Fighting for HIV/AIDS patients in Iran

Dr. Kamiar Alaei and his brother Dr. Arash Alaei, Iranian physicians who worked to treat patients with HIV/AIDS, were arrested by the Iranian government in June of 2008. Kamiar, a doctoral candidate studying in the United States, was visiting Iran for the summer.

On December 31, 2008, a one-day closed-door trial was held, after the brothers had been in Tehran’s notorious Evin prison for six months. On January 19, 2009, they were charged with being “in communications with an enemy government” and “seeking to overthrow the Iranian government under article 508 of Iran’s Islamic Penal code.”

Arash was sentenced to six years and Kamiar three years. The government used the Alaeis travel and communication with other global health workers as basis for this charge.

In November of 2010, Kamiar was released after more than two years of detention. Arash Alaei remains in Evin Prison. The doctors were awarded the Global Health Council Jonathan Mann prize for Health and Human Rights in June 2011, and during the reception, Kamiar, who accepted the prize on behalf of both brothers, spoke publicly about his experience for the first time.

GlobalPost spoke with Dr. Kamiar Alaei about his imprisonment, his work with HIV/AIDS, and his plans for the future. He continues to raise awareness about his brother’s imprisonment.

Why do you believe that you were arrested?

I was thinking about this question for 3 years — why was I arrested — and I couldn't find a logical answer. I think that you have to refer this question to the people who arrested us.

We work on HIV/AIDS, and the worst scenario that we expected was that the new government wouldn’t like us working with this high-risk group. The worst scenario was that they would ask us: “Don't continue your work.” And then we would ask them, “What do you want us to do to adapt our project to make you happy?” But we never ever thought that we may be arrested. Because we didn't do anything in politics.

Every summer I visited my country, and my brother to work in Iran in the summer. We had a lot of collaboration — to improve the knowledge of the experts, we had to have an international cooperation. International cooperation was the reason that we helped some of the experts from the U.S. go to Iran. We had a training workshop in Afghanistan and Pakistan, where we had a common language, similar culture.

The trainers continued work in the original countries, and that was all we did: an international scientific exchange program, with a focus on health, specifically on HIV and harm reduction. The government was informed about that and everything was transparent. We did this for several years, not just for one time. So, if the government was not happy with our work, they could have informed us. 

A new initiative was launched on July 19th by the Physicians for Human Rights. What happened at the press conference, and what does that mean for you and your brother?

The press conference was hosted by the International AIDS Society and Physicians for Human Rights — who have done a wonderful job the past few years for us. We called for my brother’s release and we emphasized all [the work] that we had done in the past 10 to twelve years was focused on HIV/AIDS and global health.

We didn't do anything in politics in Iran. We were very concerned about the politics. We wanted to make sure that the program could continue and the government didn’t jeopardize the program.

Even [while we were] in the prison, we wanted to continue health by educating prisoners with their general health, with communicable diseases. What we found was a need for the basic things like how to wash their hands after using the bathroom, and educating [prisoners] about general physical activity. We led them to have morning exercise, and encouraged them to study. A lot of things that we wanted to continue helping the activity of the prison, and I'm relieved that I continued my work. So that was the key issue that we wanted to emphasize, that this is all we have done, all that we have been doing, and that we will keep focus, limited concentrated on health. 

Why did you initially keep quiet about your imprisonment after returning to the United States?

I wanted to be quiet until my term had finished, [Kamiar’s term was 3 years, though he was released after two and a half years] and then, my brother’s chance [to be released] had passed, which passed last month [June]. We [Kamiar and Arash] are very pleased and delighted to be awarded by Global Council on the Jonathan Mann award. So that was a good opportunity to come forward to the public and talk about the entire story. The International AIDS Cnference [IAS2011], which was part of an international network [of global health workers], was a good opportunity to call for the release of my brother.

I cannot predict, in my country, what will happen tomorrow. But we need to have some international advocacy, specifically among scientific and health professionals to highlight the case, and make sure it is not simply forgotten. And that's why we wanted to call a global day of action for my brother. We had a lot of support from experts in global health.

Now that Ahmadinejad is in power, what is the status of treating HIV/AIDS patients in Iran?

Because we had approval [and funding] from the Global Fund, treatment for HIV [in Iran] was free of charge. Thus, technically everyone had access to treatment.

However, to find new HIV cases, you have to focus on the high risk groups, which are intravenous drug users, sex workers, and others. Now, based on the new policy of the new government, these high risk groups are less likely than before to receive the services. And that is my main concern regarding the case finding for the new HIV cases.

