Vulnerabilities: HIV and AIDS

The following is the text of the presentation given at the 2nd International Muslim Leaders Consultation on HIV and AIDS held in Kuala Lumpur, Malaysia in May 2003. This is a draft of a paper in process, and the author does not wish it to be quoted or further referenced.

The spread of HIV/AIDS within families brings up an interesting concern with addressing inconsistencies between intent and experience within the family: How do certain family structures create greater vulnerability? The first part of this presentation will look at an interesting paradox: the family, that institution through which human beings expect and receive their greatest nurturing, is the same institution that can create the greatest vulnerabilities in the spread of HIV/AIDS for women and children. When the structure of family itself causes vulnerability, critical examination is even more in order to construct ways that civil society can empower family members to challenge the abuses that occur within families. However, some see the very idea of challenging “family” as a disruption in social well being. Ultimately my question is: How can families empower all members equally despite vulnerability due to age or gender.

The first part of this presentation will examine the terms and experiences of vulnerability to HIV/AIDS for women and children as members of existing family structures in the context of Islam and Muslims. My objective is to disentangle or demystify “family” by focusing on both its supportive and destructive aspects. Family as a construct must be subjected to a rigorous analysis as part of any agenda that seeks to fight against the spread of AIDS. As such, combating AIDS will also contribute to reforms in Muslim Personal Status Laws. One goal of these reforms will be to help the family structure function as a comfort and support for all its members equally. I will review some of the underlying assumptions about family in Islamic law in as much as these historically constructed assumptions are still implemented in Muslim societies while allowing undue privilege for men and male desires. This presentation uses the HIV/AIDS epidemic as evidence of dangerous and untenable double standards in the face of modern social change and experience. I will consider structural inconsistencies that often go unchallenged when the word “family” is introduced. While seeking to retain the family ideals of nurturance and support, I will also focus on they way some family structures provide for particular vulnerabilities.

The second part of this presentation will begin to think about theological implications of combating the spread of AIDS, increasing public awareness, and empowering both direct and indirect victims of HIV/AIDS. Some family members have directly contracted the virus through abuses and misunderstandings of other members while some family members find their life style and future indirectly affected by members with HIV/AIDS.

Thinking about HIV/AIDS gender and family in an Islamic Perspective

In 2002, I had my first encounter with constructive organizational level efforts to respond to the AIDS epidemic at a meeting in Nairobi, Kenya. The World Conference on Religion and Peace (WCRP) convened as part of the HACI program (HIV/AIDS Children Initiative) launched specifically to address the needs of increasing numbers of orphans of AIDS. Dr. Vendley will no doubt provide details on WCRP’s particular project related to utilizing community based religious organizations for information, advocacy and assistance.

My experience at this WCRP meeting was important not only as a context for learning but also as it sparked my interest in the work needed in the context of Islam and Muslims with AIDS. On that occasion, African Religious leaders also gathered for a summit. The Muslim participants convened one morning to discuss the initiatives and Islam. One of the “Imams” dominated the first half of that 45-minute meeting by giving a khutbah (long speech) on the importance of avoiding zina (fornication). This khutbah was insignificant to our development of a clear “Islamic” position on the particular initiative regarding AIDS orphans. Indeed, the whole tenor of the speech was useless as a framework for developing an Islamic theological response to HIV/AIDS. Yet, such a response might be useful if developed in the future. During the time since that meeting, I have begun to think about an Islamic theological response and the problems that it might pose.

HIV/AIDS and Vulnerability

In effect, what I present here emphasizes the ways that Islam and Muslims exacerbate the spread of AIDS and that a traditional Islamic theological response can never cure AIDS. AIDS exists as an immune deficiency syndrome. It has spread to epidemic proportions; over 42 million people are affected with an estimated 3 million deaths per year. Of particular interest to my thesis is the consequence and spread of AIDS among children (under the age of 15), with additional infections of over one half million annually. In addition to its fatality, consequences here include children who become orphaned each year due to the death of their primary care takers from AIDS. The estimates are 14 million children orphaned by AIDS. What does a theological premise “la taqrabuna ‘l-zina” avail these children? How has Islam in particular assisted them towards living a life of dignity and how has it prevented them from experiences of dignity and worth, un-stigmatized by our ostrich theology and law? My experiences at the Nairobi meeting included a visit to an orphanage run by a women’s church group. To be sure, these women were also concerned with the spiritual health and development of the children in this home. What happens when religious groups, be they Muslim or otherwise, take in a child? What happens if the child had Muslim or Christian parents? Do we only take in those children who are members of our own religion? Can we raise any child with true religious choice once we take them in? It presents an interesting case vis-à-vis the concerns for these 14 million children. If we save an endangered child is the child then further endangered by loss of religious choice?

