By Shali T.
In August of 2009, the Iranian president, Mahmud Ahmadinejad, signed a ruling that would officially remove World AIDS Day from the state calendar, as it was not believed to be related to the Iranian National Identity, nor was it considered burdensome enough to public health. What seemed like blatant neglect to the accelerating spread of a virus that is epidemiologically rooted in the country’s socio-economic shortcomings, was in fact the tip of the iceberg of the Iranian Governments’ systematic failing to acknowledge the HIV/AIDS epidemic and provide adequate prevention plans for its citizens.
Iran is estimated to have 59,000 people living with HIV. However, only 37% of those infected (22,000 people) are reportedly aware of their status. Furthermore, the number of cases has more than doubled since the year 2000. This epidemic has undoubtedly had dire consequences for the Iranian population, with high rates of inflation, devaluation of the national currency, and strict political sanctions making medicinal drugs expensive and hard to find. The strong need to implement systematic measures of prevention to control the spread of the disease, especially in high-risk populations, can be felt now more than ever.
Although historically intravenous drug use has accounted for the majority of transmissions, there is a concerning increase in the rate of transmission through unprotected sex. Worldwide research findings have consistently shown that school-based sex education programmes honouring scientific accuracy are an effective way to prevent sexually transmitted infections, contribute to improving the quality of life and general well-being of youth, and promote equity. With regards to HIV/AIDS specifically, preventative strategies such as having extensive knowledge of transmission and limiting exposure to risk factors are the most effective strategies in dealing with this pandemic. Despite such evidence, school-based sex education is a highly controversial topic in Iran. Inaccurate knowledge, misconceptions, and social stigma are some of the barriers that have debilitated the development of comprehensive and scientifically sound interventions.
Ever since the 1978 revolution, Iran has become a theocratic government, meaning that their constitution and policies are based on a fundamentalist interpretation of Islam. The post-revolution government has attempted to limit its citizens’ sexual autonomy, its modes of expression, and male-female relationships by enforcing veiling, instilling sex segregation in schools, censoring sexually explicit media and legally banning premarital sex. In such a socio-political environment, there is a lack of sex education initiatives providing candid dialogue and transparent information for adolescents and unmarried youths. Although Iran has a successful national program for family planning and marital life, there is no policy on sex education in progress for unwedded demographics. This assumption that young and spouseless Iranians are not sexually active is a failure to acknowledge their sexual health needs, and makes them fall into a high-risk and vulnerable category, especially in regards to STIs.
The most important resources for sexual information among young people are satellite television, internet and their friends, all of which can be unreliable. Recent studies have revealed the high prevalence of misconceptions and lack of knowledge within the population when it comes to such topics. One study conducted by Zarei et al. demonstrated that only 19% of young adults could correctly identify methods of preventing the sexual transmission of HIV. Demographic statistics revealed that those with higher education, higher income, and those who were married scored significantly higher on their knowledge tests than their counterparts, demonstrating that only a minor group of people knew how to protect themselves against the disease.
The national sex-segregated schooling until post-secondary institutions and the lack of a standardized education policy on sexual education may widen the knowledge gap between men and women. The current system in certain primary schools for boys involves a one-off session where the principal meets with the pupils’ fathers. The two parties discuss how they can postpone the boy’s sexual development, and the father chooses if he or the school staff will be teaching his son about puberty. During an interview in the study conducted by Alireza Tabatabaie, a senior psychologist from a prominent boys school mentions that the ultimate goal of the school was to promote abstinence until marriage and a healthy sex life afterwards. He added that any explicit dialogue around such topics in contemporary Iranian society would make the pupils more sexually aware, which could lead to premarital sexual activity. The clear lack of empirical and equitable access to STI prevention underlies a major contributing factor in the HIV epidemic within the high-risk group of young adults in this country, and should not be underestimated.
This being said, institutions should utilize contextually and culturally tailored programs that are backed with research-based data, which could positively reinforce the destigmatization of sexually transmitted infections while promoting safer sex. Empowering young adults through safe sex education, raising public awareness, and breaking social taboos around HIV is essential in combating the epidemic in Iran.