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Our Best Aid For AIDS Prevention By Faruk Sarkinfada Liverpool School of Tropical Medicine University of Liverpool, UK The 18th annual World AIDS Day was observed on 1st December 2005, declaring AIDS as one of the biggest social, economic and health challenges in the world. It remains a global emergency that is said to be claiming over 8,000 lives everyday. In fact up to 5 people are said to die of AIDS every minute. The epidemics of HIV/AIDS constitute a major issue of concern in health care delivery worldwide. The most recent UN AIDS report shows that the number of people living with HIV has topped 40 million for the first time, and in 2005 alone, over 3 million people have acquired HIV. Despite the availability of Anti-Retroviral (ARV) treatment and the best efforts from governments, non profit organizations and health care practitioners around the world, HIV/AIDS is still having huge global impact and infection rates have spiked all over the world. According to reports, in India alone, at least 4.5 million people live with HIV. This is the highest in any country outside of South Africa. Latin America saw a record number of new infections. And the U.S., Canada and Europe also witnessed an increase in infections. One million people in the U.S now live with HIV with at least 35,000 infections occurring this year. It has also been projected that by the end of the decade, the number of people infected with HIV in Russia, India, China, Ethiopia and Nigeria could triple, far exceeding the number in central and southern Africa. A WHO and UNAID experts consultation has reaffirmed that unsafe sexual practices are responsible for the vast majority of HIV infections, especially in Sub-sahara Africa, and that safer sex promotion must remain the primary focus of prevention programme. HIV transmission through other means – unsafe medical practices, particularly injections - were discovered not to be supported by the vast majority of evidence, and that, unsafe sexual practices continue to be responsible for the overwhelming majority of infections. It appears that only preventive measures, which every individual could afford, will hold back the spread of HIV/AIDS. A faith-focused strategy appears to be the alternative that is currently being adopted in the global fight against HIV. The recent western model of using abstinence as a preventive strategy is based on the US “ABC” policy which was stressed by President Bush in a press conference marking this year’s World AIDS Day. He also touted the U.S efforts to extend the policy beyond the United States. ABC stands for abstinence, being faithful and using a condom. However, a more striking evidence of the efficacy of faith and abstinence in combating HIV has been demonstrated in the level of adherence to Islamic style of life, which confers a protective benefit against the sexual transmission of HIV. According to a CNN report, Africa, with only 10 percent of the world’s population, suffers over a half of the world’s HIV infections, but the “heavily Muslim Senegal is a relative bright spot on the continent, with only about 1 percent of the population infected”. This clearly demonstrates that Islamic tenets, if followed, certainly have the effect of reducing the sexual transmission of HIV. A recently published study by Peter B. Gray from Harvard University, Cambridge, indicated that in a sample of 38 Sub-sahara African countries, the percentage of Muslims within countries negatively predicts HIV prevalence. In other words, the higher the proportion of Muslims in a country, the lower would be the HIV infection rate. Association between Islam and factors related to protection against HIV transmission could be established from four main angles. Firstly, prohibition of illegal sexual intercourse is shown to be negatively associated with HIV transmission. Islam prohibits sexual promiscuity and homosexuality while encouraging marriage and discouraging divorce. The Quran describes both (adultery) and (homosexuality) as ‘evil’. Both are offences, once proven, can attract capital punishment of stoning to death as a deterrent measure so that no one could ever have interest in even approaching them and thereby nodding in the bud, the evils of such offences from the society. Secondly, the practice of male circumcision also has preventive benefit for HIV transmission. Although, assessment of circumcision for HIV prevention is complex, previous studies identified circumcision as a practice apparently decreasing HIV transmission. A study on male circumcision and HIV acquisition and transmission in Uganda concludes that prepubertal circumcision may reduce male HIV acquisition in a general population, but the protective effects are confounded by cultural behavioural factors in Muslims. Ritual washings could also increase penile hygiene, lessening the risk of HIV transmission. Because all Muslims should be circumcised, this practice has a strong negative association with HIV. Thirdly, prohibition of alcohol consumption could also have an influence on HIV transmission. By increasing risky sexual behaviour, alcohol consumption may favour higher rate of sexual transmission of HIV. Finally, the Islamic marriage code provides that before marriage contract couples must be free from certain health defects that could have serious negative effects on their marital relationship. HIV free status is therefore a requirement for marriage contract between HIV free couples. There are also provisions within the Islamic code for interaction with people living with HIV both within an outside marriage. The general moral ethics of marriage life between couples in Islam and prohibition of extramarital relationship as well as the screening of a partner who loses his spouse to AIDS, could reduce the risk of HIV transmission both among Muslims and within a Muslim Community. Although the Islamic code of practice are not strictly adhered to by every one (especially with sexual activity), there is no evidence that Islamic religious affiliation increases sexual behaviour that constitute risk factors for HIV transmission. While Islamic marital codes permit men to marry up to four wives and allows divorce, which appears to potentially increase the number of lifetime sexual partners (a known risk factor for acquiring HIV), prohibition against sex outside marriage may outweigh these risks. Furthermore, in the spread of HIV, it is the biological relationship (which favours the transmission of HIV) that should be given more attention than marriage itself. This is because marriage, in its essence, whether monogamous or polygamous or and whether in the Muslim or Non-Muslim community may have a minimal role to play in the spread of HIV in the absence of extra marital sexual relationships that may promote the spread of the infection. In fact, when viewed in terms of biological relationships, an unmarried or monogamous individual could in reality be more ‘polygamous’ in terms of extra-marital relationships than a faithful polygamous individual. Adherence to Islamic tenets that constrain sexuality would certainly give a stronger inverse relationship between HIV and Islam, and will put to rest the need for production and promotion of condom use. On the whole the architects and promoters of the US “ABC” policy on prevention of HIV transmission may certainly not be aware that the Islamic code of practice has provided the “A to Z” policy on protection against the disease. The recent trend of adopting a faith-focused strategy as the best alternative for the global fight against HIV is commendable and could certainly yield the desired result if designed and implemented effectively.
Faruk Sarkinfada 5/12/05
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