AIDS & Circumcision
By Hwaa Irfan
HIV and AIDS have challenged modern lifestyles, fundamental hygiene practices and gender relations. As a result of the pandemic, U.S. Surgeon General David Satcher, wishing to break the 'conspiracy of silence' surrounding human sexuality, urged for a national debate. Facing a history of former surgeon generals resigning or being dismissed after attempting to deal with HIV and AIDS, Satcher produced a carefully worded report that reflected America's wide and varied views on the subject.
The report asks for open discussion on abstinence, safer sex practices and contraceptives in schools (Reuters Health, p.1, 2). Elsewhere, a statement was issued challenging even the idea of contraceptives, a topic that arose at the end of a 6-day Southern African Catholic Bishops' Conference in Pretoria. The bishops felt that, "Condoms may even be one of the main reasons for the spread of HIV/AIDS. Apart from the possibility of condoms being faulty or wrongly used, they contribute to the breaking down of self-control and mutual trust" (RNS, p.1). They cited a different reason for the spread of HIV and AIDS - the decline in circumcised men.
Allah (swt) gave us guidelines in the Qur'an that play important roles in all aspects of our lives and health practices. The Qur'an even addressed the spreading of viruses. While HIV and AIDS have become the leading cause of death among women aged 20 - 40 in Europe, sub-Saharan Africa and North America (About, p.1), the world's HIV and AIDS drug industry continues to fail at finding a cure. Meanwhile, drug resistant viruses have increased and debates continue over the health benefits of male circumcision.
This, however, does not change the findings of John and Pat Caldwell, who tell a frightening story. With over 30 years experience in family dynamics and fertility control in Sub-Saharan Africa, the Caldwells began working on sexually transmitted diseases there in the 1970s, taking all existing theories into account. The most popular theory is that the disease itself originated there, however, this theory is undermined by the fact that AIDS cases occurred in hospitals in Uganda and Rwanda at the same time as they did in the West. The only common factor in the spread of AIDS in Africa that the Caldwells found was the issue of male circumcision, which was generally unpracticed in the heart of the AIDS Belt - Central African Republic, Southern Sudan, Uganda, Kenya, Rwanda, Burundi, Tanzania, Zambia, Malawi, Zimbabwe and Botswana (Caldwell, p.40).
In 1989, a joint Canadian-Kenyan medical research team at Kenyatta Medical School in Nairobi reported that during the previous year, the AIDS rate was higher among Luo migrants from Western Kenya than among the Kikuyu of Central Kenya. The uncircumcised Luo men were more likely to have syphilis or chancroids - a sexually transmitted disease characterized by soft sores in the private area. They also had an unexpected elevated risk of contracting HIV (Caldwell, p.41).
An American team, led by John Bongaarts of the Population Council, also found that the regions across sub-Saharan Africa with high levels of HIV infection among local peoples correspond remarkably with the areas where men were not circumcised. The research drew upon statistics from the World Health Organization (Caldwell, p.44).
However, uncircumcised men in Tanzania did not need to wait for agreement among the researchers to come to their own conclusions. Based on their own observations of their community and of neighboring communities, they requested circumcision for themselves (Caldwell p.46).
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Epidemiological evidence points to the inner surface of the foreskin, which contains Langerhans' cells that act as HIV receptors - a likely point of entry for uncircumcised men. A keratinized stratified squamous (scaly) epthelium (membranous tissue) covers the penile shaft and outer surface of the foreskin. This provides a protective barrier against HIV infection. The inner mucosal (mucus) surface of the foreskin is not keratinized and is rich in Langerhans' cells. During intimate relations, the whole inner surface of the foreskin is exposed to vaginal secretions, providing an increased area for HIV transmission.
Forty studies provide evidence that male circumcision protects against all sexually transmitted diseases, and that circumcised men are 2-8 times less likely to become infected. Robert Szabo concludes that circumcision, as practiced by Muslims, would be the most immediately effective intervention for reducing HIV transmission since it is done before men are sexually active (Szabo, p1-3). Epidemiologist Robert Baily of the University of Illinois, Chicago, said, "No one wants to be the first to come out with a statement in support of male circumcision." In the U.S. and Europe there are big anti-circumcision movements now, so people don't want to promote something in Africa that is discouraged here…" (Shillinger, p.2).
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Circumcised men come from communities that place a deep religio-cultural significance on this particular hygiene practice; which doesn't necessarily apply to those who do not (Shillinger, p.1). The majority of Muslims believe that male circumcision is obligatory and it is one of the five acts of cleanliness recorded in Sahih Muslim, Sahih Bukhari, Musnad Ahmed and Sunnah at-Tirmidhi (Persaud, p.1).
There are also additional obligations of hygiene and social conduct within marriage. However, this does not mean that Muslims are immune to HIV and AIDS since Islamic practices have become compromised by other factors. Currently, 50% of Moroccan women who have AIDS have been infected by their husbands (Clinton, p.3).
For now at least, the safest path to follow is one of cleanliness and purity, which modern science has confirmed.
Caldwell, John & Pat. "The African AIDS Epidemic." Scientific America 274: 3 (1996) 40-46.
Naqvi, Siki. 'Ali, M. "A Manual of Islamic Beliefs and Practice." The Muhammadi Trust of Great Britain & N. Ireland. 1991.
Persaud, T. and Ahmed Mustafa, A. "Islamic Rules for Male Circumcision." The First International Conference for the Scientific Aspects of the Qur'an and Sunnah in Islamabad, Pakistan. Islamzine.com. 08/14/01.
Reuters Health. "Surgeon General Calls for Open National Dialog on Sexuality." Reuters Medical News. 06/28/01.
Reuters Health. "Drug Resistant HIV Spreading in UK." Reuters Medical
RNS. "South African Bishops Condemn Condoms as 'Immoral and Misguided." Religious News Service. 07/30/01. Beliefnet.com 08/06/01.
Shillinger, Kurt. "Male Circumcision Cited for Differing HIV Rates Among Africans." Antipas.org 05/11/99. 1-3.
Szabo, Robert. "How Does Male Circumcision Protect Against HIV Infection." British Medical Journal. 06/10/00.