On December 8, 2012, the Joint United Nations Program on HIV/AIDS (UNAIDS) hosted a Red Gala Dinner at the Fairmont Hotel in Cairo, Egypt to raise awareness about the virus and how it affects the lives of over three hundred thousand people across the Arab world.
The by-invitation-only event featured high-profile celebrity attendees, including satirical television show host Bassem Youssef, and focused on the theme of supporting women and children affected by HIV.
The event showcased items made by local designers and even featured artisanal cupcakes from a trendy Cairo-based bakery. These items were later auctioned off and the proceeds were donated to Alexandra-based NGO, Friends of Life, which aims to provide comprehensive support to people living with HIV.
The gala fundraiser was covered by local media and may soon be featured in a photo spread in a prominent regional fashion magazine.
Missing from the evening’s programming, however, were stories about those communities most vulnerable to the virus, as well as discussion of the on-going cultural and religious debates happening at a global and regional-level surrounding HIV/AIDS.
This article is meant to encourage that conversation.
HIV/AIDS in the Muslim World – Scholarship and the “Facts”
Until recently, studies focusing on the intersection between HIV/AIDS and Muslims or Muslim-majority countries have been scarce.
Scholarship from the 1980s and 1990s focused on HIV-infection rates in Africa and examined Muslims as a statistical demographic group, if at all. Those articles that did touch on the Muslim world examined the fact that the number of people living with HIV/AIDS in the Middle East was dramatically lower than other parts of the globe, leaving one author to ponder in 1997, “Will Egypt Escape the AIDS Epidemic?”
It was not until much later that discourses on the relationship between religion and growing public health concerns began to emerge, producing enduring stereotypes. Religious pamphlets distributed throughout the Middle East and abroad detailed the writings of Muslim scholars, who portrayed HIV/AIDS as an illness pertaining to European and American homosexuals and who characterized HIV as a non-Muslim disease.
Reflecting on the lower-rates of infection in the Muslim world, American academics began to posit whether, in fact, Islamic regulations on sexuality, usage of intoxicants, and male circumcision contributed to a certain degree of immunity from HIV transmission for the Muslim community.
Only within the past two years have comprehensive scientific studies focusing on the Middle East and North Africa (MENA) region been published, attempting to fill the widely acknowledged knowledge and data-gap in the HIV/AIDS world map.
In 2010, the World Bank released Characterizing the HIV/AIDS Epidemic in the Middle East and North Africa: Time for Strategic Action, a report highlighting data collected from twenty-three Muslim-majority countries.
This groundbreaking work concludes that action must be taken by governments in the MENA-region to prevent the emergence of a widespread HIV epidemic. As reflected in the report, HIV infections exist in every country in the region with governments failing to control the virus’s spread.
As scholars and public health practitioners have warned, if no increased data-collection, prevention campaigns, or treatment programs are implemented, epidemic-level HIV outbreaks will likely occur among injecting drug users (IDUs), men who have sex with men (MSM), and female sex workers (FSMs) throughout the region.
Today researchers are asking, once again, why it is that Muslim communities appear to have lower rates of infection. Some recent articles have gone so far as to conclude that rates are lower in developing Muslim-majority countries because Muslims are less likely than Christians and Jews to have premarital sex.
While recognizing the influence of culture and religion on sexual and reproductive health, studies such as these add little value to discourses on Islam and run the risk of characterizing the religion as a universally standardized set of practices. To the contrary, Muslims throughout the world exhibit differences in both the practice and understanding of the teachings of Islam.
Notwithstanding advances in data collection and analysis on HIV/AIDS in the Muslim world, current academic work in the field of public health and sociology would greatly benefit from even richer data and ethnographic depth. While sustained interested in HIV-related scholarship should be encouraged and commended, more emphasis should be placed on both sexuality and reproductive health education, as well as anti-stigma and discrimination efforts to protect those already infected with the virus.
