Sexual transmission accounted for about 65% of newly identified HIV cases in Iran last year, replacing injecting drug use as the main route of new infections as diagnoses among women increased, a leading HIV researcher said on Thursday.
More than half of all people diagnosed with HIV historically have a record of injecting drug use, but harm-reduction programs have reduced new infections in that group, Ladan Abbasian, head of Iran's AIDS Research Center, told labor-focused news agency ILNA.
“Despite the high share of injecting drug use in the overall statistics, the pattern of new cases has changed, and in recent years most new cases have occurred through sexual transmission,” Abbasian said.
Programs distributing disposable syringes, directing injecting drug users toward methadone maintenance treatment and establishing harm-reduction and methadone treatment centers have helped curb transmission among drug users, Abbasian added.
Sexual transmission reshapes HIV pattern
Figures released in December 2025 showed that about 64% of HIV infections recorded during the first six months of that Iranian calendar year were attributed to sexual transmission, while the route of transmission was not recorded in 28% of cases.
Iran had identified 25,870 people living with HIV at the time, while the actual number was estimated at around 41,500.
A direct comparison with a worldwide sexual-transmission rate is difficult because UNAIDS primarily breaks down new HIV infections by population rather than route of transmission. Globally, key populations – including gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs – and their sexual partners accounted for 55% of new HIV infections in 2023, according to UNAIDS.
The proportion was considerably higher in the Middle East and North Africa, where key populations and their sexual partners accounted for an estimated 84% of new HIV infections in 2022, UNAIDS data showed.
Some infections categorized as having an unknown transmission route in Iran may also have resulted from sexual contact because patients do not always provide complete information about how they may have contracted HIV, Abbasian said.
A significant proportion of sexually transmitted cases involve sex between men, while having multiple sexual partners also increases the risk of transmission, Abbasian added.
Public knowledge about HIV prevalence, transmission and prevention remains inadequate, Abbasian said.
Some health experts have previously warned that government restrictions on access to contraception and the suspension of free distribution of contraceptives at some health centers could contribute to increased HIV transmission.
Fear of stigma can also discourage people from seeking HIV tests, with people living with the virus facing social discrimination.
Prevention and treatment
Condoms are not the only means of reducing the risk of sexual transmission, Abbasian said. Pre-exposure prophylaxis, known as PrEP, and post-exposure prophylaxis, or PEP, are also available, although public awareness of the treatments remains limited.
People seeking information, counseling and preventive services can use specialized HIV clinics and behavioral disease counseling centers, she added.
HIV can now be controlled with treatment but cannot be completely eliminated from the body, meaning the virus can become active again when treatment is stopped, Abbasian said.
New injectable treatments can also allow some patients to receive medication every two months or, in some cases, every six months to keep the virus under control, according to Abbasian.
People who have engaged in behavior carrying a risk of HIV transmission or believe they may have been exposed should seek testing, Abbasian said, adding that visits to behavioral disease counseling centers are voluntary and confidential.
HIV medication is provided free of charge to people who test positive, Abbasian went on to say.
Shortages of foreign currency and raw materials, unpaid insurance debts, difficulties transferring money, disrupted imports and rising production costs have increased concerns about the pharmaceutical supply chain, the Iranian news outlet Rouydad24 reported.
“The alternative routes for supplying raw materials and imports are time-consuming and can increase drug costs by up to three times,” Hadi Ahmadi, spokesman for the Iranian Pharmacists Association, told the outlet.
Shortages of raw materials, Ahmadi said, were hindering domestic pharmaceutical production at the same time that imports were facing disruption.
Rouydad24 described the problem as extending across the pharmaceutical supply chain rather than being confined to individual medicines or pharmacies, leaving patients to absorb higher costs.
Iranian citizens have also told Iran International in recent months that medicine shortages and rising prices have disrupted treatment for many patients. Some said difficulties obtaining conventional medicines had prompted people to turn to traditional medicine.
Domestic production depends on imports
About 99% of medicines by volume are produced domestically, but imports account for roughly 13.86% of the market by value, according to figures cited by the website.
The disparity reflects the pharmaceutical industry's dependence on imported raw materials, equipment and specialized products even when finished medicines are manufactured inside Iran.
Disruptions to foreign-currency transfers or shipments of raw materials can therefore affect factories before shortages become visible in pharmacies weeks or months later.
Iran's Food and Drug Administration has said raw materials and medicines are being moved through alternative routes because wartime conditions have disrupted transportation.