♥

♥

The other group that is of concern here are monogamous wives. Especially in the context of Islam, where a Muslim wife is not only expected to be, but defined in terms of her being unconditionally sexually available to her husband. Properly fulfilling this role of wife is fatal to some women, with estimates as high as 80%. That is 80% of the heterosexual women with AIDS are monogamous and have only ever had sex with their husbands. What does a theological premise “la taqrabuna ‘l-zina” avail these women? How has Islam in particular assisted them towards living a life of dignity and how has it prevented them from experiences of dignity and worth, un-stigmatized by our ostrich theology and law?

Ultimately the solutions to the problems of AIDS will not be limited to victims in the two particular sub-groups of my examination. However, I am interested in how these two groups demonstrate how empty religious platitudes are in addressing the problem and how, even when those responses are based on the Qur’an and Sunnah they are ineffective to resolve the problem.

HIV/AIDS and Sexuality in Islam

With regard to the 80% heterosexual women who contract AIDS in monogamous relations, a direct look at Islam and sexuality is called for. According to Shari’ah if a Muslim man desires intercourse with his wife, she must comply. If she does not, she is guilty of nushuz, recalcitrance. A wife who is nashizah is no longer eligible for nafaqah: maintenance or financial support. In addition, in various degrees of interpretation and application, the Qur’an asserts that the husband of such a woman may beat her. In the face of this, the vast majority of Muslim wives, those with gentle husbands, husbands of polygyny: open or secret, husbands of violence and abuse, upright husbands of moral standing and husbands of AIDS, open their legs to their men as they are not only expected, but commanded to do by that which is most popularly understood as “Islam”. Women turn towards men who have contracted AIDS and open their legs to their own death and destruction. It matters little if the men have contracted AIDS by either legal and moral or illegal and immoral means. By legal and moral means, I refer to the husband who has contracted AIDS by marrying younger more sexually virile women as confirmation of their masculine sexuality and then turn to the demure and compliant wife of longer standing. In turn, she may then give birth to or infect at birth their innocent child. The consequences for the muhsinat and qaanitat are the same: they will die because they are “good”. How does a statement, “la taqrabuna ‘l-zina” apply to them? How does “Islam” resolve this problem?

Sexuality

One of the underlying concerns for fully addressing HIV/AIDS is a hard and fast look at sexuality in Islam. To do this, I remind us first about sexuality and gender in general. My references here are to research by western feminists. In particular, I am interested in work done on the tyranny of patriarchal domination through heterosexuality or the sexual politic of domination. For the most part, marriage in shari’ah is marriage of the woman’s subordination. Whatever choice she may have in contracting marriage to a particular prospective husband, her choice is then limited within the structures of marriage and family that prevail once the marriage is consummated. There is a considerable lack of reciprocity vis-à-vis what happens in the marriage itself.

“A prime theoretical contribution of the contemporary analysis of women’s oppression can be captured in the slogan “the personal is political”. What this means is that the subordination of women by men is pervasive, that it orders the relationships of the sexes in every area of life, that a sexual politic of domination is as much in evidence in the private spheres of the family, ordinary social life, and sexuality as in the traditionally public spheres of government and the economy. The belief that things we do in the bosom of the family or in bed are either “natural” or else a function of personal idiosyncrasies of private individual is held to be an “ideological curtain that conceals the reality of women’s systematic oppressions”. For the feminist, two things follow upon the discovery that sexuality too belongs to the sphere of the political. The first is that what ever pertains to sexuality—not only actual sexual behavior, but sexual desire and sexual fantasy as well—will have to be understood in relation to a larger system of subordination; the second, that the deformed sexuality of patriarchal culture must be moved from the hidden domain of “private life” into an arena of struggle, where a “politically correct” sexuality of mutual respect will contend with an “incorrect” sexuality of domination and submission”. (Sandra Lee Bartky “Feminine Masochism and the Politics of Personal Transformation” in Living With Contradictions: Controversies in Feminist Social Ethics”, edited by Alison M. Jaggar, Westview Press, 1999; pg. 519.)