IDUs, MSM, FSWs – Susceptibility, Vulnerability, and Beyond
As noted above, the three groups – injecting drug users (IDUs), men who have sex with men (MSM), and female sex workers (FSWs) – are not only increasingly susceptible to contracting HIV, they also are more vulnerable to infection than the general population.
Each group, often seen as morally corrupt, antagonistic to traditional values, or simply a threat to the social fabric, faces heightened levels of discrimination that are aggravated by unfavorable state policies.
The following section details the challenges faced by each of these groups and some corresponding religious issues that increases their susceptibility to infection.
Injecting Drug Users (IDUs):
As a major source, route, and destination for the global drug trade, MENA countries—including Iran and Afghanistan—have witnessed an increased rate of HIV-prevalence in IDU-communities.
Through the use of non-sterile injecting equipment, IDUs often become infected with HIV. The network structure among injecting users additionally encourages risky sexual behavior, which may lead to infection.
Discussions around injecting drug users have focused on the authoritative sayings and traditions of the Prophet Muhammad (hadith) and Qur’anic verses associated with intoxicants (khamr). Some Qur’anic verses detail avoiding intoxicants, which are seen as temptations by Satan, so that one may live a prosperous life.
While IDUs are often denied compassion and viewed as sinners, the larger objectives of Islam can be read to encourage treatment for drug users. Scholars have argued that the principles of Islamic law (maqasid al-shariah) encourage harm reduction programs—public health strategies that tolerate otherwise risky or illegal behavior in order to reduce the consequences of certain behaviors—that may be justified on the basis of a drug-user’s personal struggle (jihad).
Men who have Sex with Men (MSMs):
In addressing men who have sex with men (MSM), it is worth noting the distinction between MSM-sexual practices and identification with those acts. Some have argued that terms like homosexual, lesbian, bisexual, gay, etc. are Western identity-categories, which have been imported from Europe and the United States.
Regardless, MSM should not be treated a synonym for gay or homosexual. Rather, MSM includes those individuals who may or may not identify as heterosexual, be married to a woman, or be a sex worker and have sexual relationships with other men.
Much like in Christianity, issues emerge from textual interpretation and conservative understandings of homosexuality and, more generally, sodomy. Current debates on homosexuality and Islam are prevalent, particularly regarding the degree, if any, to which Islamic law condemns or penalizes same-sex sexual behavior.
It is important to note, however, that the Qur’an does not contain the word homosexuality and, like the English language, there is no universally accepted term in the Arabic language to refer to individuals in the LGBT-community.
The story of Lut is a common reference point for many Islamically-oriented condemnations of same-sex relationships and, specifically, sodomy between men. Scholars have also noted hadith references in which the Prophet cursed men who engaged in sodomy and others that stipulate severe punishment for sodomy.
An alternative view of homosexuality in Islam is held by Dr. Scott Siraj al-Haqq Kugle via Muslims for Progressive Values, a global community grounded in inclusive and tolerant understandings of Islam. Rooting his analysis in the distinction between a sexual act and an individual’s sexuality, Kugle encourages those reading the Qur’an to distinguish between literal, semantic, and themeatic readings of the Story of Lut.
Female Sex Workers (FSWs):
HIV among commercial female sex workers is on the rise. The clandestine nature of sex-work, however, poses difficulties for those interested in collecting data about and researching the risks associated with such networks.
The frequency of client contact, often accompanied by lack of condom use and attendant drug usage, increase the likelihood of FSWs becoming infected with the virus. Two particular issues associated with increased vulnerability to HIV among female sex workers are existing power imbalances and the lack of comprehensive sexual and reproductive rights education for women.
Highly controversial and almost universally condemned, female sex work in the Muslim world exhumes discourses on the nature of sexual practices as regulated by the teachings of Islam. Unlawful sexual intercourse (zina) is heavily frowned upon in Muslim communities, and often strictly outlawed by the state.
