Acquired Immunodeficiency Syndrome (AIDS) is far more than a medical and biological problem (Hasnain, 2005). There are 33.4 million people in the world living with AIDS. The deadly disease has claimed over 25 million lives in last the three decades1. The World Health Organization suggests that the numbers will rise further in the coming years. The existing course of the epidemic is very unlikely to change unless the people affected by the virus, those at risk, and even others, jointly make an effort to adopt preventive measures and fight cohesively. Apart from the accidental modes of transmission, such as the vertical transmission from a mother to the child or through accidental infected needle injuries, certain behavioural patterns such as unprotected sexual intercourse and sharing of infected needles bring an individual to increased risk of HIV and AIDS (Palekar et al, 2007). Hence, the disease is largely avoidable by changes in personal behaviour. However, this is easier said than done because the factors that shape and influence human behaviour is very complex and extremely mystifying.
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With time, scientists and researchers have realised that social and cultural variables are important factors in one's behaviour which in turn is a big variable to HIV infection transmission. The ethical and moral issues related to HIV risk behaviours exist in all societies, but it is much more pronounced in the Muslim world. The Muslim world is large and wide, consisting of more than fifty countries, in which, nearly forty percent or more of the populace practice Islam. It stretches beyond three continents and encompasses many hundreds of culture. From Albania and Turkey in Europe, across countries bordering the Sahara in Northern Africa, and through the Persian Gulf and South Asia to Malaysia and Indonesia in the east, the Muslim world is home to over one billion people (Kelly & Eberstadt, 2005).
Thus understanding the role of social and cultural variables affecting HIV transmission in Muslim countries is critical for the development and implementation of successful HIV prevention programs in the future. The first case of AIDS in the Muslim world was officially recorded in the mid 1980s but still now many countries have not launched complete inspection, treatment, and education programs planned to prevent further spread of the epidemic. One of the major reasons behind this inaction is the assumption that adultery, homosexuality, pre-marital sex, prostitution, and intravenous drug use do not occur in the Muslim world or even if they do happen, it's so infrequent that the risk of the disease spreading in these nations is insignificant (Kelly & Eberstadt, 2005).
This paper would try to define the extent of the HIV/AIDS problem in Muslim countries, outlining the major societal and cultural problems. It will also try to highlight the challenges faced in the prevention of HIV/AIDS in Muslim societies. With two case studies from Bangladesh and Kenya, it will try to see how Islam as a religion was used as a tool to combat HIV/AIDS in these orthodox societies.
This paper will also try to suggest a few recommendations within the social, cultural and religious frameworks, to combat the growing problem of HIV/AIDS in the Muslim countries.
2.The Extent of the Problem in the Muslim World
It is difficult to get the exact figure count of the numbers of HIV/AIDS incidence, mortality rate and the prevalence of the disease in the Muslim world because many Muslim countries either do not report their statistics or are not transparent in reporting. However, Global epidemiological indicators, including the likes of World Health Organization's Global Health Atlas, indicate evidence of the growing threat of an HIV/AIDS crisis in Muslim countries. Agreeing to the same, a report from the National Bureau of Asian Research in the United States also mentions the ever-growing HIV/AIDS crisis in the Muslim world to be a grave problem that poses a potential serious threat to the nation, region and the world in itself.
Africa is one of the worst hit continents when we look at the AIDS victims and it continues to have the highest HIV/AIDS incidence and prevalence rates globally. The southern region of Africa is in worst shape. The number of HIV positive population range from 10-18% in Ethiopia, and 6-10% in Nigeria, and both nations have a major Muslim population. According to a recent report at the end of 2010, the areas worst hit in Africa will have nearly 40% Muslim population.
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Some Muslim countries, such as Nigeria and Sudan have already started to show evidence of an explosion in the epidemic rate scaling. On the other side of the world, countries like Kyrgyzstan, Turkmenistan, Uzbekistan, Kazakhstan, and Tajikistan, which were once a part of the former Soviet Union, face an upsurging epidemic. Coming to East and South Asia, India and China are the two most populated nations in the world. These two nations have a large Muslim population with 48 million in China and 138 million in India. The HIV/AIDS is on the upsurge in these regions, thus the Muslim population are not untouched (CIA Population Index, 2009).
