Counseling and Harm Reduction Centers for Vulnerable Women to HIV/AIDS in Iran
Fahimfar, N., Sedaghat, A., Hatami, H., Kamali, K., Gooya, M. M., Iranian Journal of Public Health
Background: Human immunodeficiency virus (HIV) is a public health challenge facing both developing and developed nations. Although injecting drug use is even the main route of HIV transmission in Iran, sexual route is rising gradually. Vulnerable women have been considered as important bridging population for driving HIV epidemics. To increase the access to vulnerable women, in 2007, 5 pilot centers were established in risky areas to deliver comprehensive services to women who themselves or their spouses are engaged in drug use, risky sexual behavior or have history of imprisonment. Management of Sexually Transmitted Infection, psychological counseling and harm reduction are provided by female staff. The aim of this study was to report the activities conducting in 2008.
Methods: Registered information was used to assess the demographic characteristic, HIV/ AIDS related risk factors and services delivered to clients.
Results: Till March 2008, 442 clients have been admitted. Most of them (36.2%) had 25-34 years old. 14.3% were illiterate and 31% were totally jobless. The most prevalent risk factors were risky sexual behavior (27.1%) and non-injecting drug use (23.2%). Injecting drug use was detected in 11.3% of attendees. Dividing clients according to marital status, risky sexual behavior was the main risk factor in unmarried (40.2%) and divorced (26.9%) but in married and widow ones, non-injecting drug use was the most (25.8% and 36.5% respectively). Harm reduction (40.5%) and counseling (36.6%) were the most delivered services.
Conclusion: Since vulnerable women play a critical role to spread HIV-epidemic to general population, increasing centers provide more access to this population.
Keywords: HIV, AIDS, High risk behavior, Women, Iran
Epidemics of HIV/ AIDS in Middle East and North Africa region are mainly concentrated in IDUs, men who have sex with men, sex workers and their clients. In some countries, high levels of HIV infection have been identified in networks of drug users (1).
Iran is situated in this region. After the first HIV case detection in 1986, Iran has faced a concentrated HIV epidemic among IDUs since 2000s. The response of the government has focused on this diagnosed high risk populations, mostly young male drug users. By June 2011, based on data collected from provincial levels, a total of 23125 HIV-positive cases have been identified in Iran. Among those, the most common mode of transmission (69.8%) is the shared use of needles among IDUs. Sexual contact and mother-to-child transmission have been diagnosed in 10% and 0.8% respectively. Comparing to cumulative HIV/AIDS cases, newly detected ones in 2010 were attributed to injecting drug use (66.4%), sexual contact (21.1%) and mother-to-child transmission (2.5%). The figures show that although the route of HIV transmission in the majority of newly diagnosed cases remains through injecting drug use, the role of sexual transmission has increased over the time (from 4.2% of newly diagnosed HIV cases in 2001 to 21.1% in 2010). In the same time, the proportion of women has increased gradually in all registered cases from 4.69% in 2001 to 8.5 % in 2010 (2).
The high level of HIV infection among IDUs is also a great concern because of the possibility of transmission through the infected IDUs to their sexual partners (3-5).
A study in Tehran showed that many IDUs in the sample have had multiple sex partners and condom use has not been well adopted, as about half of sexually active male IDUs reported never having used a condom in their lifetime (6).
Women are more vulnerable to HIV infection in many ways like biological susceptibility to HIV (7), less access to employment and education specially in developing countries, generally lower levels of literacy and incomes and some other reasons. Discrimination between sexes also exists, and community pays more attention to men than to women (8). …