We have approximately 23,000 registered HIV cases in the country, but Iran is estimated to have approximately 100,000 HIV cases. This means that we only found 25 percent of the HIV cases. We need to reach the rest, who are among high risk group.

70 percent of the population is less than 30 years old and 50 percent of the population is between the ages of 17-27 years old. That means that they are at high risk for addiction and other sexually risky behaviors.

You’ve spoken about the importance in countries developing a national policy as prevention. Can you expand upon that? Why is there a need for a national policy in HIV/AIDS prevention?

It is very important that that we develop a national policy in relation to HIV/AIDS. We can use the experience of some of the other developing countries so that they achieve some of the expected goals. Regarding my personal experience, I shared some of my experience with HIV/AIDS [in Iran] and spoke about how we could include HIV/AIDS prevention in national policies. We can teach the at risk groups and news people about HIV/AIDS and we could implement harm reduction among drug users and other hard to reach groups.

We had developed primary health physicians so we tried to integrate that.

Part of the attitude of the speakers [during IAS2011] was that it is doable to combat HIV/AIDS, but we need to increase access to care. We can focus on the minorities and the women, and that's very important to highlight the prevention with the care. A lot of funds are focusing on covering new drugs and vaccinations. Even vaccination is part of the prevention, but they need education and there is a lot of misunderstanding about HIV/AIDS. That needs to be ended.

Did you see all of this while you were working in Iran? For example, that education was one of the more effective ways of prevention?

That was definitely something that we had done in the past. All of the pilot projects that we had started in 1999 showed successful outcomes. Because of this we could share it, and we could design a national AIDS committee so that they included those policies [that we had implemented] in the national plan.

We involved clerks, and religious leaders in the program. Iran is a Muslim country, and the main concern of the government is the attitude of the religious leaders. Because of this it is very critical to involve the religious leaders to inform people of the benefits of thisand that was one of the key points that we think makes it successful to have a sustainable project and we wrote a proposal to the Global Fund, which we got approved (worth nearly $16 million), to make sure if the government changes and the new government doesn't prioritize HIV, we have a existing international fund to guarantee the sustainability of the project in the future.

Can we talk a little further about sustainability? What has been proven as an effective means for sustainable programs? A lot of the programs that you and your brother started are still in place today.

We wanted to integrate the project into existing programs. This way, we could use the human resources in the primary health care system which meant that they just needed education to be involved in the nation wide program. For example in the U.S. and some other developed countries, there are some projects for needle exchange programs but those projects they cannot provide methadone therapy. Or, if they provide methadone, they cannot provide other therapy.

It's very critical to integrate services together. For example, while HIV cases need care, their partners and children need prevention. All of them need social support.

This was one of our key issues in Iran. We started to integrate services, prevention, care, and social support together. We designed it as community based, and we designed it based on the needs of the target groups.

What is the next step for you personally? I'm assuming that going back to Iran under this regime is not possible, correct?

I haven't traveled back to Iran. And I have no idea if I can go back. At this time, I just focus on my brother's case because it's impossible to see the political future of my country. I would love to work in my country and any other country, but it depends on the situation if I can be useful in my country again. If they don't let me continue my work in Iran, so I have to go to the other countries, because I love to work in this program, because I believe that some people need help, so we need to do our jobs to help them. Regardless if our work is appreciated, or not.

Unfortunately, everything we did regarding HIV/AIDS was misunderstood by the government, and that was the reason that we were arrested, technically I cannot do [contribute to HIV/AIDS programs] in my country, at this time.

Maybe in the future the policy atmosphere will change and we can have the opportunity to continue my work in the country. But, at this time, I have to switch my target area [from Iran and the Middle East] to other countries, and it's for that reason that I began studying Spanish while I was in the prison. That was also the reason that a couple of months ago I went to the Dominican Republic and to the border of Haiti, to work with some Haitian immigrants. I was able to give some information about communicable diseases.

I want to go to different developing countries. That is why I am currently in the U.S. to be educated about HIV/AIDS. That is my passion for the future.

Is there anything you'd like to add to our conversation?

I have a message for the young practitioners, and physicians who are working in developing countries. The point is that if you work as individual, or for an NGO — if you're working for a small NGO or a big NGO, the point to remember is internal integration.

If you believe that what you're doing is helpful for global health, whether your work is appreciated by your organization or by the country that working in, continue to do your job. Never ever get discouraged. If the government puts a lot of pressure on you or your work, even at the beginning and with a small point or project, the impact can be exponential, and quickly you can reach any target group.