Those routes take longer and cost more, Ahmadi said.
Economic pressures have also changed how some Iranians pay for healthcare. Eghtesad News reported in July that installment payments had increasingly spread through the health sector, including for dental treatment and medicines.
Not enough currency
Iran's pharmaceutical sector requires about $2.2 billion in foreign currency for medicines and raw materials this year, but only around half of that amount has been supplied, Ahmadi said.
Changes to Iran's subsidized foreign-exchange system have added another source of pressure on medicine prices.
The Food and Drug Administration has said a complete removal of subsidized currency for medicines is not planned this year, although the allocation has been reduced for some products, including insulin.
The agency said the changes did not amount to ending subsidized currency for all medicines or necessarily signal a new wave of price increases.
Ahmadi offered a different assessment of the impact on medicines affected by the changes, saying the removal of subsidized currency for some pharmaceutical groups had pushed the cost of their raw materials up more than fivefold within several months.
Iran International reported in July that patients' out-of-pocket costs for insulin had risen more than 24-fold over about 50 days.
Higher prices fuel informal drug market
Shortages are only part of the pressure facing patients because medicines that remain available may become financially inaccessible as prices rise, Rouydad24 reported.
“If medicine is available on the market but its price increases several times over, for a patient who needs medication every month and permanently, the price increase can effectively be just as problematic as a shortage,” Rouydad24 wrote.
“If insurance cannot increase its contribution in line with price rises, part of the cost will be paid out of the patient’s pocket.”
The combination of shortages, rising prices and inadequate insurance coverage places particular pressure on people with chronic illnesses, older patients and those who depend on expensive or imported medicines, the outlet added.
Judiciary chief Gholam-Hossein Mohseni-Ejei has threatened an even harsher crackdown on another uprising. Leaked Basij audio has exposed anxiety inside the security establishment, while authorities have identified gasoline, unemployment and livelihoods as potential triggers.
Security forces have already opened fire on people protesting over jobs in southwestern Iran this week.
“The economic crisis in itself is turning Iran into a powder keg,” Khosro Isfahani, research director at the National Union for Democracy in Iran (NUFDI), told Iran International.
Fixing the conditions driving the anger would require the state to change into “something that is fundamentally not the Islamic Republic,” he said, adding that Iran’s rulers are willing to “kill as many as it takes to stay in power.”
At least 950 people have been executed since the beginning of the year. Not all were political prisoners, but the accelerating use of capital punishment has added to a wider climate of fear.
The same pattern can be seen in a renewed crackdown on compulsory hijab, cafe closures, pressure on workers and pensioners and the deployment of police onto the streets.
‘Damaged fruit’
And there is little economic relief in sight, with fewer and fewer families able to afford meat, fruit or even dairy products.
Economist Ali Dadpay points to damaged fruit, once sold cheaply to the poorest or left for the homeless, as an increasingly common measure of what many families can afford.
For decades, the Islamic Republic has sought to blame economic hardship on sanctions, foreign powers, merchants or individual officials. But Dadpay says it is becoming harder to separate what Iranians experience in the supermarket from the decisions made by the state.
Inflation, he said, has become “the perfect indirect taxation.”
Instead of openly raising the money needed to finance its policies, Tehran prints it. The rial loses value and ordinary Iranians pay the difference every time they buy food, medicine or other necessities.
They have been made “poorer and poorer and poorer,” Dadpay said, and are now in danger of being “permanently impoverished.”
Middle class no more
The deterioration is reaching people who once considered themselves middle class. Pensioners are protesting. Even some government-linked companies are struggling to pay wages that barely cover basic living costs.
“Even the middle class cannot afford,” Dadpay said.
And winter threatens to tighten the squeeze.
Gasoline is already in short supply. Mahdi Ghodsi, senior economist at the Vienna Institute for International Economic Studies, estimates Iran has lost 15% to 30% of its energy-production capacity through war damage and depreciation.
As temperatures fall, factories may have to shut down so scarce gas can be redirected to households.
Transport workers would be among those hit by worsening fuel shortages, with disruptions potentially spreading quickly through the wider economy.
‘Fragile calm’
Miad Maleki, a former senior US Treasury sanctions strategist and senior fellow at the Foundation for Defense of Democracies (FDD), says the regime is looking at the same deteriorating numbers as everyone else.
“To keep paying salaries and pensions to roughly eight million state payees, including its own security forces, the regime has been printing rials and borrowing directly from the central bank,” Maleki said.
