World AIDS Day 2025 arrives at a critical moment. UNAIDS' 2025 Global AIDS Update highlights that the global AIDS response today is shaped by inequality, discrimination, and political inaction as much as by biomedical progress. While treatment and prevention tools exist, the persistence of stigma and criminalization continues to fuel new infections.
The South West Asia and North Africa (SWANA) region illustrates these contradictions well. HIV prevalence is relatively low but remains hidden, shaped by silence, moral judgment, and fear. UNAIDS' regional review emphasizes that by 2017, nearly two-thirds of new infections in SWANA occurred in Egypt, Iran, and Sudan, and that key populations face intense stigma, discrimination, and criminalization.
In Iran, one of the countries with the highest HIV burden in West Asia, the epidemic has been rapidly evolving. For many Iranians, HIV among women entered public debate after the release of Tales (2014), a film that portrayed a young woman living with HIV after years of drug use, which faced criticisms about breaking the taboo of women using drugs and showing them on film.
A Changing Epidemic: From Injection to Sexual Transmission
UNAIDS warned in 2018 that extraordinary efforts were needed to improve testing and treatment programs in Iran due to rising infections and continued stigma. Historically, Iran's epidemic was driven by injecting drug use, with approximately 200,000 people injecting drugs nationally. Harm reduction programs, such as methadone maintenance, helped reduce transmission through shared needles.
However, by 2024–2025, national data show substantial shifts. The total number of people living with HIV is around 40,000, with the gender distribution shifting from 81% men to 68% men, and from 19% women to 32% women. Since 1986, transmission routes have changed dramatically: sexual transmission now accounts for 65.2%, injecting drug use 10%, mother-to-child 0.7%, and unknown routes 24.1%. Iranian officials have publicly acknowledged that sexual transmission is now the most dominant transmission route.
Women and Queer People at the Epicenter of Rising Infections
Several studies reveal why infections among Iranian women have increased. Research indicates that women who inject drugs more often with partners and share equipment are more likely to exchange sex for drugs or money and experience difficulty negotiating condom use. A Tehran study of 256 at-risk women found that although most had high HIV knowledge, they still engaged in unprotected sex and had multiple partners because they did not perceive themselves to be vulnerable.
Among female sex workers (FSWs), the pooled HIV prevalence is 1.52%, lower than the global estimate of 10–15%, yet researchers note that sex workers remain at high risk and require targeted monitoring and interventions. This low rate might also be due to the social and legal limitations that prevent sex workers being part of studies.
Reproductive rights also play an important role. Nearly 46% of people living with HIV in Iran are between 25–34 years old, sexually active and in reproductive years. Many women living with HIV express strong desires for motherhood, despite fear, stigma, and systemic barriers. Research shows that pregnancy can be both a stabilizing hope and a site of anxiety for HIV-positive women, who often face discriminatory treatment during pregnancy and childbirth.
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region
South Asia
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HIV and STIs
The total number of people living with HIV is around 40,000, with the gender distribution shifting from 81% men to 68% men, and from 19% women to 32% women.
Women and Queer People at the Epicenter of Rising Infections
Several studies reveal why infections among Iranian women have increased. Research indicates that women who inject drugs more often with partners and share equipment are more likely to exchange sex for drugs or money and experience difficulty negotiating condom use. A Tehran study of 256 at-risk women found that although most had high HIV knowledge, they still engaged in unprotected sex and had multiple partners because they did not perceive themselves to be vulnerable.
Among female sex workers (FSWs), the pooled HIV prevalence is 1.52%, lower than the global estimate of 10–15%, yet researchers note that sex workers remain at high risk and require targeted monitoring and interventions. This low rate might also be due to the social and legal limitations that prevent sex workers being part of studies.
Reproductive rights also play an important role. Nearly 46% of people living with HIV in Iran are between 25–34 years old, sexually active and in reproductive years. Many women living with HIV express strong desires for motherhood, despite fear, stigma, and systemic barriers. Research shows that pregnancy can be both a stabilizing hope and a site of anxiety for HIV-positive women, who often face discriminatory treatment during pregnancy and childbirth.
Stigma: The Shadow Epidemic
Across Iran, stigma can be more devastating than the virus itself. Negative perceptions, fear of transmission, and widespread misinformation about how HIV spreads — all contribute to mistrust, family conflict, and social isolation. A qualitative study describes stigma leads to rejection from family and community, homelessness, feelings of hopelessness, desire to die, anxiety and shame, and marital breakdown. Another study highlights how low awareness, fear, gender inequality, and lack of family support exacerbate the social isolation for people, and especially women living with HIV.
Healthcare settings, where stigma should be lowest, often become sites of discrimination. Healthcare providers usually hold stigmatizing attitudes due to insufficient knowledge of transmission, fear of infection, and religious beliefs. This stigma undermines Iran's ability to meet the UNAIDS 95-95-95 goals.
Why the Crisis Persists: Structural and Cultural Barriers
Gender inequality creates conditions for HIV vulnerability, as women's limited social power and economic dependence leave them exposed. Because non-marital sex, same-sex relationships, and drug use are criminalized and heavily stigmatized, people avoid testing and disclosure. Knowledge remains lower among women and lower-income groups, while provider-level stigma remains a significant barrier to treatment. Women living with HIV often face marital conflict and lack of family support, leading to isolation.
AIDS and Gender-Based Violence: A Dual Epidemic
UN Women emphasizes the strong link between HIV and gender-based violence. Women may contract HIV through coercion, marital rape, or inability to refuse sex. Additionally, after diagnosis, they may experience violence or abandonment. Integrated HIV-GBV models, such as those developed in Malawi, show success in combining psychosocial support, violence screening, reproductive counselling, and legal support. Iran's HIV response could benefit from adapting similar approaches.
The Power to Transform
UNAIDS' 2025 theme, AIDS, Crisis and the Power to Transform, reminds us that transformation is possible. For Iran, this means strengthening sexual health education, expanding voluntary testing and community outreach, training healthcare workers to eliminate stigma, improving reproductive rights and safer pregnancy programs, supporting sex workers and women who use drugs through harm reduction, and strengthening community-led networks of people living with HIV. Ending AIDS requires dismantling silence, not just scaling up medical services.
The tools to end AIDS exist. What blocks progress is inequality. The HIV crisis in Iran reveals how societies treat their most vulnerable, especially women. Ending AIDS requires making those invisibilized visible again. True transformation demands confronting stigma, strengthening rights, and placing dignity at the centre of public health.
The piece is written by Zeynab Peyghambarzadeh, a co-founder of Spectrum, a queer-feminist activist, sex educator and researcher based in the UK, and an online sociology lecturer at Iran Academia.
Photo Credits: Saied Goli/Mehr News Agency
