Most of these caregivers have raised concerns about the rising medical fees, and inadequate food and clothing. Taking care of infected children or relatives is a burden to most caregivers as most of them have to balance between their daily work and their responsibility as caregivers. HIV/AIDS also has a significant effect on the life expectancy and mortality. An increase in mortality in Iran is noticeable especially among young people who engage in commercial sex work and those who use injecting drugs (Haghdoost et al. 2011). The life expectancy of the people living with AIDS reduces as most of them die at a younger age than they would if they had not acquired the virus. The population growth of Iran is likely to slow further down with reduced life expectancy and increased mortality rates as a result of AIDS epidemic.
How to manage and contain the disease
As earlier mentioned, Iran has made progress in fighting AIDS epidemic by establishing more health care facilities to provide AIDS treatment to the HIV-infected patients. Despite the establishment of health care facilities and treatment programs, Iran still needs to introduce more programs or expand the existing ones to address the problem effectively. Controlling HIV in Iran will help to reduce the adverse effects the epidemic has on household structure and the demographics as well as the economy of the country.
It is clear that cases of HIV infections in Iran are more prevalent among drug users, commercial sexual workers and the prisoners, with sexual transmission being the highest (Bahadori, Babashahy & Hakimzadesh, 2012; Haghdoost et al. 2011). Aids experts in the country argue that more people will be infected if the government does not pay more attention to issues likes prostitution and other risky sexual behaviors. Therefore, for effective prevention and management of HIV/AIDS in Iran, the government ought to identify high-risk groups and provide efficient and appropriate prevention and treatments measures (Renani et al. 2014; Haghdoost et al. 2011). The government, for example, should improve its outreach to commercial sex workers, provide them with condoms and perform screening tests on them (Ball, Rana & Dehne, 1998). The government should also pay more attention to tackling AIDS, especially among the young gay Iranians. This can be achieved by establishing educational programs for educating the youth about the different transmission routes of the disease and counsel them how they can protect themselves from it (Montazeri, 2005). It is this sex education that would be helpful in creating awareness of the disease and encouraging the youth and prisoners to abstain or use protective measure when engaging in any intimate relationships involving sexual intercourse (Eshrati et al. 2008).
To prevent the spreading of the virus, the Iran government should enact and enforce policies that regulate the sale and use of drugs. Implementation of such policies will be helpful in preventing the transmission of the virus through injecting drug use. Drug users should be arrested, prosecuted and incarcerated. There is a perception that most prisoners, especially men, engage in sexual activities with their fellow men. Therefore, while in prison, the infected prisoners should be isolated from ordinary prisoners to avoid further spreading of the virus. The government should also encourage schools to introduce educational programs to create awareness on the disease. These educational programs are useful in enlightening students on the dangers or HIV/AIDS (Ganczak et al. 2007). The government should also introduce school-based health care facilities for treating students living with the virus. Educators, on the other hand, should provide social support to the infected students to reduce the effects of stigmatization and enhance their self-image and self-esteem (Forouzan et al. 2013). HIV/AIDS specialists and government agencies should hold conferences regularly to evaluate the status of the country in terms of HIV/AIDS to identify the strengths and weakness in the fight against the epidemic. They should identify new treatment programs that should be introduced and other areas that need to be improved.
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