Project Title: The Prevention and Control of HIV/AIDS in Iran UNDP practice area: This project is part of the HIV/AIDS, TB and Malaria mandate of the UNDP.  It is also in line with Millennium Development Goal 6. Project completed or ongoing: Ongoing

One of the beneficiaries of the support provided by the Positive Club in Tehran, a centre supported by the HIV/AIDS project in Iran.

Context:

The transmission of HIV/AIDS in Iran is said to have occurred in two waves.  The first was brought about with the first cases from 1985.  These were believed to have been the result of unsafe blood used in blood transfusions.  From then, about 5-10 cases were reported each year and the disease was reported on the country’s annual reports.  Then, in the mid-1990’s the second wave of transmission was noted with contained outbreaks a few of the country’s prisons.  These cases were the result of risky behaviour among Intravenous Drug Users (IDUs).  As a result, in 1996, the number of new cases increased dramatically.

In response to the rising number of HIV/AIDS cases, the Ministry of Health and other stakeholders created the National Strategic Plan (NSP) in 2001.  This was also partly catalysed as a prerequisite for the Project being accepted by Global Fund (GF).  Currently the Third NSP has been drafted and is being implemented.  The coverage of the Third NSP is from April 2010 until end March 2014.

There is now growing concern that Iran may be entering a third wave of HIV/AIDS transmission, this being through sexual behaviour.  In the past, the number of new cases that result from sexual transmission has remained relatively stable at around 5-8% of the total number of cases, though as of June 2010, this figure was 9.1%.^[1]

As of June 2010, some notable statistics include:^[2]

• according to the results of estimation/projection exercise conducted in 2009, the number of estimated HIV/AIDS cases was 83,000;
• the total number of reported HIV/AIDS cases in Iran were 21,435 and 3,763 had passed away from this disease;^[3]
• of the above figure, 92.4% were male;
• the 25-34 year-old age bracket included the largest percentage of cases (46.6%), followed by the 35-44 year-olds (27.3%);
• in 19.3% of the cases, mode of transmission is unknown;
• the rates of transmission for infusion of contaminated blood products and mother-to-child transmission were 1.1% and 0.6% respectively;
• among those infected through drug use, 98.9% were male, where as out of the reported infections resulting from sexual contact, 55% were female.

Project Description

The general focus of both rounds of the project are to:

1. The strengthening of assessment, surveillance and monitoring capacities in Iran;
2. Promotion of HIV information and education;
3. Reducing HIV risk and vulnerability;
4. Promote behaviour that will reduce the chance of HIV transmission;
5. Improving access and quality of HIV/AIDS treatment and care;
6. Conduct capacity building for NGOs and partner institutions.

Round 2 was given a total grant budget of USD$15,922,855.00 for Phases I and II.  Phase I of Round 8 has been given a budget of USD$9,295,097.00.

Results:

• Bio-behavioural Surveillance Surveys (BSS) – These are surveys assess the behaviour patterns of the most at-risk or high-risk target groups.  Although the Government planned to carry out these surveys previously, this Project catalysed their implementation and provided a mechanism through which they could be developed and national capacities could be created.  After an initial BSS carried out with assistance from Kyoto University, three further BSS was carried out among IDUs, prisoners and sex workers across the country in 2010.The information provided by the BSS assist in the monitoring of H IV/AIDS incidence and allow for the forecasting of future trends and outbreaks.  They also assist national partners measure the effectiveness of their HIV/AIDS interventions and programmes.  Nationally, the ready availability of this information also allows Iran comply with its international statistics and information sharing obligations.  The BSS have now been adopted by the Iranian Ministry of Health and are to be carried out on a biennial basis.
• Cooperation of the IRIB – The IRIB is the state media broadcaster.  An achievement of the Project has been obtaining the increased cooperation of the IRIB in the national efforts to raise awareness on HIV/AIDS.  Previously, this topic was not publically discussed in the media because of the considerable social taboo that existed.  However, the Project conducted sensitization workshops, which in part helped gain the cooperation of the organisation for awareness raising activities.  There has now been a surge in coverage of this topic.  This has been in the form of television teasers and dedicated awareness raising programming, and also several hours of radio coverage.  An example of this includes the broadcasting of two series of television programming on HIV/AIDS, one a series of 11 teasers and the second a mini-series of 11 short interviews with key informants.  These teasers speak openly about this topic and have all been broadcast in full.  During Round 8, in collaboration with the CDC and UNICEF, a series of 20 animated clips is to be developed and broadcast.  These clips are being developed based on a HIV/AIDS public awareness survey.  These clips have worked to raise the awareness of the public with regard to HIV/AIDS, clarify misconceptions and, most importantly, reduce the social taboo on this subject.
• Education System Integration – HIV/AIDS content has been integrated into the education system at three levels: trainers, teachers and students.  These materials work on a cascade basis.  Through the collaboration of the Ministry of Health, the Ministry of Education and the UNDP, training manuals were developed regarding life-skills based HIV/AIDS awareness.  As a result of the seminars and materials developed, of the 800,000-900,000 teachers registered in Iran, approximately 300,000 have been educated so far.  In 2010, these teachers have also succeeded educating more than 700,000 students.  By having it integrated into the education system, it is hoped that all schools in the country will deliver this information and it will be delivered in a medium familiar to students, which was not the case in the past.  Furthermore, this will help prevent the incidence of HIV/AIDS in this at-risk group.
• Positive Clubs - UNAIDS has joined the efforts of the GFATM programme to help the government with launch of the positive club initiative which has resulted in establishment of virtual communities managed by CSOs, addressing issues such as prevention, stigma and discrimination at the grass-roots levels. Nine positive clubs have now been established in different provinces covering approximately 2,400 PLHIV.
• Breaking of the HIV/AIDS Taboo and Government Sensitisation – This is perhaps the most notable outcome.  As mentioned above, Iran is a traditional and religious country.  As such, issues such as HIV/AIDS are often not openly discussed.  However, through the activities of the project, an indirect result has been the weakening, and in some cases breaking, of the HIV/AIDS taboo.  The first example is in the education sector.  Through obtaining the ascension of the education ministry in having it incorporated into the national system, the taboo related to HIV/AIDS has been greatly diminished, if not broken.  Teachers and those within the Ministry have noted that they are able to discuss this issue more freely and without the negativity previously associated with it. The availability of statistical information regarding HIV/AIDS, as a result of the BSS, studies and protocol development conducted by the project, has assisted in bringing this issue to the attention of Government officials.  This has contributed to the observation that even high-ranking officials and Government ministers are now openly speaking about this topic.  Further, all the Round 2 activities of the project have now been adopted by the Government.