The under reportage of HIV and AIDS cases in Muslim countries have a serious ill effect on the overall disease surveillance and monitoring, and hence prevention. As estimated 0.7 million people are currently living with HIV/AIDS in the Eastern Mediterranean Region but only 14, 198 AIDS cases have been officially registered since the start of the epidemic in the region3. This indicates the under detection, under reportage and surveillance difficulties.
In spite of the fact that the absolute number of HIV/AIDS cases in the majority of Muslim countries are in the Middle East and South East Asia, the African continent and other countries' complacency towards this hurting issue can prove to be costly, both in terms of lives being lost and health care costs.
The reasons for the spread of HIV in Muslim countries are still open to supposition. M.M. Pickthall in his book “The Meaning of the Glorious Qur'an” explains that Islam as a religion places high value on chaste behaviour and sexual intercourse outside marriage is declared a sin. It even prohibits homosexuality, adultery and use of intoxicants. If the Muslim countries followed these followings of Islam, then the spread of HIV/AIDS in these countries should be more likely to be lower than present situation. However, a logical mind would conclude that in spite of Islamic teachings, some Muslims do engage in activities that lead to acquiring HIV and hence the spread. These risky behavioural activities include premarital or extra martial sex. Men who tend to indulge in such risky activities have the prospect of transmitting the disease to their wives.
Though not as responsible as the men, the women, in the Muslim society are also susceptible. On a lesser scale, some women indulge in commercial sex trade - where the risk of getting infected by HIV is extremely high. These sex workers have poor social life and near to zero health care. They are not checked for sexually transmitted diseases including HIV and hence the affected ones spread the infection.
United States of America stands at a high risk of HIV infection spread through the Injection Drug Users (IDU) but more recently this is also becoming a concern in the developing countries, including Muslim countries. It is a risk because sex and drug related behaviour of the IDUs can easily facilitate the transmission of HIV and AIDS in the population (Selentano et al, 1998).
Governments of most Muslim countries have been very slow in their response to curtail the rapidly spreading disease. Despite the prevalence of evidence that the disease is epidemic, the government is slow to take actions. Rather than taking corrective measures, the policy makers in Muslim countries propagate Muslim ideals, which include abstinence from sexual practices and illicit drugs as the main protective action against HIV infection. Sexuality continues to be a topic of taboo for discussion and most government are in complete denial of facing an increasing HIV/AIDS threat (Kelly & Eberstadt, 2005).
3.The Issues Faced in Formulating Prevention
T. Scarlett Epstein defines culture as inclusive of behavioural norms of the society and an inventory of solutions. She suggests that the “success of developmental projects depends on changes in social behaviour that are often deeply rooted in traditional cultural norms, without an understanding of which it is unlikely that necessary and socially desirable behaviour changes can be expected to take place.”(Epstein, 1999) (12651 pdf)
The issue of HIV/AIDS prevention in Muslim countries is a problem entangled with difficulties. A multifaceted approach is required to handle the situation and special attention should be paid to the cultural norms. In order to implement strategies for HIV prevention in the Muslim countries, the social dynamics and practices of the population should be carefully observed. Analysis of the cultural framework in which risk behaviours arise provides noteworthy insight into those factors that shape and define the peripheral realities within which these behaviours occur. The understanding behind why people behave in certain manner and the resources available to them helps in providing them access to preventive measures against HIV/AIDS. In the high risk groups, it is important to understand that even within these groups; a few of the individuals choose to indulge in risk behaviours while others don't.
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Human actors make rational choices aimed at maximizing the expected utility of the outcome (Philipson & Posner, 1993). The subjective welfare of the actor and presence of uncertainty are two inherent components of expected utility maximization. When acquiring information is costly, an uninformed choice - one that underestimates or overestimates the risk to health of some contemplated action - may still be expected utility maximization.
Therefore, when education and counselling services are not readily and cheaply available, or accessing such services means the user has to disclose risk behaviours and is afraid to do so, he/she has no course but to make uninformed decisions. Effective counselling and education have been shown to change sexual behaviour and reduce the risk of HIV transmission even in high-risk groups.
