To obtain information about the current situation of AIDS in Iran and to inquire about the progress of the program known as 90.90.90, we went to Dr. Vahid Jahanmirinejad, an active figure in the field of AIDS, CEO of the Youth Health Club “Mehr” and advisor to the AIDS department of the Ministry of Health. Dr. Jahanmirinejad believes that the main problem in achieving the first 90, which is diagnosis, is due to cultural issues. He evaluates the services provided to diagnosed patients as satisfactory, although he admits that stigma and discrimination still affect people living with HIV. The conversation with Dr. Vahid Jahanmirinejad continues as follows:

One of the problems related to AIDS in Iran is related to disease detection. What problems exist in this area and have we made any progress?

Let me first mention the importance of early detection in disease management. Both individually and socially, HIV diagnosis is a very important issue. Because the infection is asymptomatic, when a person’s illness is not diagnosed, their immune system naturally weakens, their white blood cells decrease, and they slowly progress towards the AIDS stage. The AIDS stage is like a defenseless country with no military or security forces, vulnerable to attacks from outsiders. It is also vulnerable to internal issues, as various opportunistic infections from outside and different types of cancers from within can affect the body in the AIDS stage. This is a completely preventable phenomenon and with timely diagnosis and treatment, this progression can be stopped, white blood cells can increase again, and the virus can be reduced to zero in the blood. The person can lead a completely normal life and never enter the AIDS stage. Currently, apart from the side effects of medication, which every medication has, there will be no other problems for the person. There is a

Which groups are more susceptible to this disease? According to global standards, how can these groups be placed under care?

I must emphasize that HIV is not specific to any particular group, religion, race, or nationality. The main host of HIV are white blood cells, and all humans have white blood cells, so anyone can be infected with this infectious disease. However, it is natural for those who engage in risky sexual behaviors or have multiple sexual partners, those who need regular blood transfusions, drug addicts who inject drugs and share needles, or those who accidentally use shared blades to be more at risk for this infection. Of course, when it comes to blood transfusion, it should be noted that blood and blood products that are injected into patients are rigorously and carefully evaluated through testing, so this issue is controlled and there is no other way of transmission. Therefore, the remaining uncontrolled sexual relationships and injections that are done with contaminated needles or shared tools. In conclusion, I must say that all humans, regardless of any differences such as religion, race, nationality, and ethnicity, can be exposed to this infection

Given that you have worked in the field of children and their care in the face of AIDS, how do you see the situation of this group? Have the necessary measures been taken in our country? Please describe the problems in this area.

It is natural for street children and child laborers to be more exposed to various forms of harm, including sexual abuse, and it is constantly reported. While we should all strive to fight against this terrible phenomenon, we must also make efforts to reduce its harm. Sometimes we say that we cannot completely eradicate a phenomenon. For example, we cannot completely eradicate addiction, but we can reduce its harm, which we call “harm reduction.” In the case of street children and child laborers, if we cannot control it, we must at least reduce its harm. One necessary action is to provide these children with necessary education by NGOs or activists in this field, so that they know how to defend themselves and call for social emergency services. We should teach them not to fall for the tricks of those who may have predatory intentions. In any case, this is a knowledge that requires special skills and expertise to implement.

Individuals and institutions have made efforts in this regard, but I think that when compared to

One aspect of this disease is entangled with cultural issues. How has the fear of “otherness” complicated the issue of AIDS in our country and how can we neutralize this negative factor and with what tools?

First, it is important for us to have a general definition; when we talk about stigma, we mean the negative attitude towards individuals, the unjust judgments we make, and the shame we attach to various issues. Throughout history, there have been many diseases associated with stigma; for example, in the past and even today, it is heard that sometimes people with epilepsy are considered possessed by demons and behave strangely, or even now there is a wide spectrum of individuals with mental and psychological illnesses who are sometimes referred to as “crazy” as a stigma. While it is a disease and it is important for the person to know that they have this problem and seek help from a therapist. We know that for many people, going to a mental health clinic is sometimes accompanied by shame because they are labeled as “mentally ill” and in any case, one of the diseases that has always had stigma from the beginning is AIDS. Perhaps the reason for this is that it was first seen among homosexual Americans and

AIDS, as one of the special diseases, has a long and expensive treatment process. Do patients have the necessary support in terms of medical insurance in this regard?

