AIDS: Stigmatize or Show Mercy?
By Dr. Nadia El-Awady
IslamOnline’s Health & Science Editor
40,000,000 people are living with HIV/AIDS today, of which 3,000,000 are children under the age of 15. A particularly troubling consequence of the deadly disease is the number of orphaned children that has resulted. Today, more than 13 million children, most of who live in sub-Saharan Africa, have lost one or both parents to AIDS. By the year 2010, it is estimated that this number will jump to more than 25 million. In a world that harvests more than 40,000 refugees as a result of wars, civil strife, floods, earthquakes and destitution, AIDS also forms a formidable enemy. Refugee camps, in which 75% of inhabitants are women and children, form a rich breeding ground for the disease as a result of sexual harassment, rape, increased rates of prostitution and promiscuity amongst children, increased rates of blood transfusion, and as a result of the fact that health care workers give priority to what they feel to be more pending issues.
The numbers are staggering. The numbers are only estimates. Under reporting is the norm in too many countries. AIDS patients in many parts of the world are too scared to come forward with their disease and ask for treatment and health care for fear of stigmatization and discrimination by their families and societies. In many parts of the world, these patients are right to show such feelings of apprehension. People coming forward with their disease have faced stoning to death by their neighbors, being shunned by their friends and families, unemployment as a direct result of their illness, and failure to be properly treated by health care workers.
World AIDS Day 2002, “Live and Let Live”
World AIDS Day this year addresses this issue of stigmatization and discrimination against AIDS patients. I must admit, trying to decide on how to approach this topic, I myself feared stigmatization from the West on one hand, and from my own people on the other, if I wasn’t very careful in how I addressed the issue. The more deeply I researched however, the more convinced I became that there is a very large area of common ground that both parties accept and that both parties must cooperate in to attempt to hinder the progress of a disease that has already reached epidemic proportions.
Illness as Perceived by Muslims
It is true and unopen to debate amongst Muslims that Allah the Almighty has on occasion punished various tribes of people for their wrongful behavior. “So We sent (plagues) on them: Wholesale Death, Locusts, Lice, Frogs, and Blood: Signs openly self-explained: but they were steeped in arrogance, - a people given to sin.” (Al-A’raaf: 133)
Aisha (May Allah be pleased with her) reported: I asked the Messenger of Allah (PBUH) about pestilence and he said, "It is a punishment which Allah sends upon whomsoever He wills, but Allah has made it as a mercy to the believers. Anyone who remains in a town which is plagued with pestilence maintaining patience expecting the reward from Allah, and knowing that nothing will befall him other than what Allah has foreordained for him, he would receive a reward of Shaheed (martyr)." [Al-Bukhari].
It is also true, that Muslims see illness as a means of redemption from sins -no matter what those sins may be- and as a means of purification of the soul.
Abu Said and Abu Hurairah (May Allah be pleased with them) reported that the Prophet (PBUH) said: "Never a believer is stricken with a discomfort, an illness, an anxiety, a grief or mental worry or even the pricking of a thorn but Allah will expiate his sins on account of his patience." [Al-Bukhari and Muslim].
Muslims are also taught not to judge others. "But if they repent and perform As-Salat (Iqamat-As-Salat), and give Zakat, then leave their way free. Verily, Allah is Oft-Forgiving, Most Merciful.'' (9:5)
It is important for Muslims to keep all this in mind when considering how to manage AIDS patients.
AIDS is transmitted from one person to another in very specific ways.
· Sexual intercourse (vaginal, anal and oral) or through contact with infected blood, semen, or cervical and vaginal fluids. This is the most frequent mode of transmission of HIV world wide, and can be transmitted from any infected person to his or her sexual partner (man to woman, woman to man, man to man and, but less likely, woman to woman).
· Blood transfusion or transfusion of blood products (e.g. obtained from donor blood infected by HIV).
· Injecting equipment such as needles or syringes, or skin-piercing equipment, contaminated with HIV.
· Mother to infant transmission of HIV/AIDS can occur during pregnancy, labor, and delivery or as a result of breast-feeding.
These modes of transmission place certain groups of people at a higher risk of contracting the disease. These groups include sex workers, homosexuals and drug abusers, all of which are considered immoral and sinful in Islam, and most other religions.
The Harm in Stigmatization and Discrimination
The fact remains, however, that stigmatizing an AIDS patient as being sinful or deserving punishment serves little purpose. Besides the fact that many AIDS patients contracted the disease without being sinful, stigmatizing AIDS patients actually further promotes the spread of the disease. Stigma generally makes the disease more difficult to discuss and harder to deal with. It can spread infection through misunderstanding. It can make people hide their HIV status amidst fear of rejection from loved ones. Due to discrimination, those infected may be denied treatment by health care services, or may have difficulty getting jobs or housing.
In some African countries, only a small number of people have declared their status - although as many as a quarter of adults are infected.
In many countries in Asia, most people with HIV/AIDS get very little or no treatment and only a small handful are on anti-retroviral therapy (ART). For example, in China, it has been estimated that less than 1% receive treatment and less than 100 people are on ART, according to the National AIDS Center.