Islam, the faith in the Muslim world defines the culture of the region and this culture gives shape and meaning to every aspect in an individual's life, including behaviour. It has been suggested that behaving in accordance with religious tenets may have impacts on health and disease transmission (Ellison & Levin, 1998; Reynolds & Tanner, 1995). The following are the few societal-problems that come in the way for designing HIV/AIDS prevention programs in the Muslim world:
3.1.The Gender Disparity
In most Muslim societies there exists a gender imbalance. This fact is evident in heterosexual relations as well as the economic and social Diasporas - where men enjoy greater power than women. For most women, the ideal life is one within the four walls of her house. Most women don't get proper education and are deprived of simple resources in life and end up being unaware of their legal, civil and sexual rights (Mary & Lalita, 1995). They are economically vulnerable and are always dependent on the men.
Khairunnisa, a 25 year old with 2 children, living in the suburbs of Kolkata, India says:
“If only I had proper education I would have been living my life on own my terms. It is this illiteracy that forces me to stay under extreme inhumane conditions forced by my husband.”
- (Khairunnisa in a telephonic conversation on 30.03.2010)
The sexual activity and behaviour is considered to the man's domain and a woman is never expected to take the initiative. If a women talks about sexual matters, she is characterised as ‘loose' and highly suspected of infidelity. She should always remain silent and innocent and not know much about sexualities or contraceptives. The cultural norms do not allow women to raise questions about sexual matters and her only job is to fulfil her husband's desires (UNESCO, 2002).
There are many like Khairunnisa in the Muslim societies. This is a concern in health matters because as far as these inequalities remain, women will be more vulnerable to contracting HIV/AIDS as they are less likely to negotiate and go against their partners infected with HIV/AIDS. They are also the victims of abusive relationships and hence do not speak up even when they are infected.
3.2.The Social Stigma
The social stigma that HIV/AIDS brings along with itself exists in all the societies but is far more pronounced in Muslim cultures (Parker & Aggleton, 2003). This is because according to the religious doctrines there is a great negative sanction for illicit sexual conducts. In general cases, if there is even a suspicion of illicit sexual conduct or any HIV/AIDS infection, the affected person(s) is discriminated against and shunned by the family as well as by the community (Hasnain, 2005).
The Naz Foundation Trust, a NGO working on HIV/AIDS and sexual health in New Delhi, India brings out the issue in light.
“We carry out free HIV/AIDS test in areas such as Seelampur and Shahdara but not many Muslim women turn up for such tests. We think it is just the social stigma that prevents them from leaving their house for a ‘HIV/AIDS test'.” (The Naz Foundation Trust in response to an e-mail)
This stigma thus prevents those who are at risk from coming forward for appropriate counselling, testing (as in this case) and the treatment. This evidently creates a barrier to successful operation of prevention and treatment strategies where they do exist.
3.3.The Prevalence of Ignorance
The population in the developed countries are mostly aware of the modes of transmission for HIV infection. However, in the developing countries, misconceptions about the disease and its causes are far and rampant. Most of the people living in Muslim countries and societies remain unaware that not all HIV infections can be transmitted only through immoral sexual behaviours. They don't know and fail to realise that the transmission can also inadvertently happen though mother-to-child, contact with contaminated blood or needle or the chances of an innocent wife getting infected by the husband who might have been infected with HIV/AIDS (Hasnain, 2005).
Dhaka Ahsania Mission, a NGO that works in creating awareness for HIV/AIDS in rural areas of Bangladesh writes:
“Ours is a country with nearly 60% of the population being illiterate and nearly 50% being Below the Poverty Line (BPL), it is a challenge going to the rural areas and make the people aware of the fact that HIV/AIDS is a dangerous threat to the world and it doesn't spread only through pre-marital or extra-marital sex. It is a difficult task but we are at it.”(Dhaka Ahsania Mission in response to an e-mail)
Naz Foundation Trust adds to the same:
“The grass root level is still unaware of all the causes of the disease. When we make field trips in the villages - you can't imagine the kind of silly questions that the people ask. But, we don't blame them, not many NGOs have taken the effort to educate these people.” (The Naz Foundation Trust in response to an e-mail)
Therefore, we understand that due to this lack of education there is a major unawareness about the disease. This is a key disadvantage in the road to prevention.
