Hamedan, February 15, 2009 - During a two day field visit members of the United Nations Development Program (UNDP) and the Centre for Disease Control (CDC) visited the implementation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) project “Prevention and Control of HIV-AIDS in the I. R. of Iran” in the city of Hamedan, located in the Hamedan province. As expressed by the Executive Advisor to the Minister of Health and the Vice-Chair of the Country Coordinating Mechanism (CCM), Dr. Heidari, these joint field visits “illustrate the common goals and objectives between the two [partner] organisations”.

The GFATM project was initiated in 2005 and finished its first phase related to HIV/AIDS in 2007. Due to the successful coordination of the UNDP as the principal recipient of the grant, and the successful implementation of its partners such as the Prison Organisation and the CDC, the project was extended into a 2nd phase starting in 2007 and continuing until 2010. In addition Tuberculosis (TB) and Malaria were also added to the projects’ scope and these branch projects were taken into effect as of October 2008. The overall aim of the project is to target the Millennium Development Goal (MDG) 6, which is to combat HIV/AIDS, Malaria and other diseases.

The two day excursion allowed the receivers of the GFATM grant to visit field stations and to discuss the challenges and opportunities with male and female Intravescular Drug Users (IDU's), employees at Drop-in-Centres (DICs) and provincial representatives of the Ministry of Health. The GFATM project is an integrated part of the national programme. "It is nothing extra or seperated but an integral part of the work constantly being implemented in our National Action Plan" expressed Dr. Heidari. Furthermore he emphasised that "the activities that are currently being implemented would not have been possible without the good partnership" between CDC and UNDP. The  Resident Representative of UNDP and the Resident Coordinator of UN in Iran, Mr. Ostby expressed that "we are extremely happy with our cooperation with the Ministry of Health" and it is "under the leadership of the Ministry of Health [that] this project has led to breakthrough results and has been used as a success story or best practice in the world".

During the first day, the group visited the Medical University of Hamedan in which student and practitioners of health were taught about hospital safety and safety measures to be practiced in order to reduce the risk of HIV/AIDS. The target group for this activity was the at-risk group which included lab-assistants, fire-fighters, prison guards, medical staff, ambulance staff as well as individuals working with mortals. The group of students and practitioners that were attending the class were briefed on the use of safety boxes in their line of work, and how these boxes will be decomposed after collection by the city municipality. It was also noted that the amount of risk exposure these practitioners face will also depend on the type of needle that is used and the type of work that is carried out.

Furthermore, the group was briefed on the latest statistics on HIV/AIDS in the province of Hamedan and in the country. It was emphasised that 25-39 year olds are the largest group in risk for contracting HIV/AIDS in the country and the statistics for Hamedan also follow this national pattern. According to the figures presented, more than 80% of the affected individuals live in urban areas, and most of these tend to have a history related to IDU. According to the National Action Plan on HIV/AIDS prevention, 90% of all medical staff in the country are required to receive this form of training. In the discussions which followed the presentations, a female participant shared her experiences from working in a hospital in the past few years. She explained that “today my colleagues look more at the patients with a human rights view – without the initial fear but rather more with the thought to help” in comparison to previously. The facilitator commented that within the National Action Plan we hope “that we can reach the stage where people who are HIV positive, regardless of how they contracted it, are not stigmatised”. It is under this framework, activities such as Methadone Therapy and Drop-in-Centres (DICs) have been implemented throughout the country.

The group also took the opportunity to meet the provincial implementing group in Hamedan. During this meeting, it was possible to discuss the opportunities and challenges faced in the province and probable methods forward. Upon leaving the meeting, the groups exchanged appreciation and thanks for the hard work conducted by each party.

During the second day of the field visit, the group visited two different sites. While Hamedan has several DICs spread across the city, one main centre is operating in an area where many IDUs and homeless individuals are known to be located. In cooperation with medical staff and counsellors, the centre provides Methadone Therapy to between 80 and 150 individuals on a monthly basis, out of which most are men. Every day IDUs come to the centre, give a lab-sample and upon the result they receive their daily dose of methadone and if their lab-results come back negative they also receive a dose to be used at home on the following day. The dose given to each patient depends on a prescription by a medical doctor. The staff crushes the methadone tablet before the patients take it with a glass of water. In addition to the patients which visit the centre, precaution packages and methadone therapy is also distributed to the rural areas, with an estimated reach of 150-160 people.

During this event, the staff of the centre, which seemed very dedicated to their work, also took the opportunity to highlight the risks and problems they face. Many of these issues were responded to by the accompanying National Project Manager of the project, Dr. Mohammadrezaei, who shared the experiences of other provinces with the staff in Hamedan. One of the alternate methods, which can help reduce risk for the staff and increase the availability and accessibility of the centre for other patients, is to involve more peer groups to respond to difficult patients.

The drop-in-centre also provided a safe habitat for patients to receive food and also to use basic amenities such as the shower. In addition it was staffed with psychologist and counsellors who conducted both individual and group sessions. The psychologist explained that earlier on women used to come to the centre a lot, but since the DIC specially targeting women was opened, only 2 homeless women are visiting the centre on a routine basis. The issues mainly discussed in the counselling sessions evolve around changing behaviour, dealing with cravings and other various family issues. In addition safety kits are distributed containing clean syringes, condoms, cotton and alcohol.

The women’s DIC, was visited in the afternoon by the group. This centre, which works with 85 individuals, gives patients access to a doctor, a psychologist, a counsellor and a social worker. As explained by the staff, the patients are divided into groups depending on their psychological status, in order to assure that they receive appropriate care and support. In the group 13 sex workers have been trained as peer educators and there are plans to distribute condoms in the centre. The centre works closely with the local police which helps direct known IDU’s and sex-workers to the clinic. The patients the mission met expressed great appreciation for the opening of an only women’s centre and that they felt “in peace” when they were there.