Sex, Drugs and HIV: No Strangers to Iran
Posted by Kevin

Doctors and patients together try to raise awareness and save lives

TEHRAN -- On the outside, things look pretty good for Abdullah and his wife Zoreh. They've been happily married for five years and just had their first child, Ali Reza, now six months old.

"Everyone thinks we're so lucky," says 34-year-old Abdullah. "Our faces are red from all the congratulatory patting."

But the facade, they both know, is as fragile as their health -- which could crumble at any moment.

Iran can no longer afford to ignore its HIV problem.

Battling HIV/ AIDS in Iran.

Four years ago Abdullah and Zoreh found out they were HIV positive. They are reluctant to discuss how they may have gotten infected, saying only: "It's not clear."

While they maintain appearances, life becomes increasingly difficult with mounting medical and financial challenges. Both suffer from opportunistic infections (OIs) associated with HIV, and Abdullah has contracted hepatitis C.

"I use the motorbike as a taxi sometimes," says Abdullah, "but I don't make much money from it."

It's not enough to pay the rent on their apartment, which is being raised to $160 a month. And since 23-year-old Zoreh can't breast-feed Ali Reza, there is also the cost of baby formula, which is very expensive in Iran.

They would ask for support from their families but there's a problem: They haven't told them about their condition.

"They're laborers, they wouldn't understand yet," says Abdullah. "There needs to be a greater understanding of HIV first."

The HIV status of Ali Reza is another concern. Tests are only accurate after the baby is one year to 18 months old.

Although HIV is still a small problem in Iran compared to Africa, Europe or the U.S., it is a growing one. The Iranian Ministry of Health reports that over 12,500 people are infected. The vast majority are men; less than 700 women are infected with the virus.

The ministry says at least 1,000 people have died from the disease, which they believe has spread mostly through the sharing of needles by intravenous drug users.

And with an estimated 200,000 people shooting drugs in Iran, there's understandable concern that the number of HIV cases could skyrocket.

Dr. Minoo Mohraz, the nation's top AIDS expert and chairman of the Iranian AIDS Research Center at the University of Tehran, has been warning the government and the public about the disease for 20 years.

In the early days, she says, no one would listen. "It was very difficult in the beginning because they didn't understand -- not even the government officials believed me, she says." "Initially I was alone. Now I have a lot of colleagues helping. We had only 300 patients, now we have 12,000."

Dr. Mohraz says she saw the impact of AIDS in other places like Africa and knew it would be coming to Iran.

"The denial state is very high in our country," she says. "They believed it was all about high risk behavior, promiscuity in Africa, homosexuality in America."

Dr. Mohraz says overall awareness now is better in Iran. But there are major obstacles such as the difficulty in talking about sex and drug use in a strict Islamic country.

"Most of our population are young people. Drug addiction is great and talking about sex is not very well done," she says.

But that hasn't stopped Dr. Mohraz. She raises the issues every chance she gets -- in television, radio, and newspaper interviews. And while she agrees that intravenous drug use is a huge factor in infections, she believes that currently more people are becoming infected through unsafe sex, specifically through prostitution.

"Prostitution is illegal, so we don't have much access to commercial sex workers," says Dr. Mohraz. "With drug users we can deal with the problem very quickly. They're often in prison so we can track them more easily."

She says economic conditions in Iran have exacerbated the problem. Divorces rates are increasing, and people are getting married later, if at all. This likely increases the number of sexual partners they have, including prostitutes, increasing the risk of infection.

Dr. Mohraz says government and religious leaders know that something has to be done, but there's still a certain squeamishness to the entire issue.

In addition to creating awareness in fighting the spread of HIV, Dr. Mohraz also says it's important to destigmatize the disease.

In an examining room at the AIDS center, Dr. Mohraz examines one of her patients, Mohammed, who is complaining of a rash under his arms. He is 21 years old and a hemophiliac. He became HIV positive after being given a clotting agent containing the virus.

Mohammed says that although his family and friends are supportive, he has experienced discrimination in both obvious and subtle ways.

"Even the doctors are a little afraid of the disease," he says. "They tell me they aren't, but I know -- I can tell with the way they deal with me."

He was taking 17 anti-retroviral drugs each day but stopped when he began having stomach problems. He tells Dr. Mohraz his stomach is much better after stopping the pills, but now he's getting rashes and having night sweats, and his hair is falling out.

Dr. Mohraz decides to start a new regimen, with fewer pills, for a three-month trial period. After she writes the prescription, Mohammed asks her questions about transmission of the disease through saliva (only if blood is present) -- things he already knows, but wished that others did.

"Why don't you tell these things on TV," he says. He's a young man hoping to connect with others, maybe even have a relationship, but is frustrated by the misinformation and ignorance that add to the burden of his condition.

After Mohammed leaves, Abdullah and Zoreh enter the examination room with Ali Reza, the baby swaddled in heavy blankets against the cold outside. They talk for a bit, then Dr. Mohraz pulls out a checkbook, drafts one for the equivalent of $500, and hands it to Abdullah.

"She is the only one that helps us," he tells me. "Our families still don't know."

But both Abdullah and Zoreh hope to tell them soon.

Despite the difficulties they face, they have made some progress. They are speaking to different school groups about HIV/AIDS and help administer blood tests for those who are concerned. Though it's only volunteer work now, there's a possibility they'll be hired by a local health organization to do the same things.

They say they see a future for themselves and their baby.

"If he's positive, we'll live with the sickness," says Zoreh. "What sets us apart is that we've seen the end of it. We know what it's like to be HIV positive. Now we're just trying to train and educate ourselves for our future."