3.4.Few Other Issues
In addition to the issues mentioned and discussed above, the main challenges faced in the route to prevention of HIV/AIDS also include the grave concerns of poverty, mythical beliefs, lack of basic education, economic instability, internal conflicts, wars, lack of proper healthcare resources and infrastructure and even the intimidating role of religious leaders and activists.
Jonas Svennson (2007) in his study highlights the mythical belief when he records a local secondary school teacher in Kenya stating:
“You see somebody suffering from HIV/AIDS. You see all the signs. But they will tell you ‘ahah, huyu, ana jini' [this person has a jinn, i.e. is possessed by a spirit]. They will tell you ‘huyu ametumiwa na jini' [this person is being used by jinn]. They don't accept and you know they don't go to the doctors, because they say ‘amerogwa', [he/she has been bewitched], and so on. Maybe they feel it is shameful because Islam as a religion does not encourage immorality.”(Unnamed teacher in HIV/AIDS and Islamic religious education in Kisumu, Kenya)
To summarise, the issues mentioned above are not the only ones that the Muslim countries and societies are facing at large. However, it is established that the existing social, cultural, economic and religious frameworks that exist in the Muslim societies do not provide a smooth channel for prevention against HIV/AIDS.
The growing gender imbalances in HIV/AIDS rates among women and the propensity of the virus to be found excessively among the marginalized community in the Muslim world, deeply reflects the ingrained systems of societal inequality that inadvertently helps to further stretch of the epidemic.
Control of the HIV/AIDS epidemic in Muslim countries now largely depends on an amalgamation of individual and community level efforts to bring about the effective change in behaviour to break and control the string of transmission.
4.A Tale of Two Cities
4.1.Kisumu, Kenya: Islamic Teaching in Schools
Kisumu, the port city in western Kenya is the third largest city in the country. Islam and the Muslim presence in Kisumu dates back to at least 19th century (Said, 1995). The percentage of Muslim population in Kisumu is a politically sensitive issue. The data from various resources prove the same. According to 2003 Kenyan Demographic and Health Survey, the Muslims constitute 8% of the population (CBS, 2004). The CIA World Fact Book states that its 10%, whereas, Arye Oded (2000) estimates that the percentage of Muslim population is 20% and rising. The Kenyan Muslims suggest strong scepticism towards the official statistics and indicate that their percentage is as high as 40% (Yahya, 2005). Nevertheless, we can conclude that Muslims are a religious minority in Kenya, but a visible one.
Kisumu is also one of the most HIV/AIDS affected areas in the world. According to the studies carried out in 1998, the prevalence of HIV infection was around 20% for men and 30% for women (Hargreaves et al, 2004). More recent surveys in 2007 have shown that the figures have dropped and it is because of such programmes that are being carried out in places like Kisumu (CBS, 2004, p 223).
Today, the role of the news media has grown more than ever, perhaps because of the centrality of the news on offer (Wolfsfeld, 2007). There is a worldwide discussion on the role religion plays in relation to HIV/AIDS and with the media being far more prevalent, everything is under the lens. The media coverage focuses on religious opposition to usage of condoms, assertion of sexual abstinence and marital fidelity as the foremost paths of protection. However, there are also suggestions that the ‘religious faith based' organisations and religious leaders may play a significant positive role in fighting the spread of HIV/AIDS (Lagarde et al., 2000 & Odiwuor2000).
Some of the organisations in Kisumu have taken the Islamic Religious Education (IRE) approach to combat HIV/AIDS. They are funded by the Swedish International Development Agency (SIDA). The year 2002 onwards a new syllabus was introduced for primary and secondary schools that paid special attention to the happenings in the contemporary society. This includes addressing issues of health and as a consequence the issue of HIV/AIDS (MEST, 2002a, p. iii; 2002b, p. v.)
