AIDS first came to Iran in 1987 and according to UNAIDS, it's currently "accelerating at an alarming trend." The agency estimates between 10,000 and 60,000 people are infected (although some experts put that number as high as 70,000).

Iran has the highest rate of drug use in the world, and more than 60 percent of HIV infections are among injection drug users. Opium has been a traditional recreational drug in Iran, but there has been a shift in recent years to heroin, particularly among younger Iranians. The country is on a major drug trafficking route from Afghanistan to Europe and is estimated to have between 1.5 million and 6 million drugs users, including 150,000 to 600,000 who use injecting drugs.

Forty percent of all those with HIV are 25-34 years old and there's real fear that the virus will spread further among Iran's relatively young population. The majority of Iran's drug users are male and under age 19. Studies show more than half of them are married, which leads to concerns that without serious intervention, HIV will be transmitted to their wives and children.

The Iranian government has been surprisingly pragmatic in confronting the threat. Although opium and drug treatment centers were banned following the Islamic Revolution, and drug users were incarcerated or sometimes executed, in the mid-1990s the country experienced a "paradigm shift," according to Dr. Kaveh Khoshnood, a professor of epidemiology at Yale University School of Public Health.

The government acknowledged the problem and not only legalized treatment programs but began offering needle exchange and methadone clinics. Dr. Kamiar Alaei, an adviser to Iran's Ministry of Health, described the prevention program he and his brother set up in the city of Kermanshah to a 2003 audience at the Asia Society. It included needle exchange, condom promotion, methadone maintenance, peer education and psychological support. The brothers were invited to join in writing Iran's national strategic plan to fight AIDS and by 2003, more than 21 of their clinics had been set up throughout the country -- and more than 20 programs had been set up within prisons. In addition, the government has set up free testing, counseling and treatment programs in all regions of the country and is sharing its strategy and experience with neighboring countries in Central Asia, including Pakistan and Afghanistan.

In January 2005, the head of the judiciary, Seyed Mahmood Hashemi Sharoudi, issued an executive order reinforcing the legality of these programs: "... this is to remind judges at all courts of justice and prosecutors' offices throughout the country that ... the said interventions are clearly void of ... malicious intent but rather motivated by the will to fulfill the mission of protecting society from the spread of deadly contagious diseases such as AIDS and hepatitis," he wrote.

However, according to Dr. Khoshnood, there is a constant internal debate over the benefits and morality of harm reduction and in practice "the law on the books is different from the law on the streets." Police harassment of drug users and harm reduction programs continues. In one incident in March 2006, security forces rounded up thousands of drug users and forcibly interned them in camps. Though public health authorities were permitted to provide clean needles and methadone in the camps, approximately 60 percent of those surveyed by one public health official reported shooting up the first night they were there, before the clean needles were available. And several weeks later, the drug users were released back into the general population.

Some experts express concern that with the more conservative regime of Mahmoud Ahmadinejad now in power, the country will move away from some of the its progressive policies. But Dr. Khoshnood is reassured by his colleagues in Iran that "the public health approach will triumph," and there continue to be optimistic signs. In December 2005, clerics, star soccer players and film and television celebrities joined together with UNICEF to kick off a "Unite for Children, Unite Against AIDS" program. The speakers addressed stigma and one cleric made an impromptu promise to educate youngsters who belong to the Basij, Muslim volunteer groups. According to UNICEF: "The occasion was all the more special because it marked the first time girls were allowed into a stadium alongside boys to watch a football game."

* Note: Figures reflect most recent statistics from UNAIDS and the World Health Organization.

• Related Links
• UNAIDS Country Report: Iran
  This page has UNAIDS statistics on HIV/AIDS in Iran, an epidemiological fact sheet and analysis of the problem. It notes that, injecting drug use "drives the epidemic" in Iran and that "[B]ased on the reported data, the HIV epidemic in the Islamic Republic of Iran appears to be accelerating at an alarming trend."
• Innovative Approaches to AIDS in Iran
  Here is the transcript of a panel discussion held at the Asia Society in October 2003. Dr. Kaveh Khoshnood of Yale's School of Public Health and Dr. Kamiar Alaei, an adviser to Iran's Ministry of Health lay out the stats on AIDS in Iran and detail some of the country's "innovative" prevention and treatment programs.
• AIDS Crisis Brings Radical Change in Iran's Response to Heroin Use
  "Fearing an AIDS epidemic, Iran's theocratic government has dropped a zero-tolerance policy against increasingly common heroin use and now offers addicts low-cost needles, methadone and a measure of social acceptance," reports Karl Vick in The Washington Post. (July 5, 2005)
• The Rise of Harm Reduction in the Islamic Republic of Iran
  This briefing paper, created by the Beckley Foundation Drug Policy Programme, outlines the history of drug use and policy in Iran and the recent developments in harm reduction efforts including needle exchange and methadone treatment. It also includes the text of the January 2005 judicial order reinforcing the legality of treatment programs.
• Overview on HIV/AIDS and Women in Iran
  This paper was given by Masoumeh Ebrahimi Tavani (MS.M), the midwifery principal officer of Iran's Ministry of Health and Medical Education at the 25th Congress of the Medical Women's International Association in 2001.