Published online 25 July 2011 | Nature | doi:10.1038/news.2011.438

News: Q&A

Iranian AIDS doctors continued work behind bars

Brothers still unsure of why they were imprisoned.

Kamiar Alaei.Kamiar Alaei.JIM WATSON/AFP/Getty Images

Kamiar and Arash Alaei are Iranian HIV/AIDS doctors who were jailed in 2008, accused of collaborating with an enemy government. Before their imprisonment, the Alaeis pioneered the integrated treatment of HIV infection with counselling and drug rehabilitation, and their approach to care in prisons has been hailed by the World Health Organization as a model for the rest of the Middle East to follow. The brothers have been awarded this year's Jonathan Mann Award for Global Health and Human Rights. Kamiar was released last November, and Nature caught up with him at the International AIDS Society conference in Rome last week, where he was gathering support to petition for his brother's release.

What is it like to be a scientist or doctor in Iran today?

As a scientist, you want to discover things, to find solutions. For this, you need to have collaboration, but the Iranian government makes it difficult now. You can only develop a good knowledge base from exchanging your experiences freely with other scientists. You need to be able to go to conferences to find out the latest research, and not wait years for data to be published in journals.

You've said you and Arash became more like social workers than doctors — in what way?

We had no real idea about how to design a programme, so we just asked patients what they wanted. As a physician, I assumed that what my patients needed most was care. I found out that they also really needed counselling on how to cope with HIV. Some people said their husbands and wives had left them. Some committed suicide out of despair.

And this social responsibility extended to acting as matchmakers for your patients?

Stigma was stopping our patients from getting married and having a family. So we introduced HIV-positive men to women who were also HIV-positive. I showed them pictures of each other, asking them who they liked. They would laugh and say, 'this one looks too old', or 'I am not sure about him'. They got back to life — it made them feel human again. The BBC even made a documentary on it called Mohammad and the Matchmaker.

Why did you focus on prevention in prisons?

Prisoners are one of the most at-risk groups for HIV infection in Iran. But condoms and needle exchange programmes are very sensitive issues in an Islamic country, so we had to think carefully about how to provide services. For instance, prisoners had the right to conjugal visits. So we provided counselling, and then, almost as an aside, offered condoms as well. We provided methadone and clean needles by offering them alongside antiseptic swabs.

Did you ever think you would be in prison one day yourself?

Never. We never expected to be arrested. The worst scenario we imagined if the new government was not happy with our work was that they would tell us not to continue. We would then have asked them how they wanted us to implement or design our programmes. We would have adapted.

What were you imprisoned for?

The Iranian government said it was communication with an enemy government, but we don't know which government they meant, since officially Iran has no enemy governments according to its National Security Council report.

Why did they target you and Arash?

I thought about this for three years in prison, and never came up with an answer. I guess it was because we worked on HIV/AIDS and we worked internationally. But we only ever focused on health, not politics. We were very conservative about what we said because we didn't want to jeopardize our programme.

How is Arash doing in prison now?

I am not able to communicate with him, but my mother visits regularly. He is doing good. He is strong.

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How did you and Arash keep up the motivation to care for prisoners even when you were in jail yourself?

We believe in doing what is right, regardless of whether we have support. The prisoners were the same target group, but now we were inside the walls too. We realized there were health problems other than HIV. For instance, we helped prisoners stop smoking. We got them to exercise, and we made it fun by setting up football and volleyball championships. We asked them to paint mountains and rivers on their walls to make their environment nicer. We got publishing companies to donate books to educate the prisoners. We got prisoners to teach each other languages – I learnt Spanish.

How was the transition back from prison to doing your public-health doctorate at New York University?

It was very hard. My brother and I had always lived together, studied together, worked together, travelled around the world together, and we were in prison together. It's not over. When I sleep, I still feel like I am in prison in my dreams. In Arash, part of my heart is still in prison. 

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