The IRE syllabuses explicitly mention HIV/AIDS. In the primary syllabus, HIV/AIDS is presented together with “‘corruption, drug abuse and environmental degradation'' as ‘‘emerging issues'' that the teachings of Islam should be related to (MEST, 2002a, p. 181). Similar mention is found in the secondary syllabus using “challenges of life” instead of “emerging issues” (MEST, 2002b).
The students are taught about HIV/AIDS within the context of akhlaq, moral teaching and explained how they have moral social responsibilities. The students are expected to learn not only about how the disease is transmitted but also how to use Islamic measures in controlling the HIV/AIDS pandemic. This is essential to the programme as previous academic literature and research proves that the HIV/AIDS prevalence in Muslim societies is less in comparison to others.
Anthropologist Peter Gray confirms the same and in an attempt to explain the phenomenon, he states that ‘‘several Islamic tenets may have the effect, if followed [my emphasis], of reducing the sexual transmission of HIV'' (Gray, 2004). He even provides examples and explains how the Islamic ban on alcohol consumption, which is one form of risk behaviour that can lead to HIV/AIDS risk, can be one factor. He adds hygiene is another aspect, pointing to ‘ritual washing'. Islamic ‘ritual washing' involves a ‘larger cleansing', which includes Ghusl, a bath undertaken to attain ritual purity, Tahara, the cleansing after sexual intercourse. Gray further refers to other studies and indicates that male circumcision may reduce risk of contracting HIV infection (Gray, 2004). However, the direct relationship between male circumcision and lesser risk of HIV-transmission is not accepted by every scholar (Boyle, 2004 & Siegfried et al., 2005). Lastly, Gray even points out to the religious bans on pre and extra-marital sex and homosexual relationships (Gray, 2004).
Hence we see that IRE teaching in its truest sense in the primary and secondary schools can make the difference.
The students in Kisumu are being taught about how to relate to those who are affected by HIV/AIDS, immoral trends in the society and its effects, which includes the spread of HIV/AIDS. Examples of sexual perversion are given, and those include zina (pre-marital and extra-marital sex), homosexuality, prostitution and incest.
The issue of condom usage is a tricky one for the teachers in class. When one teacher was asked if she discusses contraceptives in class. She replied:
“No, usually I don't. But some students will say: ‘Madam, condoms are not allowed in Islam': It usually ends up in a very interesting debate. The students will say, ‘condoms are not allowed in Islam'. Then I will tell them. ‘Then abstain!' They will tell me ‘We can't', and so it goes. . . . It is usually very tricky [laughter]. You know. Religion will tell you ‘no contraceptives' unless it is very very necessary. Like if you are going for hajj [pilgrimage]. But you see now, you've got to tell them that if you cannot abstain, which is the Islamic ideal, then use condoms. But I would not advice you to do that. And then there is the AIDS epidemic, so what do you do? You just tell them that this is what the religion is saying. But I know that you are in adolescence stage, you are developing, you want to explore . . . then you just have to be extra careful, and use condoms.”(Unnamed teacher in HIV/AIDS and Islamic religious education in Kisumu, Kenya)
Thus we find that the fight Islamic education is being used for social development. We know that religious education has an important role in socialising individuals into a group. This approach connects Islamic beliefs, practices and norms to the issues of daily life, HIV/AIDS in this case and works towards combating the issue at the root - by teaching the young kids about the same.
Several field studies carried out in Kisumu reveal that 95% of the school kids claimed that they had been taught about HIV/AIDS in the school. Interestingly 60% of the students agreed that Islam was the solution for HIV/AIDS in Africa. Many would raise doubts over the question but if we go by the observations of Peter Gray then Islam in its ‘truest sense' can certainly help fight AIDS (Svensson, 2005).
There are no official statistics comparing HIV prevalence among the Muslims and non-Muslims in Kisumu but a longitudinal study involving the students who are taught about HIV/AIDS with an Islamic approach may show positive results in the future (Svensson, 2005).