In Cambodia, access to care is limited, particularly in rural areas. Some international organizations offer care and are giving ART to some 300 people. ART is costly and difficult to administer. Many drugs for opportunistic infections, on the other hand, are affordable, effective and simple to administer. They can lengthen life and ease pain and suffering considerably. Yet many countries do not even offer such drugs. As a result, many people suffer unnecessarily.
HIV testing is another area where discrimination is evident. Voluntary HIV tests and counseling is often limited, not well known, inaccessible or only in urban areas. People may also be deterred from getting tested because of laws that restrict an individual’s confidentiality.
Blaming certain groups also allows societies to avoid the responsibility of dealing with the epidemic. This denial can be dangerous. Governments may hide cases, fail to gather accurate data or not care for people with HIV/AIDS. Officials may use figures of detected cases rather than estimated cases to downplay the magnitude of the epidemic in their country. People at risk may also be in denial. They may assume a false sense of security by believing only “outsiders” or marginalized groups can become infected.
As Muslims, we are fortunate to have in our culture and way of life the basic essential elements of an effective solution. Decency, modesty and virtuous sexual morality are vital factors in controlling the virus causing the AIDS epidemic and its spread. Figures published by the World Health Organization on the spread of AIDS in the world show very clearly that Islamic values and traditions, although not fully adhered to or respected, represent a strong and effective means of prevention against the spread of the virus in Muslim countries. Rates of infection in Muslim countries are far lower than those in non-Muslim ones. Infection is also much lower amongst Muslims living in non-Muslim countries. This fact should not prevent us, however, from opening our eyes to see a problem that is growing amongst us.
According to the World Health Organization’s Global HIV Epidemic Report for the year 2002, 28.5 million people have AIDS in sub-Saharan Africa. The Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe all have more than 1 million AIDS patients each, with South Africa alone standing at 5 million.
A total of 1,000,000 AIDS cases are present in East Asia and the Pacific with China holding a total of 850,000.
South and Southeast Asia are home to 5,600,000 AIDS patients with India at 3,970,000; Indonesia at 120,000; Malaysia at 42,000; Pakistan at 78,000; Thailand at 670,000 and Viet Nam at 130,000.
North Africa and the Middle East have approximately 500,000 AIDS cases with 8,000 in Egypt, 7,000 in Libya, 13,000 in Morocco, 450,000 in Sudan and 9,900 in Yemen.
The Right to Treatment and Compassion
As long ago as 1993, the Islamic Organization of Medical Sciences held the Seventh Islamic Medical Seminar in Kuwait in which more than 130 Islamic scholars, medical practitioners and scientists, representing more than 23 countries participated. One of its most important recommendations was that: “Regardless of how a person contracts AIDS, everyone has the same right to the necessary medical treatment, psychological support and health care. Once infected, patients must report the fact to their doctors to prevent the spread of infection to others. Doctors are under obligation to give the proper treatment, taking all measures to protect themselves and others against infection. Affected persons must be made fully aware of how best they can prevent the deterioration of their own health and protect others around them. No AIDS sufferer should have to endure any injustice, discrimination or humiliation as a result of his or her predicament.”
World AIDS Day (December 1st) happens to come this year during the Muslim Holy Month of Ramadan. Let this day be one of mercy and compassion on our fellow human beings.
· AlBadri, M., ‘The Aids Crisis - A Natural Product of Modernity's Sexual Revolution’, Available from: http://www.islamset.com/bioethics/aids/index.html
· Islamset 6-8 December 1993, ‘AIDS-Related Social Problems - An Islamic Perspective-Recommendations’, Available from: http://www.islamset.com/bioethics/aids1/recomm.html
· Joint United Nations Program on HIV/AIDS June 2002, ‘Situation Analysis of Discrimination and Stigmatization Against People Living With HIV/AIDS in West and Central Africa’, www.unaids.org/wac/2002/AnalysisDiscrimination.pdf
· UNAIDS 7-12 July 2002, ‘The Report on the Global HIV/AIDS Epidemic "The Barcelona Report"’, Available from: http://www.unaids.org/barcelona/presskit/report.html
· USAID/UNICEF/UNAIDS July 2002, ‘Children on the Brink 2002’, Available from: http://www.unaids.org/barcelona/presskit/childrenonthebrink.html
· World Health Organization, ‘HIV Fact Sheet’, Available from: http://www.who.int/hiv/abouthiv/fact_sheet_hiv.htm
· World Health Organization November 2002, ‘Report on the Global HIV/AIDS Epidemic 2002’, Available from: http://www.who.int/hiv/pub/epidemiology/pubepidemic2002/en/
· World Health Organization, ‘Stigma and Discrimination: Live and Let Live’, Available from: www.unaids.org/wac/2002/WADKIT_en.pdf
· WHO-EMRO, ‘Refugees and AIDS’, Available from: http://22.214.171.124/asd/AIDS&Refugees.pdf