Response to a letter Recent Advances of the HIV Surveillance System in Iran: Current Situation and Ways Forward

Ivana Bozicevic, ,

Other Contributors:

July 12, 2013

We very much appreciate the letter that Dr Haghdoost and colleagues wrote in relation to some of the issues outlined in our paper HIV surveillance in MENA: recent developments and results and, in addition, described some more recent developments in HIV surveillance in Iran.

We would like to reflect on several issues that they raised.

Our paper states that Djibouti, Iran, Morocco and Pakistan can be classified as having fully functioning HIV surveillance systems as trends in HIV prevalence in these countries can be assessed over time for certain population sub-groups. Surveillance systems in these countries have a sufficient quantity and quality of the data that can be used to guide the programmatic responses. We also mentioned other nine countries that have partially functioning HIV surveillance systems.

As described in the Methods section of our paper, the assessment of the quality of HIV surveillance systems was based on the questionnaire sent to National AIDS Programmes (NAPs) of the countries of the WHO Eastern Mediterranean Region (EMR) in 2009, 2010 and 2011, and not on the data presented in the paper by Garcia Calleja et al published in Sexually Transmitted Infections in 2010. As described in our paper, to assess the quality of HIV surveillance systems we adapted a method developed by WHO and UNAIDS.123

As one of the limitations, we outlined that data were provided by the NAPs, which might have missed data sources collected by other agencies that Haghodoost et al. mention, such as surveys in partners of IDUs. However, as planning of surveillance and programmatic responses is lead by the NAPs, we think that collecting data from NAPs gives an appropriate insight into the type and quality of data that the countries use for planning and evaluating the national HIV response. We are aware that many studies might be undertaken in the EMR, but their results are not disseminated, and this is particularly the case with studies done in groups at higher risk of HIV that are heavily stigmatized.

In relation to some other issues that the colleagues raised, surveys using respondent-driven sampling were done in many other countries in the Region (some of these are referenced in the paper) as well as Mode of Transmission studies.4

We have not reflected on the reasons for the improvements in HIV surveillance in North Africa and the Middle East, but we believe this has been due to greater availability of funding provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria and capacity building efforts of numerous international and national agencies.

We agree with Dr Haghdoost and the colleagues that there are substantial improvements in HIV surveillance in Iran though significant challenges remain in bridging the gaps that the system still has. One of them is certainly in conducting studies on HIV and sexually transmitted infections in MSM and transgendered individuals, which due to prevailing stigmatization are still lacking throughout the Region.


1. Garcia Calleja JM, Jacobson J, Garg R, et al. Has the quality of serosurveillance in low- and middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect 2010;86(Suppl 2):ii35-42

2. Walker N, Garcia-Calleja JM, Heaton L, et al. Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic? AIDS 2001;15:1545-54

3. Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero- surveillance in low- and middle-income countries: status and trends through 2007. Sex Transm Inf 2008;84: i85-91.

4. Mumtaz G, Hilmi N, Zidouh A, El Rhilani H, Alami K, Bennani A, Gouws E, Ghys P, Abu- Raddad L. HIV Mode of Transmission Analysis. Rabat: Kingdom of Morocco. Ministry of Health, Department of Epidemiology and Disease Control, 2010.

Conflict of Interest:

None declared

Conflict of Interest

None declared