AIDS and the Muslim world

‘ONE Campaign’, a global advocacy group, proudly declared on the eve of World AIDS day 2014 that the HIV/AIDS pandemic has reached a ‘tipping point’, in the sense that more people were added to life saving HIV treatment than the number of new cases recorded. This was a first in the decades-old fight against HIV. This may be a significant development and herald the beginning of the end of HIV pandemic but and may require several more painstaking years to actually come to fruition. Lost in the euphoria, lies the sobering fact; that there are around 35 million people living with HIV in the world today. There were 2.1 million new cases recorded this year, down marginally from 2.2 million last year. A disease that primarily affects young adults, and with a long latent period, the economic burden of HIV/AIDS is very high.

The discourse of HIV in the Muslim world has traditionally been quite ‘othering’, in the sense that HIV has long been ingrained into the average Muslim psyche as being the quintessential ‘non Muslim disease’.  Remarkably, the commonest modes of spread of HIV, namely high risk sexual contact (specifically  homosexuals and commercial sex workers) and intravenous drug abuse are both strictly forbidden in Islam. Added to that, the protection afforded by near universal circumcision among Muslim males produced remarkable results. The disparity in incidence of the disease between North Africa and Sub Saharan Africa (the disease prevalence in North Africa is 10 times lesser than in Sub Saharan Africa) has often been attributed to the Islamic practices and social norms.

The social norms in Muslim societies that enjoin chastity and fidelity, also lead to identification of HIV/AIDS as a taboo subject which spills over into stigmatization of people lining with HIV.

In this context, a long oversimplified claim about Muslim societies being a watertight bulwark against AIDS proliferated. While supported by statistics, such a claim has, in the long run contributed to an exact opposite result; some of the countries where the AIDS/HIV incidence (while still relatively low) has shown an increase over the preceding years include countries like Bangladesh, Indonesia, Kazakhstan and Kyrgyzstan (UNAIDS report,2013). Muslim societies, like other religious societies, perhaps only more so, shows a certain denial when it comes to HIV. The social norms in Muslim societies that enjoin chastity and fidelity, also lead to identification of HIV/AIDS as a taboo subject which spills over into stigmatization of people lining with HIV. A culture of silence prevails which leads to profound public health challenges in the form of under reported disease incidence and poor utilization of health services. This stigmatization also silently enables the spread of HIV as tracing of sexual contacts and drug users becomes impossible. At a higher level, a sense of governmental complacency in terms of budgeting and instituting national AIDS control programs exists. Misplaced fears about anti HIV/AIDS campaigns also make matters complicated in spreading awareness of the disease. It does remain a bit of a travesty that a society that enjoys an intrinsic advantage against AIDS should lose it due to certain culturally adopted mindsets.

On the other hand the discourse in the post modern societies tends to divorce questions of morality from disease. The medical fraternity is primed to exhibit a non judgmental attitude towards high risk groups and AIDS patients. The expected dynamic of a doctor patient relationship is friendly, non judgmental and non discriminatory. This enables a sense of empowerment among the victims of HIV/AIDS and improves their subjective experience of health services leading to greater confidence, compliance and in turn, success of disease control programs. A new approach of controlling disease, called ‘harm minimization’ wherein high risk groups are provided with education as well as protective means has been very successfully used to prevent the spread of HIV. Instead of the old zero tolerance policy (as implemented in the USA), countries like Australia and Canada have used the harm minimization strategy of providing sterile needles, drug withdrawal treatment and HIV education to high risk groups with great success.

Quite often, AIDS control campaigns mimic the agendas of sexual freedom and redefining of ‘morality’. Such an approach totally ignores the ill effects of removing the Islamic character of Islamic societies that, by and large, protected them from AIDS pandemic in the first place.

While the new approaches are quite successful in preventing spread of HIV, there seems to be a  total disregard for social sensitivities of Muslim societies by the global AIDS organizations. The advocacy for empowerment can sometimes become a proxy for imposition of societal changes leading to erosion of values. Quite often, AIDS control campaigns mimic the agendas of sexual freedom and redefining of ‘morality’. Such an approach totally ignores the ill effects of removing the Islamic character of Islamic societies that, by and large, protected them from AIDS pandemic in the first place.

In the light of this disparity of approaches, a ‘new normal’ can be defined by Muslim societies. A continued effort to strengthen the values and mores that protect against HIV should be encouraged. Meanwhile, it should be remembered that enjoining chastity and morality remains a pursuit independent of the effects of disease and health. Discouraging sexual promiscuity and drug abuse remains an Islamic endeavor irrespective of whether these acts cause disease or bodily harm or not. Sin and repentance, punishment and forgiveness are recurring themes in Islamic theology. The idea of compassion, especially to the one who is suffering, is considered noble in Islam. The Islamic ideal of covering people’s faults and not disclosing them to the world can be a starting point of instilling a non judgmental attitude among the health care personnel. The ‘harm reduction’ strategies mentioned earlier are very much in line with objectives (maqasid) of shariah, that is, to avoid the greater evil.

In a nutshell, I argue that Islamic moral viewpoints are inviolable theologically and should be viewed as a sort of highly sophisticated social contract rather than as a mere set of taboos.  The ideas of chastity before marriage, fidelity to the spouse and avoidance of anything deemed lustful (or ‘fahsh’, whether open or concealed) go a long way in keeping a society physically and spiritually healthy. The uncompromising rejection of intoxicants, drug abuse and all activities leading to it, is a strong deterrent to HIV spread. The fight against AIDS cannot be considered sincere if it seeks to remove these very values. Simultaneously, the culturally ingrained ‘silence’, the judgmental attitude, and the identification of AIDS as a ‘non Muslim disease’ should be done away with. The health professionals and social scientists (religious scholars including) should promote a more humane and open minded approach by encouraging harm minimization strategies for high risk groups while working for their rehabilitation. This would reflect a culturally acceptable and highly effective best of both worlds strategy.