Table 1 Contextual factors affecting the HIV/AIDS policy-making process
From: Comprehensive analysis of the HIV/AIDS policy-making process in Iran
Themes | Sub-themes |
|---|---|
Situational factors | Synthetic and psychoactive drugs “A problem we have in this area, is the high supply and easy accessibility to drugs and psychoactive substances, which makes the control of substance use difficult” (participant 15). Child labour and street children “I, myself, have heard from one of health ministry administrators that the frequency of AIDS among street children is fourfold higher than its mean among the population” (participant 7). Consumerist lifestyle and irresponsibility “Within these nine years that I have worked as a consultant, I have seen that the luxury-oriented lifestyle of people and their unrestrained behaviors have resulted in disruption between family relations and … a majority of young people have turned toward wrong sexual behaviors, which, well, have altered the mode of HIV transmission towards the sexual way” (participant 27). Virtual networks “Currently, judiciary announced that they have arrested a band who misused virtual networks to advertise illegitimate concubine marriage and earned a huge amount of money…” (participant 8). Migration to the margins of metropolises “In recent years, migration to metropolises has increased. Well, they come to the cities to have a good income. However, due to weak financial ability, they inhabit in marginal settings, where there is a prone environment for unemployment, addiction, sex works and…” (participant 3). |
Structural-managerial factors | Inter-sectoral structure “I attend the different meetings of CCM. The thing I see there is that there is a low level of coherence and discipline between the organizations…” (participant 18). Intra-sectoral structure “… I have figured out that the main cause of our problems to prevent/control AIDS in Iran is that the issue has no influential custodian and trustee manager…” (participant 9). Executive management “… in many situations, when they [the representatives of related organisations] come to the meetings, they do not have a real structure to execute the programmes, and it is difficult for them to define AIDS control programmes within their routine duties” (participant 8). Financing and resource provision “… but, this ministry do not have a good budget for such a work. In real, there is not such a budget to be allocated to such works (AIDS control programmes)” (participant 14). |
Socioeconomic factors | Issues related to traditional culture “AIDS has a social obscenity, which cannot be easily discussed about, informed about or educated on. The reason is the interrelation between AIDS and sexual issues” (participant 15). Issues related to religion “When one is going to promote condom use within society, it means that he is going to promote out-of-marriage relationships. Well, this is in contrast to what is said in our religion” (participant 17). HIV/AIDS and sexuality as a taboo “As long as there is a taboo on discussing sexual issues, there would not be a good progress in our situation on HIV/AIDS issue…” (participant 15). Pervasive stigma of HIV/AIDS “… this stigma is such a horrible stigma that a HIV positive patient refrain from being hospitalized in this ward [infectious diseases ward], which is a ward for all kinds of infectious diseases. Because, they fear that their relatives or friends know about their disease [AIDS] …” (participant 33). “As soon as they [people] know that you are HIV positive, they think that you have had the disease from unconventional way [sexual way]. Once I was in a dentistry office when the administrator asked: When did you get? It doesn’t become you, at all! Soon she thought that I have gotten it from that way!” (participant 38) “Ordinary people don’t understand us at all! They think that we have committed a big sin, and now we don’t have right to live in this city, like others …” (participant 36) “As soon as the dentist heard that I am HIV positive, asked me respectfully to leave the dentistry office as soon as possible …, well, do you expect us to blaze that we have HIV wherever we go?!” (participant 38) Traditional education system “We see in our religious books that the rulings on sexual issues are openly described …. But, when one says that such issues should be educated to public, some says that this is in contrast to our religion” (participant 21). Addiction to drugs “During these two years that I have worked as a consultant, almost all of people who referred to me have had the disease from sexual way. A majority had also used such drugs [the new psychoactive substances] and then had had sexual relations” (participant 31). |
Political and Legal factors | Centralized political system “AIDS policy-making in the country has highlighted the participating role of private sector in terms of service delivery to increase the level of service accessibility among the patients” (participant 2). Top-down policy-making “Some of senior managers are extremely sensitive toward some statistics and indices related to AIDS, and so do not like those statistics to be spoken about” (participant 21). Lack of trust into NGOs “In general, the NGOs in our country are considered as a threat, and so are not allowed to be well developed.” (participant 12). Conflict between macro policies “Coming the policy of growing birth, the contraceptives are also disbanded, which has become a new dilemma” (participant 15). |
International factors | International agencies “… through a part of available resources, global fund is influential on the domains of addiction and AIDS” (participant 34). International trends and events “The pressure and the influences of international organizations to execute their emphasized policies have resulted in an emphasis on the approaches that are not relevant to the culture and the context of our society” (participant 17). |