July 2005
Behind the Veil of a Public Health Crisis: HIV/AIDS in the Muslim World
One fifth of the world's population today is Muslim, and this vast expanse of humanity may represent the next major "risk region" for contagion of the HIV/AIDS pandemic. Indeed, in the years immediately ahead, the AIDS pandemic is all but sure to exact a grim toll in a number of vulnerable populations with volatile polities--places unlikely to cope with the significant social stresses and economic burdens of AIDS. From Bosnia-Herzegovina and Albania in Central and Eastern Europe to Malaysia and Indonesia in the East, HIV/AIDS already appears to be making significant inroads into vulnerable Islamic populations. In many Muslim countries the spread of the epidemic has gone unrecognized and untreated. On the other hand, some Islamic states are now beginning to take some decisive steps in the struggle against AIDS--but will the requirements of successful mass HIV-prevention campaigns be consonant with what local populations regard as "Islamic values"? These and other questions were considered by Nicholas Eberstadt and Laura M. Kelley, coauthors of a new study on the topic, at a July 8 AEI conference.
Nicholas Eberstadt
AEI
I will start by trying to put our study into perspective. HIV is a disease that transferred from another species to human beings. Some scientists believe that it jumped to humans between World War I and World War II, or possibly soon after World War II. Approximately 70 million people have been infected with the disease and, barring other premature events, it is always fatal.
An enormous amount of attention has deservedly been given to the HIV/AIDS problem in Africa, especially in sub-Saharan Africa. Some of these countries report adult prevalence rates of 25 or 30 percent; in some cases prevalence is even higher. Some attention has been paid to the unfolding HIV/AIDS epidemic in China, India, and Russia. There has also been some work on the pandemic in Latin America, in part because the Brazilian government has taken ownership of the pandemic and has made inroads in combating the epidemic.
Over a billion of the world’s inhabitants are Muslim, and yet no attention has been paid the question of AIDS in the Islamic expanse. It seemed to us that it was a dog that was not barking, and silence on the issue seemed suspicious. Sometimes the lack of information can tell us things in and of itself.
Laura M. Kelley
The Muslim world’s billion-plus people are spread across three continents. There are more than fifty countries with a Muslim population of 40 percent or more. The population is diverse but shares many beliefs and practices that could contribute to an explosion of HIV/AIDS in the years to come.
Autocratic rule is common in Muslim countries, and in many states the Qu’ran is used as a religious text, a source of law, a guide to statecraft, and an arbiter of social behavior. This, coupled with the low level of development seen in many areas, has made many Muslim governments slow to respond to the HIV/AIDS epidemic.
There is an expectation that the behaviors that contribute to the spread of HIV/AIDS are not present in the Muslim world. That expectation is completely out of touch with reality, however. Although premarital sex, homosexuality, drug use, and sex workers are looked down upon, their presence in the Muslim world is very real. Because the practices that spread HIV/AIDS are unacknowledged they present a greater threat to the public health of Muslim countries. Muslim governments have been reluctant to address the crisis because they believe that it implies an acceptance of the behaviors that spread the disease.
The first HIV/AIDS cases in the Muslim world were recorded in the mid-1980s. Foreigners were blamed as AIDS found its way into the blood supply, which may still be unsafe today. There remains a severe social stigma against AIDS patients. Infected individuals and their families are ostracized. In many countries, people with HIV can be denied medical care and are often fired from their jobs. Suicide is common among infected Muslims--in a Kermanshah clinic, for example, 60 percent of patients committed suicide within a year of diagnosis. Many incidents of violence against infected persons have been recorded.
High-risk groups in the Muslim world are ill-equipped to protect themselves from the disease. Commercial sex workers, male and female, have little knowledge of transmission and few use condoms regularly. The existence of homosexuality in the Muslim world is largely unacknowledged, and there are few steps taken to educate high-risk groups about safe sex.
More should be done to educate the public about the dangers of HIV/AIDS. In Egypt, 60 percent of patients with sexually transmitted infections failed to mention condoms as a preventative measure. In Bangladesh, many commercial sex workers reported knowing that condoms can protect against HIV transmission, but only 11 percent use them. Still, many people are concerned about HIV/AIDS and would like to know more about prevention.
AIDS treatment is expensive--two to three times per-capita GDP for most Middle Eastern and North African countries. It is also difficult to find: public programs are rare, and most treatment is obtained from private physicians. The governments’ hands-off approach could alienate the public as the social challenges of HIV/AIDS grow.
Some countries that are on the verge of emerging as regional powers (such as Iran, Nigeria, and Malaysia) may be slowed, and foreign investment could be delayed. Poorer countries like Bangladesh may find that the strides they have made toward development and improvements in public health are stalling.
Some mosques are stepping up to deliver AIDS education while discouraging the behaviors that spread the disease. The influence of imams and female leaders in the mosques could have a powerful effect on transmission rates.
Women are especially disadvantaged in HIV/AIDS education because they spend less time at school and have lower literacy rates. These trends must be addressed to ensure the safety of future generations. Governments could also provide counseling for women who work as remittance laborers and reach out to women in the community or in the workplace.
One immediate action that Muslim countries should take is to implement needle exchange programs. A less urgent, but still important need is to create methoadone maintenance programs, which will reduce drug-related crime. Longer-term goals include strengthening programs to end drug dependency and offering more counseling to drug users.
Commercial sex workers need greater counseling as well. More importantly, however, poverty alleviation campaigns targeted at women will help reduce prostitution. Efforts to stop the trafficking of women and children also need to be strengthened.
Muslim countries should enact legislation to ensure that people suffering with HIV/AIDS do not lose their jobs, health care access, or insurance. HIV/AIDS knowledge should be taught in schools, and more should be done to encourage the acceptance of the infected.
In the early 1990s, South Africa’s HIV/AIDS rates were similar to that of Thailand. Early action on the part of the Thai government has helped to maintain a low rate of prevalence. The South African government, however, did not take steps to educate the public and combat the disease, and the prevalence rates in that country skyrocketed to 25 percent by 2000. The Muslim world is at a crossroads right now, and the course of action it chooses in the next few years will determine if the disease will be contained as it is in Thailand, or if it will face a crisis of the magnitude that South Africa faces today.
AEI research assistant Courtney Richard prepared this summary.
