Recent Advances of the HIV Surveillance System in Iran; Current Situation and Ways Forward

Ali Akbar Haghdoost, MD, PhD, professor of Epidemiology and Biostatistics in Kerman University of Medical Sciences,

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June 24, 2013

We very much enjoyed reading Dr. Bozicevic's paper about the recent developments in HIV Surveillance in MENA in a recent issue of your journal [1]. Some topics discussed in that paper concern us and we would like to share a few opinions about the current HIV surveillance system in Iran and its recent advances. In the paper it is stated that only two countries in the region (Morocco and Sudan) have a partially functioning HIV surveillance; however, we assume this is based on the data presented in a study conducted in 2009 [2] and at present, Iran has also a somewhat functioning HIV surveillance system. For example, Iran has done a pretty fine job in controlling the HIV infection among IDUs and monitoring the epidemic trend in pregnant women [3]. Iran has been also conducting biannual bio-behavioral surveys among IDUs, FSWs, IDU partners, and prisoners [3]. More recently, size estimation programs have been introduced to the system and we have conducted size estimation studies in estimating the size of at risk populations [4]. On top of the above, Iran is one the only countries in the region that has conducted Respondent Driven Sampling as well as Mode of Transmission studies [3, 5]. What is more, the number of HIV/AIDS related publications in Iran (in PubMed database) has doubled in a five- year period which is also an evidence of improvement of the system [6]. We think a number of reasons may have contributed to this progress. The role of the Regional Knowledge Hubs in HIV/AIDS Surveillance in educating healthcare providers and researchers as well as health policy makers cannot be ignored [7]. These educations have been given through national and international workshops and sending out educational packages to different policy makers, from members of the parliament to those in the presidential office. We assume highlighting the burden of HIV/AIDS in the upcoming years has been successful in drawing policy makers' attention to the seriousness of the HIV epidemic across the country in a way that controlling HIV/AIDS throughout the country was a serious concern in the recent presidential debates. Despite all the achievements in addressing the HIV epidemic, there is still a lot to be done and the current system still suffers to a considerable extent. For example, likewise most countries in the region, MSM and transgendered populations have long been overlooked in the HIV surveillance system; ignorance mainly originated from the stigma surrounding such populations. We think one of the main challenges to be overcome is the pitfalls in the case finding and reporting system of Iran. The sensitivity of case finding in Iran is low and following up the HIV patients and assessing their adherence to therapy is a major challenge in front of healthcare providers [5, 8]. Although the case reporting system is not fully functioning, a national computer-based is being launched in the country that opens a window of hope in fixing the defects in the current reporting system. The Ministry of Health is really optimistic about this system; however, its effectiveness is yet to be evaluated.

References: 1. Bozicevic I, Riedner G, and Garcia Calleja JM. HIV surveillance in MENA: recent developments and results. Sex Transm Infect, 2013. online: p. 1-6. 2. Garc?a Calleja JM, Jacobson J, Garg R, et al. Has the quality of serosurveillance in lowand middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect, 2010. 86 (Suppl 2): p. 35-42. 3. National AIDS Committee Secretariat and Ministry of Health and Medical Education. Islamic Republic of Iran AIDS Progress Report On Monitoring of the United Nations General Assembly Special Session on HIV and AIDS.2012, available at:,1.PDF2012. 4. Shokuhi M, baneshi MR and haghdoost AA. Size Estimation of Groups at High Risk of HIV/AIDS using Network Scale Up in Kerman, Iran. Int J Prev Med, 2012 .3(7): p. 471-476. 5. Nasirian M, Doroudi F, Gooya MM, et al. Modeling of Human Immunodeficiency Virus Modes of Transmission in Iran. Journal of Reaserch in Health Sciences, 2012. 12(2): p. 81-87. 6. Saba HF, Kouyoumjian SP, Mumtaz GR, et al. Characterising the progress in HIV/AIDS research in the Middle East and North Africa. Sex Transm Infect, 2013. online: p. 1-5. 7. Mostafavi E, Haghdoost AA, mirzazadeh A, et al. Regional HIV knowledge hubs: a new approach by the health sector to transform knowledge into practice. Health Promotion International, 2012. online: p. 1-7. 8. Haghdoost AA, Mostafavi E, Mirzazadeh A, et al. Modelling of HIV/AIDS in Iran up to 2014. Journal of AIDS and HIV Research Journal of AIDS and HIV Research, 2011. 3(12).

Conflict of Interest:

None declared

Conflict of Interest

None declared