Other debates around FSWs have focused on the Islamic permissibility of condom usage. Believing that condom usage promotes promiscuity, many Muslim organizations and leaders have spoken out against condoms and their inclusion in Islamic approaches to HIV/AIDS.
For sex workers—as with all individuals—condoms are an important way to protect against HIV transmission. There have been suggestions from some Muslim thinkers that condom usage may be permissible. Others argue that condoms may be justified through the Islamic jurisprudential maxim that the individual should always choose the lesser of two evils. Still other discussions on condom-usage and Islam suggest that if the Muslim individual knew of his HIV-positive status, it would be preferable for him to use a condom than to willfully inflict harm on another individual.
HIV/AIDS as a Religious Issue – the Cairo Declaration and Beyond
In late 2004, Muslim and Christian religious leaders from around the Arab world gathered in Cairo at the Regional Religious Leaders Colloquium, which included attendees like the Egyptian theologian, Yusuf Al-Qaradawi, the Grand Mufti of Egypt, Ali Goma’a, and the former Grand Imam of Al-Azhar, Mohamed Sayed Tantawy.
The meeting resulted in high-level Arab religious leaders signing the Cairo Declaration of Religious Leaders in the Arab States in Response to the HIV/AIDS Epidemic (Cairo Declaration), which encourages a faith-based approach to both HIV/AIDS prevention and treatment.
While reiterating that both abstinence and faithfulness should be the cornerstone of prevention efforts, the declaration places emphasis on out reach to vulnerable groups, particularly IDUs, MSM, and FSWs.
The signing of this document was a welcomed developmemt. Too often, religious scholars have chosen to focus on the supposed immorality of those individuals infected with HIV. One prominent and representative example of this can be found in the work of the Sudanese-born Islamic thinker and Professor at the International Islamic University, Malik Badri.
In a pamphlet based on lectures held during the late 1990s, The AIDS Dilemma: A Progeny of Modernity, Badri decries AIDS as a result of the modern sexual revolution, which facilitated the spread of the disease in the American homosexual and drug-using communities.
By 2009, however, Badri had adopted a less accusatory tone and focused instead on promoting an Islamic HIV/AIDS prevention model. Indeed, a religious trend seems to be emerging, one that focuses on compassion instead of condemnation.
Now living in Malaysia, a prolific Afghan scholar of Islamic law, Mohammed Hashim Kamali,** has promoted this theory of compassion in examining issues associated with HIV/AIDS. While he does not advocate a particular program for treatment or prevention or comment on whether or not condoms should be utilized, he does focus on the need to eliminate prejudice and stigma associated with HIV/AIDS.
Kamali is not alone in supporting a more compassionate Islamic approach to the disease. Positive Muslims, a South African-based NGO, is one example of a faith-based organization using religiously grounded initiatives to combat stigma and discrimination. Founded in 2000, Positive Muslims works to support South African Muslims living with HIV/AIDS, to increase awareness of the disease, and to encourage compassion among the entire Muslim community for those suffering from the emotional and physical effects of HIV.
In July 2012, the Global Commission on HIV and the Law released Risks, Rights, and Health, a report that provides evidence-based analysis on the ways in which the law has both mitigated and exacerbated the spread of HIV.
The report also calls on governments to outlaw all forms of discrimination, repeal punitive laws, and reform ineffective approaches to drug-use and intellectual property regimes, among others.
The Commission’s report should be taken as a frank admission that when it comes to HIV/AIDS, faith and religion matter. Throughout the report, the word sharia appears roughly fifteen times. Additionally, there is an abundance of references to religion, religious figures, and cultural traditions.
Whether espousing compassion for the sick or condemning perceived immoral behavior, religion has an intimate relationship with HIV/AIDS patients, particularly those living in Muslim communities. Civil society actors must not forget to engage with religious figures and consider the ways in which religion impacts those groups most susceptible to the disease.
*This article was updated on January 16, 2013 to correct for the nationality of Mohammed Hashim Kamali. The article originally described Mr. Kamali as being of Indonesian origin.