Fortunately, one of the strengths of our program is very good access to diagnostic, counseling, and treatment services for those living with HIV. More than 250 centers in our country provide services to those affected, completely free and confidentially, while maintaining confidentiality. In these centers, known as “Behavioral Disease Counseling Centers,” anyone can receive counseling. All individuals, without the need for identification cards or any form of identification, can receive counseling on HIV and any infectious diseases, and if necessary, free HIV testing is also provided. If the results are positive and definitive, all services such as free vaccination for necessary vaccines, free counseling by trained psychologists in this field, general practitioners, and infectious disease specialists are also available free of charge. They visit and provide expensive drugs that are currently inaccessible to 12.6 million people in the world, completely free to these individuals in Iran. In addition, any necessary follow-up services or additional tests such as PCR virus are also provided free of charge. According to

How do you assess the access to medication and medical facilities for patients with AIDS in Iran?

If we want to review the goals of the 90-90-90 program, the first 90, which is proper and maximum diagnosis, requires a very extensive cultural and educational effort, unfortunately we have performed very poorly in that area. And the third 90, which was solely the responsibility of the Ministry of Health, has been 97% implemented and we have been successful in that, which shows that we need to work on this issue and cooperate with the Ministry of Health, Education, Radio and Television, and all organizations should work together to reach a point where we can identify individuals who are living with HIV without knowing it and put them under treatment, so that we don’t reach a point where the number of infected individuals becomes so high that we may face difficulties in treating them in the future, especially considering the current sanctions that may not allow us to provide necessary resources. We need to sound the alarm that the number of individuals we are currently providing free medication to is 15,000

During the pandemic of coronavirus, what measures have been taken to support people with AIDS due to their vulnerability, and what biological procedures should these patients take into consideration due to their weakened immune system?

Contrary to what we all thought, these patients were not at a higher risk of contracting COVID-19 and there were not as many severe cases or deaths reported among them. Research showed that individuals with HIV who are under treatment have a similar risk of COVID-19 as the general population. However, the difficulty was ensuring their access to medication. During these times, with all the issues and problems such as remote work, quarantine recommendations, and social distancing, it was possible for these individuals to face challenges in accessing treatment. We made arrangements and fortunately, there were no issues with access to medication in our country. Without exaggeration, the treatment and services provided to citizens with HIV are excellent. In our region, there are few countries with such services. It doesn’t matter what ethnicity, nationality, or religion the patient has, anyone living in Iran can receive free services at behavioral disease counseling centers. Even some immigrants who still have legal residency issues can receive free services if they go to the counseling centers

In comparison to other countries, especially those with similar economic situations, how is the current state of HIV prevention and treatment programs in our country and can we say that we have been successful?

I mentioned before that our services, diagnostic and treatment facilities, free services, counseling services, etc. that have been provided for these individuals are very good. In terms of reducing the harm of drug use and injection addiction, we have also done a good job, to the point that the percentage of HIV in the injection addict group has significantly decreased in a decade, due to the good rehabilitation work that was done and was praised by international organizations. The thing that we have a lot of problems with is cultural work that needs to be done. For education and awareness, especially for youth and adolescents, and another issue that we have not done well in is preventing discrimination, which not only requires reducing stigma, but also needs education and cultural work, and legislation. This is a recent occurrence and the process of enacting anti-discrimination laws has been going on for a long time, with lawyers working on it and collaboration between the Ministry of Health and the Ministry of Justice in this regard, but it has taken

If there is any point that you feel needs to be mentioned, please do so.

Address to our dear people, especially the youth and adolescents, I would like to first mention that HIV is one of the many infectious diseases. There are many diseases and microbes, and the trend in our country shows that the age of contracting these diseases is decreasing while the number of cases is increasing. Among these diseases are HIV, sexually transmitted diseases, and simple infections. We may think that these are well-known diseases, but due to the high number of unprotected sexual relationships and lack of education in this area, and also because many people feel embarrassed to use condoms to prevent these diseases, they end up self-treating when they see symptoms and feel ashamed to go to a doctor. This only worsens the consequences and complications of these diseases. You may not believe it, but a simple infection can turn into a disease that can lead to infertility and spread infections, even to newborns. Or a person may delay going to a doctor to the point where if they had gone earlier, it could have been

Thank you for the time you have given to the peace process.