Iranian doctors' conviction could damage public health
Authors: Kristin Elisabeth Solberg
Journal: The Lancet (2009)

The recent conviction of two Iranian doctors could be detrimental to public health and sour relations between academics in Iran and the rest of the world. Kristin Elisabeth Solberg reports. The conviction of the pioneering Iran-ian HIV/AIDS doctors Kamiar and Arash Alaei could have devastating effects on public health in the region and around the world, human-rights groups warn. On Dec 31, 2008, the Alaei brothers were tried behind closed doors in the Iranian capital Tehran. After a brief trial, in which some of the charges were kept secret, they were found guilty of plotting to overthrow the regime, and sentenced to 3 and 6 years in prison. The Iranian authorities claim the brothers, who founded the country's first HIV/AIDS prevention programme in the late 1990s, were part of a US$32 million, US-funded “intelligence war” aimed at stirring up civil unrest and starting a revolution. Human-rights groups have condemned the trial as unfair and politically motivated, and have warned of its far-reaching consequences on public health. “Public health will suffer in Iran, and around the world”, said Jonathan Hutson, chief communications officer with the US-based group Physicians for Human Rights. He added that the doctors were not known to be politically active. “If these doctors were engaged in any kind of warfare, it was only the battle to prevent and treat AIDS”, he said. In a region where HIV/AIDS is taboo, the Alaei doctors' work is widely regarded as pioneering and innovative. Working with the blessing of Iran's religious leaders and the passive approval of the government, they believed in a holistic approach to the treatment and prevention of the infection, focusing primarily on harm reduction and injecting drug users. Among their initiatives is a nation-wide needle-exchange programme—reflecting the needs of a country with one of the highest proportions of heroin users in the world. Their work has been praised by WHO and UNAIDS, and is widely seen as a model for the rest of the Middle East. The region faces one of the fastest growing HIV/AIDS rates in the world, but its rulers have so far done little to combat the threat. The charges against the Alaei brothers seems to stem from their work. The evidence against them, say human-rights groups, seems to include training people in public-health work; engaging with international non-governmental organisations; and attending conferences abroad. “These are not crimes, it is good medicine”, said Hutson. Reflecting the view of the medical community he said it was “shocked” when it learned of the arrest of the brothers in June, 2008. The case could curb scholarly exchange between Iran and the rest of the world, campaigners now fear. Joe Amon, director of the HIV/AIDS Programme at Human Rights Watch, is alarmed by the potentially devastating effects of the case, especially on Middle Eastern countries. “It will be harder for Iranians to share their experiences, in, for example, harm reduction and HIV prevention, with other countries in the region”, he said. But the effects of the trial could reach far beyond HIV/AIDS, Amon warned: “It will also be harder to learn from the experiences of other countries in addressing various different problems—be it HIV, SARS [Severe Acute Respiratory Syndrome], or avian influenza—which are really critical to global health and security.” It remains to be seen whether the case also signals a shift in Iran's HIV/AIDS policy, or if the government is simply warning against close ties with the west. The conviction could be part of a general crackdown on opposition figures and activists ahead of the presidential election in June. If so, the many HIV/AIDS clinics set up by the Alaei brothers in Iranian cities and prisons should be allowed to continue their work. But with the doctors behind bars, campaigners believe the drive to battle HIV/AIDS will be substantially reduced. Some campaigners remain hopeful that the brothers will be released. Several scholars with ties to the west have been arrested in Iran since President Mahmoud Ahmadinejad took over in 2005; most have been released without conviction. The Alaei brothers' attorney has announced that he will appeal the verdict. Some activists believe that the government will respond to the public outcry from health professionals around the world. “The doctors should be freed immediately, so they can go about their business saving lives in Iran”, said Hutson.