Mr. Erasmus Morah, the UNAIDS country head in Kenya sums up the issue in the following way:
“The religious approach is one of the best ways to educate the audience who are naive about the issue....if you're doing it at the lowest level possible then it helps our larger goal.”(Erasmus Morah in response to an e-mail)
4.2.Dhaka, Bangladesh: Fighting AIDS in Mosques
The first case of HIV/AIDS in Bangladesh was recorded in the year 1989. Since then the number has just kept rising up. The UNAIDS estimates that the number of people infected by HIV in the country is high at 12,000.4 The overall presence of HIV in Bangladesh is less than 1%, however, due to limited access to counselling and the dominance of the social stigmas, many Bangladeshis are not aware of their HIV status. Although being at a lower level of risk, UNICEF predicts that Bangladesh remains extremely vulnerable to an HIV epidemic, given the socio-cultural status of the country. The emergence of such an epidemic can prove to be futile for the poor nation. UNICEF predicts that the HIV rate in general adult population can rise to 2% by 2012 and 8% by 2025.
Bangladesh is doing well in comparison to other Muslim countries in controlling the AIDS epidemic. Comprehensive and tactically viable preventative measures are making sure that the gradual spread of HIV infection doesn't spread.
One of the organisations working hard on this front is the Islamic Foundation of Bangladesh. This is a constitutional body of the Religious Affairs under the Ministry of Government of Bangladesh. The main objective of the Islamic Foundation of Bangladesh is to promote understanding of the social ethics and principles of Islam through education, dialogue, and multi-media information programs in the society. However, the foundation also focuses on HIV/AIDS awareness programs. It is here they have really brought a difference in the Bangladeshi Muslim society (Huda, 2006).
The foundation trains the Imams, the religious leader of a mosque, who is highly respected within the community, to create awareness in the society. They are encouraged to cite verses from the Quran and the Hadith to warn people about illicit sexual activities that might bring them to risk of being infected by HIV.
The Friday prayers are auspicious for Muslims around the world and usually there is a large gathering. The same is the situation in Dhaka too. The prayers are usually followed by Khutba, the Islamic sermon where public preaching takes place (Fathi, 1997). During recent times the topic of discussion at Khutbas, has seen a drastic change. HIV/AIDS, a topic of taboo for a Muslim society is now being freely discussed by the trained Imams at these congregations.
Moulana Azad, who now works as a Project Director for Bangladesh AIDS Program (B.A.P) has been attached with the Islamic Foundation of Bangladesh in the past. He explains the step by the foundation.
“An Imam is supposed to speak about social issues in a Khutba. I am glad that the present day Imams are speaking about HIV as this is one of the most dangerous social issues Bangladesh and rest of the world are staring at. There can be up to 400 to 500 people in a large mosque for Friday dhuhr (noon) prayers. If we consider that even half the imams across the country speak about HIV and AIDS, then the reach can be far and wide. A lot and lot of people will listen to what the Imam has to say....and not just listen; they would follow because an Imam is a man of high position in our society.” (Moulana Azad in response to an e-mail)
The Imams trained by the Islamic Foundation of Bangladesh not only speak about the issue in Friday prayers but they also have different ways of reaching the people. They speak about it every morning after the Fajr (Morning) and Maghrib (Evening) prayers. Though the turn-out is not as big as Friday dhuhr prayers but the message is send across to those few ‘extra' people (Huda, 2006).
To reach across to the women the foundation organises special workshops led by women peer educators. These workshops are frequent and advertisements are carried out inviting women from all walks of life to come forward. The names of the women attending the workshops are kept confidential for their privacy concerns.
Moulana Azad adds:
“HIV doesn't differentiate within a man or a woman. We all know it's really difficult for the women in our society. Because of the social stigmas and discrimination they find it tricky to come out in the open. It is here where workshops such as these come in extremely essential as their names are kept confidential.”(Moulana Azad in response to an e-mail)
The Islamic Foundation of Bangladesh has done commendable work in the last few years and 51,000 Imams have been trained under the programs. These Imams have continued sending out the awareness about HIV/AIDS in the society and thus helping the larger cause of preventing the outburst of the epidemic.
