HIV in Iran: onset, responses, and future directions

Abstract

Iran, a country in the Middle East and North Africa (MENA) region, has been actively involved in the fight against HIV/AIDS over the past three decades. The unique features of the HIV epidemic in Iran are reflected by the modes of transmission and its recent changes to improve management and prevention programs. In this review, we recount the initial onset and subsequent spread of HIV infection in Iran, beginning with the first case diagnosed to the ongoing responses and most recent achievements in controlling this epidemic. Although in the MENA region, Iran is one of the pioneers in implementing pertinent policies including harm reduction services to decrease HIV incidence, drug injection still continues to be the major risk of infection. In line with other nations, the programs in Iran aim at the UNAIDS 90-90-90 targets (UNAIDS 90-90-90 global targets to end the AIDS epidemic by 2020: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression) and to eliminate mother-to-child HIV transmission. In this article, we discuss the strengths and shortcomings of the current HIV programs and offer suggestions to provide a better perspective to track and respond to the HIV epidemic. More generally, our account of the national religious and cultural circumstances as well as obstacles to the approaches chosen can provide insights for decision-makers in other countries and institutions with comparable settings and infrastructures.

Fig. 1.

Iran has three leading institutes for HIV research, training, and surveillance. [IRCHA was established in 2005 and is a leading center for HIV clinical management and research. HIVHUB was established in 2009 as a World Health Organization Collaborating Center for HIV Surveillance. SHARC was established in 2009 and mostly focuses on HIV prevention sciences and behavioral interventions].

Fig. 2.. Annual number of new diagnosed HIV cases in Iran from 1986 to 2018.

Center for Communicable Diseases Control, Ministry of Health and Medical Education. Latest statistics on HIV infection in Islamic Republic of Iran, April to June 2017. 2018 [16].

Fig. 3.. Changes in the transmission routes in Iran from 1986 to 2017.

Center for Communicable Diseases Control, Ministry of Health and Medical Education. Latest statistics on HIV infection in Islamic Republic of Iran, April to June 2017. 2018 [16].

Fig. 4.. Facilities and levels of treatment and care for HIV/AIDS in health system of Iran.

1. HIV/AIDS Surveillance System in the Islamic Republic of Iran: History, Structures and Processes. 2019 [83]. 2. The Report of the Project Recommended Model for Integration of HIV/AIDS in Primary Health Network. 2011. (The Research Project was done according to agreement between Centers for Disease Control and Prevention (CDC) of Iran, Iranian Research Center for HIV/AIDS (IRCHA) and Joint United Nations Programme on HIV/AIDS (UNAIDS) in Islamic Republic of Iran.) [84].