Key Elements of Success:

• A key element of the projects success has been its ability to achieve stakeholder buy-in.  This has been done through two main mechanisms:
  • The Country Coordinating Mechanism – This has brought together partners from the Government, private sector, NGOs and academia that were previously not part of the main project body.  This has been particularly helpful as these partners are able to develop working relationships with one another.  It has also increased the sense of ownership in the project outcomes that previously did not exist.
  • Sensitisation and Awareness Raising – As a main constraint of the project is the lack of information in the public and among policy makers, the project team has worked to overcome this as much as possible. One example of this has been through holding a sensitisation workshop for middle and top managers of the IRIB.  This workshop allowed for these decision makers to become more aware of the importance of the project objectives and how they can help in the battle against HIV/AIDS.  A flow on effect from this workshop has been a substantial increase in the amount of coverage the top of HIV/AIDS receives in national media.
• Constructive partnership established between the Global Fund for AIDS, Tuberculosis and Malaria, the Government of Iran, UNDP and other UN agencies for the success of the GF grants in the country has been a key to the success of the GF funded programme in Iran. UNDP’s role of the “honest broker” role, given that the GF Board have placed Iran under the “Additional Safeguard” arrangements, allowed the country to benefit from the donor resources. The recipe for UNDP’s success has been an effort to gain trust in its role from the Government counterparts, while providing the required accountability towards GF.  This has been coupled with increased delivery efficiency on UNDP’s side, which has reinforced the trust from both sides.

Lessons Learned:

• Development of National Capacities – It is critical that national capacities be developed so that that once the project is complete, its activities may continue through being adopted by national partners. To ensure that such capacities are developed, it is important that projects work to incorporate a national adoption strategy into the end of their project plans.
• Collaboration – The more collaboration there is between parties involved in the intervention process, the more likely it is that the project will be successful.  This can be achieved by ensuring that those involved feel like partners and have a sense of ownership the goals of the project.
• Bureaucracy Reduction – To ensure the efficient implementation of project activities, it is important to reduce bureaucratic obstacles where possible.  This was demonstrated in the arrangement of two of the implementing partners: The National AIDS Office and the Global Fund Project Office.  Although these two entities were on the same floor of the same office building, they were technically separate entities.  This made the coordination of activities difficult because of the bureaucratic barriers that had to be overcome.  To overcome this, it was decided that the two offices should be combined.  This has since allowed for much smoother coordination and also increased the sense of collectivity between the organisations.

Partners:

Funding Partner: Global Fund for HIV/AIDS, Tuberculosis and Malaria (Global Fund)

Principle Recipient: United Nations Development Programme (UNDP)

Sub-Recipients: Ministry of Health Centre for Disease Control (CDC), Prisons Organisation (PO), Ministry of Education (MoE)

Sub-Sub-Recipients: Welfare Organisation (WO), University of Medical Sciences, Islamic Republic of Iran Broadcasting (IRIB), Iranian Blood Transfusion Organisation (IBTO).

Related links:

UNDP-Iran Information Page: http://www.undp.org.ir/index.php/hivaids-tb-malaria

Global Fund Information Page: http://portfolio.theglobalfund.org/Country/Index/IRN?lang=en

For more information contact:

Hedieh Khaneghahpanah
Project Officer/M&E Analyst
HIV/AIDS Grant
UNDP Iran
Tel: (9821) 2286 0691-4 (x 427)
Fax: (9821) 2286 9547
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Footnotes:

Last updated March 2011

[1] Joint United Nations Programme on HIV/AIDS – Iran, Report of the Visit of Mr Michel Sidbe, UNAIDS Executive Director, Tehran, Tehran, (11-12 October 2010), p1.

[2] Joint United Nations Programme on HIV/AIDS – Iran, Report of the Visit of Mr Michel Sidbe, UNAIDS Executive Director, Tehran, Tehran, (11-12 October 2010), p1.

[3] This figure being the cumulative total since surveillance began.