5.Recommendations: The Road Ahead
As confirmed, the Muslim world is not untouched by the HIV epidemic. Hence, there is an emergent need for developing and implementing policies and effective programs that raise AIDS education and prohibit the stigmas surrounding it. Like most religions, Islam too condemns homosexuality and sex outside marriage. The most ideal protection is abstinence from sex and to remain faithful to one partner, however, the point should be recognized that there is a difference between ideal and real world situations. The risky behaviour that brings about a higher chance to get affected by AIDS is not allowed by Islam, but they indeed are practised. The main challenge facing the Muslim world is to bridge this gap.
5.1.Harm Reduction: A Possible Way
Harm reduction should be implemented in the all the Muslim countries since it is a pragmatic philosophy that targets to reduce risks to the individual and the community itself. Harm reduction is an approach to remove stigmas and illegal behaviour from the society. Though this approach is prevalent in some Muslim countries but the religious scholars seem to be divided on the concept it follows. In countries such as Uganda and Indonesia, where the threat is rapidly rising, the religious scholars are taking a more flexible stand and justify the usage of condoms and clean needles through Quranic and Hadith teachings. The clarification given is that the sanctity and importance of life is greater than the sin of condom usage and this strategy should be used as emergency measure to prevent the epidemic (Kelly & Eberstadt, 2005).
However, the Muslim countries where the prevalence of HIV/AIDS is less or non-existent, the religious leaders believe that approving promotion of condoms will encourage sexual promiscuity. To end this controversy, the Organization of Islamic Countries (IOC), a 57 member group of Muslim countries from the Africa, Middle East, Caucasus, Balkans, Central Asia, Southeast Asia and South Asia should draft a regulation and design harm reduction strategies for the Muslim countries.
5.2.The Role of the Religious Leaders
The religious leaders in the Muslim community have a huge impact in the society with what they preach. In order for prevention of HIV/AIDS and designing successful campaigns in the Muslim society it is important to note the critical roles these religious leaders play. Collaboration with the religious leaders and scholars will be the best step forward. However, there are critics of the same who believe that the work of religious leaders is not to speak about such immoral issues.
When asked, “Shouldn't the central body of Imams in the state take a collective action and make it mandatory to generate awareness about HIV/AIDS, especially in the villages?” one of the most senior Imams in Kolkata seemed agitated and said:
“The work of an Imam is of utmost respect and it is highly dissolute of them to speak and preach about such immoral issues as HIV/AIDS.”- (An Imam from Kolkata in a telephonic conversation)
People who are against the ideas of the religious leaders and scholars are less and few. In Kolkata itself the Asian Muslim Action Network (AMAN) Foundation, an organisation that seeks to raise awareness about HIV/AIDS has been engaging Imams in their plan of actions for a couple of years now. This move has been highly successful.
Sohail Ahmed, the secretary of AMAN in the state of West Bengal highlighted the reason behind this move.
“We thought about it a lot and then decided to involve the Imams because they are the most respected voices in our community. We have to realise that the rate of literacy is very low in our community and hence any campaign carried out in television or newspaper will work only to an extent. On the other hand this population respects an Imam and holds him in high esteem. So his voice will be a voice of power and belief. We organize frequent workshops where Imams turn out in large number to participate and learn. Then they go out and preach. It's a simple but effective process.”(Sohail Ahmed in a telephonic conversation)
Involving religious leaders and scholars can be extremely beneficial. Studies and data from the past confirm the fact. In 1992, the Islamic Medical Association of Uganda designed an AIDS awareness campaign for the Muslim society in Uganda. The campaign involved twenty three trainers educating over 3,000 religious leaders and scholars, who then went back to educate their communities about HIV/AIDS during the religious gatherings (Farrel, 2003). After two years, the awareness level were tested and the studies found that there was a significant increase in accurate knowledge of HIV transmission, methods of prevention and the associated risk behaviours. Strikingly, there was also a notable reduction in self-reported sexual partners among young respondents of less than 45 years of age. In addition, there was a considerable increase in self-reported condom usage among males in urban areas. Reports in 2004 confirmed that there is a huge decline in HIV/AIDS prevalence among the members of the Muslim community in Uganda, with a drop from 18% in the 1990s to 6% in 2004 (Kelly & Eberstadt, 2005).
