AIDS Crisis Brings Radical Change In Iran's Response to Heroin Use

TEHRAN -- Fearing an AIDS epidemic, Iran's theocratic government has dropped a zero-tolerance policy against increasingly common heroin use and now offers addicts low-cost needles, methadone and a measure of social acceptance.

For two decades, Iran largely avoided the global AIDS crisis. But today, officials are alarmed by a 25 percent HIV infection rate that one survey has found among hard-core heroin users and worry that addicts may channel the virus into the population of 68 million.

Recently released from prison, Behnam, 25, is back in south Tehran and again using heroin. The government now offers low-cost needles and methadone. (By Ramin Talaie For The Washington Post) Free E-mail Newsletters Today's Headlines & Columnists See a Sample  |  Sign Up Now Breaking News Alerts See a Sample  |  Sign Up Now

Supporters of the government's new approach laud it as practical and devoid of the wishful thinking and moralism that they contend hampers policies on drug abuse and AIDS in some other countries, including the United States. "I have to pay tribute to Iran on this," said Roberto Arbitrio, head of the U.N. Office on Drugs and Crime in Tehran.

Bijan Nasirimanesh, who heads a drop-in clinic that dispenses needles, bleach and methadone in a hard-hit area of south Tehran, said, "It's ironic that Iran, very fundamentalist, very religious -- very religious -- has been able to convince itself" to embrace such policies.

Opponents often argue that tolerance of life-destroying drugs is simply unacceptable and in the long run breeds acceptance and higher drug use. But in the theocracy's most dramatic rejection of that approach, the ayatollah who heads Iran's conservative judiciary issued an executive order embracing "such needed and fruitful programs" as needle exchanges and methadone maintenance.

Ayatollah Mohammad Esmail Shoshtari, the justice minister who has shut more than 100 newspapers and imprisoned political opponents, instructed prosecutors in a Jan. 24 letter to ignore laws on the books and defer to Iran's Health Ministry to counter the spread of AIDS and hepatitis C.

"This was a very crucial step," said Ali Hashemi, director of Iran's Drug Control Headquarters, a cabinet-level office. "Inevitably we have to do this in order to reduce the risk of AIDS."

The policy demonstrates the complexities of Iran a quarter-century after the Islamic revolution and U.S. Embassy takeover that still defines its theocratic government for many Americans. Though power remains concentrated in unelected clerics who brook little political dissent, the government has demonstrated flexibility on a variety of subjects, including birth control and sex-change operations, which the clerics recently authorized.

After the revolution, Iran treated drug users as criminals, throwing hundreds of thousands of them in jail. Now it has joined the ranks of countries that acknowledge the difficulty of eradicating drug addiction and focus instead on curbing the most immediate dangerous behaviors that go with it.

Surveys of Iranians who test positive for HIV show that two-thirds were infected by dirty needles. To reduce the spread of infections, the government not only makes needles available without a prescription, but through subsidies makes them extremely cheap, so as to discourage re-use.

"You pay less than 5 cents for a syringe," said Azarakhsh Mokri, of the government's National Center for Addiction Studies. "People purchase up to 100 at a time."

The government also encourages addicts to stop injecting by providing free methadone, a surrogate opiate that is taken orally. This spring, the parliament, dominated by conservatives, voted to allow any doctor in Iran to dispense methadone, though under strict monitoring guidelines."It's quite amazing there's been this shift," said Rich Schottenfeld, a professor of psychiatry at Yale University, which won a waiver from U.S. sanctions on Iran to carry out a study financed by the National Institute of Drug Abuse to compare drug treatments. "Five years ago, my colleagues there didn't anticipate that methadone would even be allowed," he said.