IRAN

1
IRAN
2
Country information

• Population 71,368,000
• Male female ratio 1.031
• Literate three-fourth ( 72)
• Unemployed a fourth ( 25) of countrys
  population
• Life expectancy at birth 70 years
• Languages Persian
• Age structure Two- thirds are under
  30 years
• Half of the population under the
  age 20

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Capital city

• Tehran
• Area 18637 sq.km Population 10343965
  (persons)

4
HIV/AIDS Situation in Iran

• first case 1986 (a hemophilic 7 years old boy)
• Nationally, more than two third (66) of all
  reported cases are among injection drug
  users(IDU).
• 62 between ages of 25-44

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• HIV/AIDS - adult prevalence rate
• low less than 0.1
• Estimated HIV Infected 20,000
• Notified HIV/AIDS Cases (1986-2002) 4424
• 95.5 of cases are male

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Consultant clinic

• Placed in west health center of Tehran
• VCT has been offered from 2002
• free of cost
• Anonymously
• voluntary post-test
• pre-test and counseling

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People who attend value

• The anonymity
• convenience of the site
• PLWHA support groups
• Free of cost services
• Being welcomed by healthcare personnel
• Youth-friendliness of VCT services
• Being placed within a primary-health-care clinic

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Factors with a negative impact on the decision
to attend VCT included

• The perception that one would not be able to cope
  with a positive test result and would be too
  disturbed to continue normal life or would commit
  suicide
• The belief that being HIV-positive is equivalent
  to having AIDS and being near death
• The belief that one would die sooner if ones
  HIV-positive status were confirmed
• The belief that one is not vulnerable to HIV
  infection despite risky sexual behavior
• Fear of rejection by family and friends, and of
  discrimination and stigmatization

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Other Problems

• Number of VCT service is small
• Stigma around HIV is still high
• Community must be prepared to accept and use such
  services
• Testing is not performed in the clinics and test
  results came back from the laboratory a week or
  more after testing
• Still more men than women are seen, reflecting
• Referral system is weak

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• Encouraging behavior change is further
  complicated by a lack of services and widespread
  poverty through most of the client
• Not all doctors, nurses and health workers were
  knowledgeable about HIV/AIDS
• VCT interventions are costly and require
  infrastructure support and trained personnel that
  may be unsustainable, nor can such
  labor-intensive techniques achieve broad
  population coverage

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Suggestion

• Train HIV-positive people to speak publicly about
  their HIV status
• A more efficient approach is to find cases in
  settings where PLWHA are concentrated
• Establish the feasibility and acceptability of
  rapid on-site testing
• Access to partner and pre-marital counseling and
  testing for young couples

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More suggestion for providing youth friendly
services

• a. Clear national policies to address the minimum
  age of VCT service use without parental consent.
• b. Youth-oriented advertisement and promotion of
  services
• c. Youth-friendly counseling and referral to
  other health and psychosocial support services
• d. access to particularly vulnerable young people
  (out-of-school and street children).
• e. Peer education The young HIV-positive
  outreach educators
• f. Young people who test positive need help in
  coping with their status, including disclosure to
  their families and sexual partner/s.

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And still more suggestion

• Identify and effectively target relevant
  audiences
• Collect qualitative data on psychosocial and
  cultural factors influencing attitudes and
  behavior in target populations, and identify key
  themes and behavior change goals
• The referral systems between clinic, community
  and district hospitals need to be strengthened
• Integration of VCT services in HIV/AIDS/STI/TB
  care and referral ensure continuity of care
• Not limiting some services (STI, TB or MMT) to
  specific days of the week by different doctors
  and different nurses
• Counselors need mental support because they have
  the difficult task of counseling and are under
  extreme emotional pressure This meant that
  patients who attended the HIV clinic dont had to
  come back on another day if they were on TB
  treatment, or STI or drug use .

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And some more

• Technical and financial support is needed to
  improve quality and coverage of VCT services
• Training and support to religious leaders and
  Islamic health professionals so that they can
  effectively support AIDS prevention and education
  activities in their communities in ways that are
  consistent with Islamic teachings.
• Expansion of prevention and care services to
  rural areas and under-served low socio-economic
  neighborhoods in urban areas, and for young
  people in both urban and rural areas.
• Expanded community based care linking clinical
  services with home-based care.
• Establish protocols to evaluate impact and
  provide feedback for programmatic activities.
• Disseminate lessons learned upon project
  completion.