5.3.Transparent Governments Required
The Muslim nations need to come together in open. There is a lack of clear information in the Muslim nations as only a handful of cases are recorded. The major health organizations don't have a clear count of these nations. It is time for the leaders of these countries to realise the epidemic their nations are facing which needs urgent assessment. The system needs to get transparent, for both, the ones who are affected and the ones who are not.
One of the Muslim governments that are supposedly did things right was the Iran government under President Mohammad Khatami in the years 2000-2005. The administration was very forthcoming about the extent of the epidemic in the nation and the urgent need to control and prevent further spread. The government also passed laws to protect the rights of the affected in order to reduce the social stigma and discrimination people face in Muslim societies. Mahmoud Ahmadinejad, who came to power after Khatami, has carried the good work ahead and recent developments look even more promising (Kelly & Eberstadt, 2005).
There is also an urgent need in Muslim countries for enhancing HIV prevention and therapeutic services for high-risk groups, such as drug abusers, commercial sex workers and those with alternative sexual lifestyles.
5.4.Western World's Efforts
The Western world too needs to come forward and assist the Muslim societies grappling with this crisis. The West can cooperate with the Muslim leaders and design and implement culturally acceptable and appropriate behavioural change and counselling programs. Most of the Muslim countries lack the infrastructure to support a HIV/AIDS care - countries such as United States of America can help in designing and improving the public health systems in the Muslim countries that are lagging behind. An improvement in general public health system can also help reduce other health problems and in general raise the quality of life in these countries.
Limited attention has been paid to the manner in which social, economic and political variables restrict or enable individual behaviours related to AIDS. The association of variables such as social and human capital along with religiosity compels prevention of efforts to look beyond the traditional biomedical model of AIDS prevention. The prevention has failed in the past, or rather not worked at its best because not much research was done to note the critically important cultural dimensions. The models developed in the Western countries can be tailored and adjusted according to the local Muslim culture to address the needs of those who are at risk or are suffering from HIV/AIDS.
The threat of rising HIV/AIDS infection in the Muslim world is a major cause of concern. This problem needs effective education in public health method for controlling the spread of HIV/AIDS. There are many political, social and cultural barriers preventing the treatment services. There is an immediate need to cross these barriers. The goal of prevention is an ongoing process, open to change and flexible to adapt. Opening to such changes and adapting to such flexibilities within a difficult and rigid cultural and religious framework is not easy but there lies the challenge. As the success stories of Kenya and Bangladesh revealed, it can be done. One of the ways to reach out to the audience is through the religious teachings itself and in doing so the religious leaders play the most important role in the society.
The recommendations mentioned in the paper included the fact that risk needed to be viewed within the context of the social subculture of Muslim countries in order to design strategies to reduce it. The Muslim countries need to come together, the religious leaders need to lead in true sense and with transparency in national governments along with some help from the western world this problem can be fought. However, none of the above with be successful without reducing the stigma HIV/AIDS brings along with itself in the Muslim countries.
7.Limitations and Learning of the Study
A number of barriers came into the way of this study. To begin with, the major health organisations in the world do state that HIV/AIDS in a major problem in the Muslim world but there are no specific data available. The reasons being that UNAIDS and WHO don't provide data of HIV/AIDS patients based on their religion nor do the Muslim countries come up with correct facts and figures.
Secondly, success stories from the Muslim world is rare and few. The story about Kisumu, Kenya was an interesting one considering the high rate of prevalence but I just had to rely on the few secondary data available. Though I did get considerable and important feedback from the people attached to UNAIDS in Kenya and different NGOs in Bangladesh and India.
Thirdly, it was a difficult task asking unknown people to open up and discuss their problems over the phone. I had to make several ‘warm-up' calls just to know them better way before talking to them about the subject. Inspite of doing so only a handful of people discussed their problems without any hesitation.
Lastly, the biggest challenge I faced was in talking to the religious leaders about their role in HIV/AIDS prevention in the Muslim societies. It was extremely difficult to get to them as not many of them were comfortable in talking about a topic still considered to be a taboo. One of them had doubts about my motive behind this study while other raised concerns over my religious identity. However, here also I did manage to get considerable feedback from some of them.
There were other limitations and barriers to the study too but on the whole it proved to be an opportunity of extreme learning and gratification.
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