According to the article “Sexuality, Diversity, and Ethics in the Agenda of Progressive Muslims” by Scott Siraj al-Haqq Kugle in a recent volume entitled Progressive Muslims from One World Publication, Muslim scholars apparently were already ahead of the feminist here:

“In comparison with many other religious traditions, it has often been noted that Islam is a religion that has evaluated sexual life positively. Articulating the integral relationship between spirituality and sexuality is one way that the Prophet Muhammad challenged his society. It remains for us, today, to continually struggle with that challenge. The system of norms, rules, and laws created by Muslims in the past (a collective body we call Shari’ah) does not absolve us of this challenge. It may, in fact, create complexities that drive us to reinvestigate the topic while presenting obstacles to a just resolution of those complexities. Scholars in the contemporary period have not lived up to the standards and frankness of pre-modern Islamic scholars, and much work has yet to be done on the question of sexuality in Islamic scripture, law, and society. Many scholars and Islamic leaders in the present shy away from honest discussions of sex and sexuality, with all its promise and problems. Muslims in pre-modern times certainly were not shy about discussing matter of sex and sexuality, so why should we be so prudish? The most basic goal of this essay is to return to us the contemporary Muslims, the “awe and bewilderment” that al-Ghazali felt when considering sexual pleasure.

Sexuality is connected not just to spirituality, but to politics as well. What is required of us in political situations is an acute sense of justice, but we often ignore or obscure justice when it comes to matter of sex and sexuality. We need to think more clearly about “intimate citizenship”, how personal, emotional, and sexual dimensions of our lives (which are often locked away as “private”) actually have very public and often political consequences.” (Scott Siraj al-Haqq Kugle ,“Sexuality, Diversity, and Ethics in the Agenda of Progressive Muslims” in Progressive Muslims from One World Publication, 2003, pg 191.)

Coincidently this article takes a thorough look at the issue of homosexuality and presents the reader with various classical interpretations of the story of Lut from the Qur’an. Yet even in the new territory being forged by this article, Siraj never manages to disentangle his compliments of the past and critique of the present, from the extent to which even his struggle to look more affirmatively at sexuality is based primarily on male sexuality. What is considered here as Islam’s lack of prudishness in the classical period was still on the basis of the predominant notion of human being, i.e. the male human. Furthermore, the Qur’an itself, as well as the shari’ah is founded upon male sexual experience. I have looked elsewhere at how the Qur’an seems to affirm masculine pleasure and experience. In the Qur’an I point to three specific incidents that give a cross section of male sexuality and fantasies without ever responding in an equivalent manner to women and women’s sexuality.

Foremost however is the Qur’anic affirmation of marriage in general, which can be said to be gender neutral. The underlying assumption of an overwhelmingly heterosexual social order is that women and men should be engaged in healthy sexual exchanges. However, the first indication that there are some disproportionate elements in this general gender neutral formula is in the attention given to men’s “right to satisfaction” from the verse on women as tilth, then the conditional permission to multiple wives and concluding in the afterlife with meticulous details concerning the huris of paradise. Not only do no equivalent articulations exist in the Qur’an about women’s sexual satisfaction, the Qur’an refers to post-menopausal women as being “beyond want” despite ample evidence to the contrary. Following closely upon this, the emphasis on sexuality in the law is overwhelmingly on male heterosexual satisfaction.

An HIV positive woman is not an indictment of the promiscuity of the woman, since: “Men are qawwamun” (4:34) can be seen as recognition of the unequal power dynamics of masculine and feminine sexuality. It is not in the command form implying perhaps the idea that it is an edict, to be fulfilled by the mere nature of being a man. It is stated in the form of an active participle recognizing agency and being. A man may fulfill qiwamah. Therefore women must yield sexually to this Qa’im, whether he is acting in a manner mustaqim (straight) or crooked. An anology could be made between the sexual moralities of an HIV positive married Muslim woman and pregnancy in an unmarried Muslim woman. Neither is proof of a woman’s indiscretion. With today’s fertilization sciences, pregnancy is not even proof of intercourse. Surely evidence shows that there are multiple causes of pregnancy other than a woman’s consent. However, both cases lend themselves well to the idea that women are more vulnerable in Muslim societies.

