The sixth and final meeting in the Islam, Gender, and Reproductive Health series focused on public perception and understanding of sexual health, particularly HIV/AIDS, in the Middle East and North Africa (MENA) regions. Featuring Carla Makhlouf Obermeyer, a World Health Organization scientist and associate professor at the Harvard School of Public Health, and Sultan Aziz, director of the Asia and Pacific Division of the United Nations Population Fund, the event was co-sponsored by the Middle East Program, Environmental Change and Security Program, and the Global Health Initiative, and supported by USAID's Office of Population and Reproductive Health and the Interagency Gender Working Group.

In her presentation, Obermeyer explored public perception of HIV/AIDS in the largely Muslim MENA region, where prevalence of the disease is low. She also addressed how these perceptions affect prevention and treatment efforts. In the recent past, the virus was seen as a "disease of the West, where sexual mores were decadent. There was this sense that this could not happen in the region because of Islam and rules that require no sex outside of marriage," she said.

To explain the possible reasons for the virus' negligible impact on the region, Obermeyer posited, "It's clearly a hypothesis worth considering that the low prevalence in the Middle East and North Africa region is tied to Islam as a religion and to some of the practices that it implies regarding risky behavior." Yet finding conclusive data to support or refute this theory is virtually impossible given the high percentage of Muslims in the region. With no control group, Obermeyer asked, "What are we going to compare them to?" She did cite, however, an African study that compared the prevalence of Muslim and non-Muslim populations within one country. Results from this study showed that of the five factors entered in the statistical analysis, only two were significantly correlated with lower prevalence—percent Muslim and per capita income.

Prevalence in the region may be low, but Obermeyer called attention to the global rise in cases of HIV/AIDS. Preventing an increase of HIV/AIDS throughout the area, she said, will entail demystifying the disease, ending misconceptions about transmission, and updating healthcare practices. To exemplify the need for such changes, Obermeyer cited a report that while clinics in Yemen do not have enough medical gloves, they fumigate rooms vacated by HIV patients for five days. "There is this discrepancy between ritual purification and standard healthcare practices," she said. "Yemen may be an extreme case, but I think there is a need for more attention to some of these problems in health settings." In her own research, Obermeyer found connections between Islamic beliefs and misconceptions about HIV/AIDS. "In the case of those who had sinned, it was just retribution for such behavior," she said. "But in the case of children who might be infected in mother-to-child transmission, or in the case of tainted blood, this was a trial sent to test the faith of the believers."

Despite lingering misconceptions, Obermeyer said she has recently seen positive shifts in governmental approaches to the disease. Citing efforts in Saudi Arabia and Iran to track and gather information on high-risk groups—such as sex workers and intravenous drug users—she said, "The notion that this is a taboo subject that no one is touching is crumbling gradually. And this is a good thing." She also noted that focus on the disease is beginning to shift away from a purely medical perspective: "I'm seeing a little more epidemiology and a little more behavior, although we have a ways to go before we have some really interesting surveys."

Additionally, she identified a number of innovative approaches to dealing with the negative perceptions toward those with the disease, including a program supported by a theological study in South Africa called "Theology of Compassion and Harm Reduction." Using examples from different sources of religious doctrine, this new approach emphasizes that religion "demands compassion for those who are sick rather than punishment and that it is better to reduce the harm than to punish people," she said. Iran, for example, is pioneering this approach with intravenous drug users by setting up confidential testing and counseling instead of punishment.

Obermeyer also noted several NGO initiatives in countries such as Lebanon and Egypt, where AIDS societies, television programs on safe sex, and youth projects are beginning to emerge. "Most people are ready for a more compassionate attitude, so long as they are well informed and there are ways to protect themselves," she said. Emphasizing the need for such programs and for continued dialogue, she concluded, "As this is a disease that is transmitted by behaviors, it calls for a very different approach than a purely medical approach. It has to touch on questions of world view and questions of gender. It requires a multisectoral response."

Providing a historical context for many of the issues of Islam and sexual health that Obermeyer discussed, Sultan Aziz began by addressing the role of religion in issues of marriage, fertility, and women in society. The Koran, he noted, while the foundation of Islam, does not address how one should act in many situations. "If divine revelation has been silent or was silent about something, it is or was permissible and people were free to practice it," he said. This lack of specificity has led to wildly different interpretations on such issues as marriage, abortion, fertility, and female education. For example, the four Sunni schools of law—Hanafi, Maliki, Shafi'i, and Hanbali—each have different views on abortion. Aziz noted that while the Hanafi school allows abortion up to the 120th day of pregnancy, the Malaki schools allow abortion only if the mother's life is in danger.

Aziz believes that the attitudes toward issues not specified in the Koran have largely evolved in private. The resulting absence of public dialogue, he said, "is creating an entire generation that is going to set the clock back." Additionally, he said, "I suspect that none of the debates are public because it is considered in most societies shameful. And this notion is reinforced by culture and Islam. Nonetheless, people look for justification and the source. So how do we get information to women in the house?"

Bridging this divide from private practice to public discourse may take time: "For every pro-family planning, pro-forward-looking position, there are at least as many beliefs of how we should go back to the teaching of the prophet," he said. Adding to this problem, Aziz noted, is the inability by many Islamic governments to provide basic social services, resulting in fundamentalist organizations providing them instead.

Creating public discourse and changing current beliefs and practices in regard to women's rights begins with education for girls, Aziz said, who citied women being "frozen out of education as one of the biggest challenges we face." He believes that education and money are key factors that contribute to the uneven power distribution of men and women. Yet he also believes that this problem does not necessarily stem from Islam: "Fundamentally, the issue [of women's rights] is not driven by Muslim men. It has to do with power of relationships between men and women."

Drafted by Alison Williams.


  • Sultan Aziz

    Director, Asia and Pacific Division, United Nations Population Fund
  • Carla Makhlouf Obermeyer

    Scientist, HIV Department, World Health Organization; Adjunct Associate Professor, Harvard School of Public Health