“Ejei’s threat tells you they know how fragile that is.”
Dadpay points to Venezuela and Zimbabwe as reminders that governments can survive extraordinary economic deterioration. Money can be printed, salaries can be deposited and the machinery of the state can continue operating even as the population becomes dramatically poorer.
“Yes, it works,” Dadpay said. But what it produces is “a miserable impoverished situation.”
Iran’s rulers learned in November 2019, however, how quickly the calculation can change. A sudden gasoline price increase led to spontaneous protests that Tehran crushed with lethal force.
‘Revolutions are not advertised’
Inflation is easier to disperse. It quietly takes purchasing power from millions of people without creating a single moment around which they can mobilize.
The danger for Tehran comes when that diffuse suffering suddenly becomes concrete: an empty gas station, a bread shortage, a missed salary, a delayed pension or another sudden price decree.
That is when, Maleki said, scattered grievances can acquire “a single address and a single date.”
But there is another calculation now: fear.
Iranians have seen what happens when they confront the state. Ghodsi said the expected cost of taking to the streets has become enormous because people know they could be shot or killed.
And yet, he said, “society is boiling.”
What changes that calculation may ultimately be impossible to forecast. Ghodsi believes it could take an unpredictable shock. Isfahani looks for something even less measurable: the image, death or act of defiance that suddenly turns private anger into a collective cause.
Mahsa Amini became such a moment in 2022. Isfahani said he has not seen an equivalent tipping point yet. “It’s never about number,” he said.
He quoted his late father: “Revolutions don’t advertise their time of arrival. They arrive.”
The Islamic Republic may not know when, or whether, scattered economic grievances will converge into another uprising. But its threats, preparations and response to smaller protests are already showing how it intends to confront one.
Global News identified him as Mohammad-Reza Ghafouri-Fard, a 45-year-old Edmonton resident who has done business in Canada under the name Sal Ghafouri and whose father, HassanGhafouri-Fard, was a conservative Member of Parliament and former vice-president to Akbar Hashemi Rafsanjani.
Citing a recently declassified Canadian Security Intelligence Service (CSIS) report, Global News said Ghafouri had been the subject of a long-running investigation over his alleged work for Iran’s military and the Islamic Revolutionary Guard Corps.
According to the report, CSIS said Ghafouri was “involved in the research and development of Iranian military technologies” and allegedly helped develop a guided anti-aircraft missile system and an electronic warfare tool intended to counter US aircraft.
The report said CSIS also alleged that Ghafouri participated in a “covert procurement structure” that used a company in Southeast Asia to obtain components for Iranian military projects that were unavailable because of sanctions.
Government contracts
Global News said public records showed companies founded by Ghafouri received more than $2 million in government contracts, including from the Royal Canadian Mounted Police and Department of National Defence.
The report said Ghafouri had been flagged by immigration investigators for national security reasons in 2017 but later won procurement contracts, including two worth more than $1.5 million from the Canadian military. His companies continued receiving federal money after CSIS completed its security screening report in 2023, it said.
Alleged military work
Ghafouri worked for Iranian company Rabi Kosar, which CSIS described as conducting research and development for Iran’s military.
According to the CSIS report, Ghafouri worked on the Shahin missile used in Iran’s Mersad air-defense system, the RAAD electronic warfare project and the SINA direction-finding system, which had military applications including locating ships in the Persian Gulf.
CSIS alleged Ghafouri was later reassigned to procurement work, where requirements for military components were passed to a Malaysia-based contact who sourced parts from third countries, including the United States.
Ghafouri returned to Iran in 2015 and met twice with members of Iran’s Ministry of Intelligence and Security, who questioned him about his activities in Canada and advised him on how to respond if approached by Canadian police or intelligence services.
Citizenship case
Global News said Canada’s immigration department informed Ghafouri in May 2026 that it was launching proceedings to deny him citizenship on the grounds that he was a “threat to the security of Canada.”
Canada Border Services Agency had separately decided to launch deportation proceedings against him over his employment activities in Iran but withdrew the case in November because of an “inability to use the required evidence.”
His lawyer, Bjorna Shkurti, told Global News that Ghafouri “strongly disputes the allegations made against him” and intends to pursue all available legal avenues.
Global News said Ghafouri is also pursuing legal action over delays to his citizenship application and has argued in court filings that he answered CSIS questions truthfully, contributed significantly to Canada and does not pose a security threat.