♥

♥

Vulnerability and Gender

Much of my information in the following was taken from the World Health Organization. Their data was as old or as recent as December 2001. “In most societies, girls and women face heavier risks of the HIV infection than men because their diminished economic and social status compromises their ability to choose safer and healthier life strategies.” Gender roles powerfully influence the course and impact of the epidemic and affect the extent to which AIDS affects vulnerability. Gender inequalities, the different attributes and roles assigned to women and men in society affects their ability to protect themselves and cope with its impact. “Reversing the spread of HIV therefore demands that women’s rights are realized and that women are empowered in all spheres of life”, especially sexually. The factors that increase the vulnerability of women and girls to HIV “include social norms that deny women sexual health knowledge and practices that prevent them from controlling their bodies and deciding the terms on which they have sex.” In addition to this are “women’s limited access to economic opportunities and autonomy, and the multiple household and community roles they are saddled with.”

The proportion of women living with HIV/AIDS has risen steadily. Women are often affected at an earlier age than men. Girls are five or six times more likely to be infected than teenage boys. There is also growing evidence that a large share of new cases of HIV infection is due to gender based violence in homes, schools, the workplace and other social spheres, to say nothing of situations of civil disorder and war where women and girls are systematically targeted for abuse, including sexual abuse. HIV positive women are also discriminated against when trying to access care and support. Meanwhile the burden of caring for ill family members rests mainly with women. Discrimination in care support and women’s own indispensable support roles often mean that many will seek assistance for their own illness much later than will positive men. Without women-specific programs being integrated with other services such as ob-gyn, social support, substance abuse, nutrition and the like, women’s particular needs and vulnerabilities will not being formulated and will render any agenda said to effectively assist in the reduction of the spread of AIDS hopelessly problematic.

The “la taqrabuna ‘l-zina” agenda is one such problematic agenda. It does manage to increase the stigma of all HIV positive cases. Muslim women who are described in the Qur’an in terms particular to their sexual virtues especially feel the concern for moral propriety. The significant role played by stigma in reducing the gains of a battle against HIV/AIDS needs its own attention. Like rape, women are more clearly the ones most victimized, but they are also the ones more likely to be stigmatized by its occurrence and as such will more than likely hide their experience in order to avoid the negative social and spiritual consequences of such a confession. On the other hand, when a woman stands forward to pronounce her opposition to those factors that increase women’s vulnerability, she herself may be cast in a negative light with suspicions about her morality being whispered behind her back. In this force of stigma, it is no wonder that women are still among the minority of those who have worked comprehensively to help construct a more compassionate paradigm, including the “Islamic” religious paradigm, to confront such an issue.

Yet only with women’s full participation and empowerment can the disease actually be arrested. In this regard, an Islamic perspective on HIV/AIDS is impossible without simultaneously addressing women’s empowerment, including their sexual empowerment in the context of the patriarchal paradigm that still predominates our notions about sexuality in Islam. A new paradigm that promotes women’s rights to know (i.e. be informed) to say no (i.e. refuse) or otherwise determine independently the exact nature of their own sexuality and their responses to the predominance not only of heterosexuality, but to the tyranny of it.

How does “Islam” resolve this problem?

There are no Qur’anic verses on epidemics, whether of the immune deficient or SARS type. Yet Muslims must address these problems. Furthermore, if a Muslim is efficient at bringing about a cure, or resolving the issue of the spread of these diseases, we might want to associate his or her “Islam” with the consequence of their research or medical findings. If we do make this association, however, it will at best be indirect. Even if the successful researcher makes an explicit or direct statement that the work was accomplished as a result of his or her being Muslim, it will be impossible to refer to a specific Qur’anic verse or prophetic ahadith that can stand as the foundation of the technical skills, medical know how or research methods that could actually prove to bring about the solution. In a sense this gives us, as Muslims, the greater freedom in participating fully and responsibly in the search for a cure. If we fail, we cannot be indicted as bad Muslims. On the other hand, if we are successful, we cannot associate our success explicitly to Islam, even as we take inspiration from it.

Likewise, we cannot blame a failure of Islam as the cause for AIDS. If we address shortcomings within family law, as conditional upon the safety and security of those whose lives suffer from existing family structures, then we can help to reconstruct the law to remove those factors which help the spread of AIDS. Although these structural problems may be seen as secondary causes of the spread of the virus, the process of reducing the spread of it has shown the need to address all causes. Furthermore, these structural changes have other positive results in formulating more egalitarian families and society.

As a non-medical person, and one who does not contribute to disease research, I am clear that I cannot propose a solution to HIV/AIDS. My concern here is to address the ways that hollow Islamic theological rhetoric is made hallow or sacred by authoritarian means. Religious leaders, scholars and medical personnel cannot resort to these empty platitudes to excuse them from dealing directly with a problem of this catastrophic proportion.

