The professional work of the co-Presidents started in the land of their birth, Iran. It is here that the very constrained cultural and social circumstances led the Alaei brothers to painstakingly develop a unique approach to advancing the human rights of the most discriminated and excluded members of society through the humanitarian and inclusive approach of health and its response to high risk groups such as intravenous drug users.
They were able to develop their activities in responding to the HIV/AIDS epidemic from a tiny corner of a health facility in 1997 as a pilot to a national strategy approved and funded to the tune of $16 million by the Global Fund allowing for free treatment for HIV throughout the country and with the supportive fatwas of religious authorities and the full backing of government authorities including several ministries. Their years of practice, engagement and strategising followed.
A unique insight gained by the co-Presidents was that rather than trying to create new channels for health delivery, that would be of risk of being swept aside in light of changed political fortunes, they should embed the projects into existing programs and the country’s existing primary health care system. This also allowed for the training of thousands of existing healthcare professionals to respond compassionately to these at risk groups in relation to previously taboo health concerns.
Through their innovative approach, the position dramatically shifted from one of outright rejection to the embedding of HIV/AIDS prevention into sustainable national policies. It did so through a “‘bottom-up’ approach that involved not only HIV/AIDS patients but also their partners, their families, and the community … [and] a harm-reduction approach that included needle exchanges for injecting drug users, promoting condom use, and supporting peer education and counseling.”
This allowed the co-Presidents to engage at risk groups about HIV/AIDS and implement harm reduction among them, allowing them access to groups previously hidden due to the tremendous social stigma attached to them. It also allowed for an integrated health service delivery, since when “HIV cases need care, their partners and children need prevention. All of them need social support.”
Over time, their innovative method become an award winning and successful model of HIV prevention promoted by the WHO as the ‘Triangular Clinic’ and hailed in scholarly publications. The Triangular Clinic model was recognised as seeking to “address injecting drug abuse through a harm reduction approach, while also providing services for the treatment of sexually transmitted diseases (STDs) and the treatment, care and support of people living with HIV/AIDS”. Their work was described by Physicians for Human Rights in this way: "[t]heir landmark efforts to bring patients, communities and families together to reduce stigma and provide comprehensive Aids prevention and treatment are remarkable and remain singular achievements in healthcare in Iran." The needle-exchange aspect of the work was also recognised by the UN Programme on HIV/AIDS in 2008 as one of the "clear examples of courageous, visionary leadership in the response to HIV".
This serves as the hallmark of the IIHE approach. It takes a profound and comprehensive right to health approach to advancing human rights for high risk groups suffering tremendous social stigma. It has been described by the IIHE co-Presidents in this way: “[a]ny one programme may work for a subset of the drug addicted population or at a certain point in a person’s recovery, but to reach more people and to achieve the desired results we must have a more comprehensive programme, offering a wide range of options for treatment, harm reduction, and recovery.”
This holistic approach shows unique promise in unfavourable and conservative social and political contexts - in part due to a ‘don’t ask’ policy - and due to its ability to deeply engage a wide range of actors throughout society in bringing about this changed approach.
Though a change in political mood cast the co-Presidents into prison in Iran and later forced them into exile, that has allowed the IIHE approach to be developed, operationalised and tested in a wide range of other national contexts.