Likewise, finally, the case study on Thailand shows how a country modifies its policies and approaches as it addresses the changing drivers of its HIV epidemic.

IRAN

Iran sits directly on a key drug transit route running from Afghanistan to markets in the Persian Gulf, Turkey, Russia, and Europe (Nissaramanesh et al., 2005). Although non-injecting use of opium is more prevalent than injecting drug use, the country has an estimated 112,000 to 300,000 IDUs. HIV prevalence among IDUs ranges from 0.5 to 13.0 percent (Aceijas et al., 2004), and 60 to 70 percent of HIV transmission is IDU-related (Mokri, 2002).

After the 1979 Islamic Revolution, the country embarked on a tough anti-drug campaign that emphasized strict enforcement of new drug laws, the closure of treatment and detoxification programs, and the opening of compulsory rehabilitation camps (Nissaramanesh et al., 2005). Over the past 20 years, some 1.7 million Iranians have been imprisoned for drug offenses (State Welfare Organization, 2000, as cited in Nissaramanesh et al., 2005). However, in the 1990s, the policy changed to reflect the recognition that drug dependence is also a medical problem. Drug users who access treatment are now exempt from penal punishment and the country reopened short detoxification programs and created narcotics anonymous support groups and abstinence-based therapeutic communities (Nissaramanesh et al., 2005).

By the end of the 1990s, it became clear that these efforts were insufficient. The Iranian government encouraged its medical and public health experts to talk with drug treatment experts from other countries. This dialogue and several other factors led to a more comprehensive approach to reducing HIV transmission among drug users, including psychosocial services, opioid agonist maintenance therapy, drug-free treatment, and access to sterile needles and syringes (Nissaramanesh et al., 2005). Other factors leading to Iran’s policy changes included the advocacy role of nongovernmental organizations and civil society, the cooperation between the Ministry of Health, the prison department health authorities, and other stakeholders on drug treatment and HIV/AIDS, and the education of senior policymakers regarding HIV prevention for IDUs (Razzaghi et al., 2006).

In 2000, Iran began its first pilot methadone project in a psychiatric hospital, and in 2002 a major outpatient methadone maintenance program opened in Tehran. Other maintenance treatment programs have since started in other parts of the country, although buprenorphine is not yet widely available outside of special research and demonstration programs. The Ministry of Health has expressed satisfaction with these projects and is



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