Pubdate: Thu, 04 Apr 2002 Source: New York Times (NY) Copyright: 2002 The New York Times Company Contact: http://www.nytimes.com/ Details: http://www.mapinc.org/media/298 Author: Neil MacFarquharehran Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) CONDOM AS A PROBLEM WORD: IRAN GRAPPLES WITH A SURGE IN AIDS How to teach teenagers about safe sex without even whispering the word condom is one of the delicate questions facing the Islamic Republic as it grapples with a surge in AIDS cases. Take the pamphlet designed for adolescents by the Iranian Center for Disease Control. "The best way to avoid AIDS is to be faithful to moral and family obligations and to avoid loose sexual relations," it says. "Trust in God in order to resist satanic temptations." Condoms are not mentioned. Fighting AIDS without contradicting some basic Islamic teachings can prove a quandary in a country where homosexuality is illegal and sex outside marriage is considered a weighty sin. The premise that the Islamic revolution was supposed to eliminate all social blemishes only magnifies the difficulty. "As officials, we cannot talk about things that are opposed to our culture, opposed to our religious beliefs," said Dr. Muhammad Mehdi, a specialist in infectious diseases who runs the Center for Disease Control, which is trying to check the small but rapidly growing number of AIDS cases. "Premarital sex is inappropriate and un-Islamic. So we can't say things to teenagers like, 'Use a condom.' " Yet he is among a small group of activist doctors determined to exorcise the taboos that surround AIDS. The doctors are spurred on by the troubling conditions that allow the disease to spread and an official mandate from the supreme leader, Ayatollah Ali Khamenei, to fight it. "We raise awareness, and people draw their own conclusions," Dr. Mehdi said. Through January, Iran had identified 3,438 people who have the human immunodeficiency virus, which causes AIDS. An overwhelming majority of those people are male drug addicts. So far, 350 patients have died and an additional 35 have fully developed cases. The Center for Disease Control estimates the actual number of H.I.V.-positive Iranians at 19,000. Other sources give higher figures. Although still limited in a country with a population of 70 million, the potential for disaster looms, given widespread needle sharing among 1.2 million confirmed drug addicts. Three years ago, Iran identified just 300 people with H.I.V. "It is spreading very fast," said Dr. Mahboobeh Hajiabdolbah, an AIDS specialist at Tehran University's sprawling Imam Khomeini Hospital. "Most of the addicts are young, and the numbers are just going to get higher and higher, especially because promiscuity is rampant," Dr. Hajiabdolbah said. "Our problem is with them, because we cannot reach them." Some are in jail, some live in border provinces distant from programs created in Tehran, and many lead transient lives. The programs against addiction faced parallel obstacles, but have gradually spread across Iran. AIDS is a more tangled issue, however. In view of the macho and religious traditions, gay sex remains so deeply in the closet that few patients will even confide to their doctors that it could be the source of their disease. Extramarital sex is similarly hidden. Although drug addiction is now widely acknowledged, tolerance has limits. The anti-AIDS organization here recently provoked outrage by suggesting that the prisons, where addiction is endemic, start needle exchanges. The idea was officially rejected as encouraging addiction. But the organization persuaded a few wardens individually to try it on the sly because the method has worked in lowering incidence of the disease in other countries. Government hospitals treat AIDS patients free, at a cost of $1,000 a week per patient for the cocktail that suppresses the disease, Dr. Mehdi said. But the doctors will not give AIDS medications to prisoners, because their compliance with the strict schedule of taking the medications is too random in the chaos of the overcrowded prisons. In the infectious diseases ward at Imam Khomeini Hospital where AIDS patients are treated, a 30-year-old released prisoner recalled how he grew addicted to injecting heroin during a nine-year sentence and caught the disease. "I don't remember anybody knowing anything about the disease," the emaciated man with close-cropped hair said. "We only had a concept that it was like a nuclear bomb, that an AIDS patient was more dangerous than a nuclear bomb. I had no idea that AIDS could come to Iran, it seems ridiculous. I thought Africa was very far away and it could never come here." Much of the problem starts with the fact that policy makers are squeamish about any frank discussion. Until a few months ago, although the word condom had been introduced to AIDS pamphlets for adults, it continued to be banned on radio and television talk shows. Condoms are available in pharmacies. But the basic government point of view is that telling teenagers about them will inspire the youngsters to start having sex. "The policy makers think if you talk about something it will encourage the activity," said Dr. Minoo Mohraz, one of Iran's first AIDS specialists, who put her foot down a few months ago over the ban on broadcasting the word condoms. "I said if they won't let me talk about condoms and sexual behavior, I won't come on the program. So they said I could talk." Although a minority of teenagers engage in sexual activity, those who do often have unprotected sex. "There is no knowledge about sex," Dr. Mohraz said. That attitude is largely supported even by conservative clerics who say Iran has to confront the disease. Rather than relying solely on imported Western experience, however, some experts contend that the Islamic Republic should employ its singular traditions in the fight. Muhammad Abai Khorassani, a cleric and a member of Parliament, suggests that encouraging the religiously sanctioned practice of temporary marriage might help. It involves a couple's staying married for a generally brief period of time specified in a contract. "AIDS is a result of lust," Mr. Khorassani said in an interview. "It happens when couples are not committed to each other. and so they run after different partners. Even temporary marriage brings more commitment between couples, and young men would not chase prostitutes." Mention of the disease crops up more frequently these days as in films that reflect social concerns. In "A House Built on Water," a winner this year at the country's most prestigious film festival, a young woman goes to her gynecologist seeking a hymen replacement so she can marry an expatriate Iranian who has come home seeking a virgin bride. Through blood tests, the doctor learns that she is H.I.V. positive and warns that she has to tell her fiancACopyright . She refuses, knowing that it will kill the marriage offer. "I will just tell him later that I got it through his whoring," the weeping patient tells the doctor before promising not to have children. "I just want to save myself, not ruin someone else's life." Fear of the disease and the desire to hide it underscore the hurdles. On a recent sunny morning, Dr. Hajiabdolbah and Dr. Mohraz met a 16-year-old hemophiliac and were stunned to learn that his parents had just told him that he had H.I.V. The parents learned of his infection three and a half years ago. "I have no feelings," said the boy, Said Ayoughi, who is believed to have caught the disease from tainted blood products imported before Iran screened them. Next to him, his mother, all in black, wiped away tears while his father sat stoically. "Except for us," the mother said, "nobody else knows, and we blocked all information from reaching him." "If people knew," the father added, "who knows how they would react." Dr. Mohraz noted that it was a common problem. "Knowledge about the disease is limited," she said. "So people are afraid of the patients, run away from them. It's going to change. But the disease still has a stigma." - --- MAP posted-by: Beth