Until recently, studies focusing on the intersection between HIV/AIDS and Muslims or Muslim-majority countries have been scarce. Scholarship from the 1980s and 1990s focused on HIV-infection rates in Africa and examined Muslims as a statistical demographic group, if at all. Those articles that did touch on the Muslim world examined the fact that the number of people living with HIV/AIDS in the Middle East was dramatically lower than other parts of the globe, leaving one author to ponder in 1997, "Will Egypt Escape the AIDS Epidemic?"
Reflecting on these lower-rates, American academics began to posit whether, in fact, Islamic regulations on sexuality, usage of intoxicants, and male circumcision contributed to a certain degree of immunity from HIV transmission for the Muslim community.
Only within the past two years have comprehensive scientific studies focusing on the Middle East and North Africa (MENA) region been published, attempting to fill the widely acknowledged knowledge and data-gap in the HIV/AIDS world map. These reports state that if no increased data-collection, prevention campaigns, or treatment programs are implemented, epidemic-level HIV outbreaks will likely occur among injecting drug users (IDUs), men who have sex with men (MSM), and female sex workers (FSMs) throughout the region.
These three groups are not only increasingly susceptible to contracting HIV, they also are more vulnerable to infection than the general population. The following sections detail the challenges faced by each of these groups and some corresponding religious issues that increases their susceptibility to infection.
Injecting Drug Users (IDUs):
As a major source, route, and destination for the global drug trade, MENA countries -- including Iran and Afghanistan -- have witnessed an increased rate of HIV-prevalence in IDU-communities. Through the use of non-sterile injecting equipment, IDUs often become infected with HIV. The network structure among injecting users additionally encourages risky sexual behavior, which may lead to infection.
Religious discussions around injecting drug users have focused on the authoritative sayings and traditions of the Prophet Muhammad (hadith) and Qur'anic verses associated with intoxicants (khamr). Some Qur'anic verses detail avoiding intoxicants, which are seen as evil temptations, so that one may live a prosperous life.
While IDUs are often denied compassion and viewed as sinners, scholars have argued that the principles of Islamic law (maqasid al-shariah) encourage harm reduction programs--public health strategies that tolerate otherwise risky or illegal behavior in order to reduce the consequences of certain behaviors--that may be justified on the basis of a drug-user's personal struggle (jihad).
Men who have Sex with Men (MSM):
In addressing men who have sex with men (MSM), it is worth noting the distinction between MSM-sexual practices and identification with those acts. MSM should not be treated a synonym for gay or homosexual. Rather, MSM includes those individuals who may or may not identify as heterosexual, be married to a woman, or be a sex worker and have sexual relationships with other men.
Current debates on homosexuality and Islam are prevalent, particularly regarding the degree, if any, to which Islamic law condemns or penalizes same-sex sexual behavior. It is important to note, however, that the Qur'an does not contain the word homosexuality and, like the English language, there is no universally accepted term in the Arabic language to refer to individuals in the LGBT-community.
The story of Lut is a common reference point for many Islamically-oriented condemnations of same-sex relationships and, specifically, sodomy between men. Scholars have also noted hadith references in which the Prophet cursed men who engaged in sodomy and others that stipulate severe punishment for sodomy. More progressive scholars advocate focusing on the distinction between a sexual act and an individual's sexuality and encourage those reading the Qur'an to distinguish between literal, semantic, and thematic readings of the Story of Lut.
Female Sex Workers (FSWs):
HIV among commercial female sex workers is on the rise. The clandestine nature of sex-work, however, poses difficulties for those interested in collecting data about and researching the risks associated with such networks. The frequency of client contact, often accompanied by lack of condom use and attendant drug usage, increase the likelihood of FSWs becoming infected with the virus. Two particular issues associated with increased vulnerability to HIV among female sex workers are existing power imbalances and the lack of comprehensive sexual and reproductive rights education for women.
Highly controversial and almost universally condemned, female sex work in the Muslim world exhumes discourses on the nature of sexual practices as regulated by the teachings of Islam. Unlawful sexual intercourse (zina) is heavily frowned upon in Muslim communities, and often strictly outlawed by the state.
Other debates around FSWs have focused on the Islamic permissibility of condom usage. Believing that condom usage promotes promiscuity, many Muslim organizations and leaders have spoken out against condoms and their inclusion in Islamic approaches to HIV/AIDS. Though for sex workers -- as with all individuals -- condoms are an important way to protect against HIV transmission. There have been suggestions from some Muslim thinkers that condom usage may be permissible.
Recently, in July 2012, the Global Commission on HIV and the Law released Risks, Rights, and Health, a report that provides evidence-based analysis on the ways in which the law has both mitigated and exacerbated the spread of HIV. The report also calls on governments to outlaw all forms of discrimination, repeal punitive laws, and reform ineffective approaches to drug-use and intellectual property regimes, among others.
The Commission's report should be taken as a frank admission that when it comes to HIV/AIDS, faith and religion matter. Whether espousing compassion for the sick or condemning perceived immoral behavior, religion has an intimate relationship with HIV/AIDS patients, particularly those living in Muslim communities. Civil society actors must not forget to engage with religious figures and consider the ways in which religion impacts those groups most susceptible to the disease.
A longer version of this article was previously published in Muftah.org and has been abridged and reproduced with the magazine's permission.