HIV/AIDS and Zina

If HIV/AIDS was merely the result of immoral or un-Islamic behavior then non-Muslim countries should have a higher percentage of cases. However, highly industrialized countries like the United States have more active measures to curtail the spread of the disease perhaps because they do not resort to such an equation. When the emphasis is on reducing the spread of AIDS and not on taking a moral high ground, then more effective means for its reduction has resulted. Again, the underlying presumption that this disease can be directly linked to some un-Islamic level of moral behavior precludes the efficacy of other factors to determine the actual spread or safety and protection from its fatalities. The United States began its campaign against the spread of AIDS without the religio-moral high ground that can thwart an effective response to the epidemic. Without name-calling, isolation, silence and denial, it was able to address the spread. Simultaneously, the U.S. also launched the first ever such public campaign to promote celibacy among American youth. Commercials show popular and sophisticated young people engaged in a number of activities, going to school, earning and saving money, or creatively engaged in the arts, articulating their reasons for abstaining from sex until they are married. Whether this is true or not seems to be beside the point: it has more effectively advocated for abstinence.

HIV and Shari’ah

My concluding remarks are based on the impossibility of an exclusively Islamic theological response to HIV/AIDS. I don’t mean to sound pessimistic or un-Islamic here, but I have already stated that:

“Even if the successful researcher makes an explicit or direct statement that the work was accomplished as a result of his or her being Muslim, it will be impossible to refer to a specific Qur’anic verse or prophetic ahadith that can stand as the foundation of the technical skills, medical know how or research methods that could actually prove to bring about the solution. In a sense this gives us, as Muslim, the greater freedom in participating fully and responsibly in the search for a cure. If we fail, we cannot be indicted as bad Muslims. On the other hand, if we are successful, we cannot associate our success explicitly to Islam, even as we take inspiration from it.”

Indeed, I see Islam as inspiration for making my comments here as forceful and hard hitting as I could in order perhaps to jolt my own soul out of any tendency towards what Faisal Abdul Rauf calls the “ostrich approach” to Islamic theology in the face of seemingly insurmountable odds that do find an explicit and simplistic textually based solutions. In his book Islam: A Sacred Law: What every Muslim Should Know About Shari’ah, Abdul Rauf reminds us that Shari’ah is the “operative formula by which the Muslim determines what is good and ethical”. What is good conforms to divine intent. “The primary focus of the shari’ah is on humankind’s journey towards intimacy with our Creator… It protects the religion from the vicissitudes of history.” Furthermore he considers that “it is the law of Islam that is arguably the most important element in the struggle waged between traditionalism and modernism..” and recommends that we draw our temporal into the eternal… and “think about the morality of issues that were not posed to us before …” Indeed, if the “Islamic point of view” has not yet been established,” he asserts there “ought to be”.

Yet he refers to the three responses by Muslims to modern dilemmas. Number one is the “ostrich approach”: bury our heads in the sand and quoting ahadith and Qur’an, especially those to imply Muslims are on a moral high ground and thus unaffected by these new dilemma. The second is to build a Muslim society by establishing standards adhering to divinely ordained values. The third is to develop a methodology to integrate us into the society at large without losing our religious integrity and identity. Clearly this third option will be the most affirmative one in response to HIV/AIDS.

The nuts and bolts of any affirmative action on legal reforms will be drawn from a variety of sources of Islamic law, textual and ijtihadic. How they have been used and can be use vis-à-vis HIV/AIDS is not fixed, yet using them is essential. Differences in their usage need to be plainly spelled out, showing the ways of using the various criteria and our own sense of moral imperative to achieve optimal opportunities to benefit HIV/AIDS sufferers and to prevent further spread. We must be honest, however, that this is a process. For something like HIV/AIDS there is no simple precedent. AIDS is an indiscriminant, equal opportunity killer: it matters little if you pray everyday or never pray at all. Therefore we will not be able to resolve the problem by the ostrich logic that pretends good Muslims don’t contract AIDS, let alone die from it.

With respect to legal reforms I am intentionally deferring to those experts on matters of jurisprudence with this one important caveat gleaned from my experiences addressing issues of Islam and gender for several decades. No interpretation, application or positive development can proceed without every effort to include the ones whose agency is most directly affected by the case presented. HIV positive persons and victims of AIDS from all sectors of society must be included in the process of resolving the problem if we hope to achieve effective results. In this respect it is the reality of the ones who experience it, which determine not only the nature of the experience, but the positive responses to it for the goals of education, curtailment and control.

Email: