HIV/AIDS in the Muslim World

The National Bureau of Asian Research (NBR), a Seattle-based, non-profit, non-partisan research institution (i.e. 'think tank'), has released a troubling report entitled Behind the Veil of a Public Health Crisis: HIV/AIDS in the Muslim World, written by Laura M. Kelley and Nicholas Eberstadt.

As the global AIDS epidemic has worsened in recent years, much of the attention has been on Africa, and for good reason. India¹ has also been in the spotlight, as has Eastern Europe, and even more recently, Asia. Sadly, if this June, 2005 NBR report is accurate, then AIDS has not only reached the Muslim world, but it has firmly entrenched itself in a society still largely in denial:

What is especially troubling to behold is the reluctance to admit that Muslims engage in exactly those same dangerous behaviors that support the transmission and spread of HIV/AIDS elsewhere. This attitude of denial is deeply rooted in the cultural and religious attitudes of Islam and supported by the many authoritar­ian regimes that populate the Muslim world. This reluctance even to recognize the problem will only accelerate the epidemic and make it more difficult for the international community to provide meaningful support and treatment. Another sobering implication is that is now truly a global crisis in terms of both geography and impact.

Even in cultures with relatively liberal views towards sexual conduct and drug use (sexual encounters and needle sharing are the two primary conduits for HIV), there is a strong social stigma attached to sufferers of the deadly virus. In a devoutly religious culture, the burden on victims must be truly unbearable.

The NBR report offers three main arguments:

Despite the fact that the Muslim world is home to many of the behaviors—such as premarital sex, adultery, prostitution, homosexuality, and intrave­nous drug use—which have helped spread the HIV virus in other countries and regions around the world, many governments in the Muslim world have been slow to respond to the rapidly spreading disease.

Two characteristics of the Muslim world in particular are resulting in both a denial of the problem and a lack of pro-active organized efforts for infection control: 1) the fusion of faith and statecraft in many Islamic countries and 2) weak or absent democratic practices.

Government response has varied: some countries like iran and Bangladesh have been relatively proactive in admitting to and beginning work on the problem, while others have been much more passive.

Note that the first main argument highlights some of the high-risk behaviours associated with the spread of HIV/AIDS. Obviously what the authors are implying is that many high-risk habits which are frowned upon or forbidden in Muslim society are in fact taking place. Denying so has resulted in, and will result in further inaction against AIDS; inaction in turn results in an uncontrollable spread of the virus throughout a community which denies its very presence.

The report also offers five "Policy Implications":

The successes of Thailand’s aggressive anti-HIV campaign contrasts starkly with the dramatic mushrooming of the crisis brought on by South Africa’s reluctance to tackle the problem—a difference which clearly demonstrates the need for countries in the Muslim world to tackle these problems now.

If leaders continue to ignore the problem, AIDS could debilitate or even destabilize some of these societies by killing large numbers of people in the 15 to 49-year age group, thereby depriving these countries of some of their best, brightest, and most economically productive members.

One immediate need is to make good faith efforts to survey for infection all commercial sex workers, drug abusers, and those with alternative sexual lifestyles—not simply those who identify themselves as being either infect­ed or possibly infected.

Sweeping legislative and social changes—such as protecting the legal rights of the infected, promoting safer alternative behaviors among high-risk groups, and spreading the message that being a good Muslim can include taking care of those infected by the disease—would be helpful in combat­ing the spread of HIV. HIV/AIDS-education and control efforts could also become part of each citizen’s zakat (charity duty).

The international community can also assist by helping poorer countries establish social programs, advising on the public health infrastructure required to support successful treatment, or simply sharing experience in drug treat­ment and behavioral change efforts—all steps which would be most effec­tive if tailored to local needs.

The second implication is a good point; from a dispassionate, societal perspective, a true AIDS pandemic would infect and kill the most 'productive' and 'economically valuable' members of society (i.e. those of working age). Taking it a step further, HIV can also be transmitted from mother to child which creates generational expansion. It is in a government's best economic interest to protect these 'valuable' citizens; that is what gives a cynic like me hope that steps will be taken in every corner of this corporate planet, eventually.

I encourage anyone interested to read the full, 18-page report, but here are the highlights:

SCOPE OF THE CRISIS

• Muslim world: 50 countries; 3 continents; many hundreds of cultures; over 1 billion people
• very diverse community; majority of Muslims are non-Arab and live outside the Middle East; wildly varying social and economic backgrounds
• common bond: lack of separation of faith & state, relative absence of democratic systems
• one woefully low estimate suggests 1 million HIV sufferers in North Africa, the Middle East and predominantly Muslim Asia
• many Muslim countries lack comprehensive surveillance, treatment and education programs
• a common assumption is that premarital sex, adultery, prostitution, homosexuality and intravenous drug use do not occur (or happen infrequently) in the Muslim world
• the denial of risk and lack of infection control is enabling HIV/AIDS to spread from higher-risk to lower-risk groups
• almost 60% of HIV-positive Iranians (e.g.) commit suicide within a year of diagnosis

CRISIS RESPONSE

Perhaps surprisingly, Iran has been extremely progressive in dealing with the problem (I would argue that they are currently more progressive towards addressing HIV/AIDS than some western nations e.g. the U.S.):

• former President Khatami has been forthcoming with the world press about the scope of the problem
• Iran has passed laws to protect the rights of the infected and even to reduce the social stigma associated with the disease
• HIV education is now standard cirriculum in many Iranian public schools
• needle exchange programs have been offered in high drug-use areas of Tehran
• syringes are now sold over-the-counter in many pharmacies
• drug treatment programs are currently being strengthened
• the commercial sex trade is still in dire need of help, however

Bangledesh is another Muslim society showing advancement:

• considerable progress in HIV-education and prevention efforts
• efforts to increase condom use, including among the young
• awareness programs in mosques (!)
• religious leaders, including a few women, have been trained to deliver educational & prevention messages

Most other Muslim countries are ignoring the problem:

• no surveillance programs in countries with significant intravenous drug use, such as Afghanistan and Iraq (countries which also happen to be under military siege by America and probably need to address their electricity and drinking water situation first)
• Saudi Arabia and other Gulf states have traditionally blamed foreign workers/visitors for the presence of the disease

FUTURE IMPACT

• Iran and Bangledesh, despite their efforts, are expected to face a severe epidemic; Iran's emergence as a regional superpower is in jeopardy while Bangledesh faces perpetual widespread poverty
• 1990: Thailand and South Africa both had a very low (but growing) national prevalance of HIV. Thailand, with international help, began an aggressive anti-HIV campaign while South Africa ignored the problem. From 1990-2000, Thailand's percentage of infected adults crept up from near-0% to about 2.5% (if I'm reading the graph correctly). In the same timeframe, South Africa's percentage of HIV-infected adults jumped from near-0% to 25% (!!). Muslim countries must act aggressively, and immediately.

Muslim countries would be wise to use religion to help deal with the impending calamity:

• teach safe behaviours to higher-risk groups (presumably first admit the existence of said groups!)
• teach that caring for the infected is entirely consistent with Islam
• promote tolerance (to address the suicide problem)
• HIV/AIDS education could become part of each citizen's zakat (charity duty)
• a portion of the zakat tax could be used to set up official treatment & prevention programs

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¹ Check out the incredibly selfish and arrogant tone of the CBS report (60 minutes) I've linked to. I guess the only way to sell a news story to the U.S. population is to tie it to terrorism and national security. God forbid you simply report on a global problem out of empathy.