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Mina Nabil
Professor ______
Rhetorical Writing and Composition
10 May 2015

The Prevalence of HIV/AIDs in the conservative societies of the MENA

region
The Human Immunodeficiency Virus (HIV) is an incurable sexually
transmitted infection that progresses in the affected individual until it finally
results in Acquired Immunodeficiency Syndrome (AIDS). First brought to
public attention in the 1980s, it has garnered a fearful reputation due to its
high fatality rate, lack of a cure and a general public ignorance about the
disease and how it is transmitted. In the United States, over half a million
people have already died from the disease since it was first diagnosed, while
an estimated 1.1 million individuals are currently living in an HIV positive
state of health (The HIV/AIDS Epidemic in the United States). Sub-Saharan
Africa has been the most hard-hit by the AIDS epidemic, with the region
accounting for around 70% of all HIV/AIDS cases (HIV and AIDS in subSaharan Africa).
Historically, the Middle East and North African (MENA) region has had
some of the lowest rates of HIV/AIDS in the world, with just 0.1% of the

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population infected. This is especially interesting considering the high rates

of HIV incidence found in the neighboring African countries. Many factors
have been put forward in order to try to explain this phenomenon, with the
main reason cited is that the highly conservative and religious nature of
Middle-Eastern society (which greatly frowns upon sexual activities outside of
marriage and completely rejects homosexual relations) has generally limited
the spread of HIV in its societies.
According to Shawky et al, HIV was first diagnosed in Kuwait and
Lebanon in 1984, a full three years after the first officially diagnosed case of
HIV in the world (4). HIV cases were soon diagnosed in the rest of the Arab
countries from 1985 onwards, and by the year 2000 all 17 Arab countries
had officially diagnosed cases of HIV/AIDS (Shawky et al. 4). Despite this
early introduction of HIV/AIDS into Arab and Middle Eastern societies, rates of
transmission and infection have remained relatively low compared to other
countries. However, this historically low rate has been increasing in recent
years, possibly due to the instability caused by the conflict and civil war that
has plagued the region since the Arab Spring. On a smaller scale, lack of
proper sex education in schools, the stigmas associated with discussing sex
and using condoms and the refusal of the government to protect or even
acknowledge at-risk groups are all contributing factors to this increase in
rates of HIV/AIDS transmission and infection.

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In a cross-sectional analysis carried out in Eastern Zimbabwe, it was

found that Christian men had a lower risk of contracting HIV than
Zimbabweans who followed other religions such as animism or who did not
follow any religion at all (Mazou, Schumacher, and Gregson 7). Moreover,
Agardh, Tumwine, and Ostergren found that Ugandan university students
who were religiously observant were less likely to engage in extramarital or
risky sexual relations, while students who did not identify as religious
engaged in sexual relations significantly earlier than their religious
counterparts, as well as having had a significantly higher amount of sexual
partners (Agardh, Tumwine, and Ostergren 1). In a separate study, Kagimu et
al. found that a decrease in the religiousness of Ugandan university students
was associated with an increased incidence of HIV infection (1). This lower
risk of HIV among religious people may be attributed to the fact they most
probably see this disease as a form of divine punishment in return for
sinning. This form of thinking is also exhibited by Tanzanian church-goers,
who in addition to the aforementioned also erroneously believe that prayer is
the only cure for HIV (Zou et al 11). In Puerto Rico, it was found that although
religious attitudes contributed to the stigmas surrounding HIV/AIDS, these
same attitudes also encouraged people to volunteer to care for HIV positive
individuals on the basis of helping the sick and needy (Varas-Diaz et al 13).
In contrast, a study of orphaned Zimbabwean girls found that memberships
in the Apostolic church were associated with increased rates of early

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marriage when compared with Protestants, and that early marriage in itself
increased the risk of HIV transmission (Hallfors et al 11).
In light of the somewhat conflicting evidence presented in the above
literature review, an interesting question arises: Is there a relationship
between a lower incidence of HIV/AIDS and religiously observant societies
such as the ones found in the MENA region?
As can be seen, the involvement of religion in HIV prevalence can be
considered to be a double-edged sword. Is it beneficial in sufficiently curbing
the spread of HIV or does it lead to increased rates of transmission due to
the substitution of scientific thought for faith-based belief?
On the one hand, religiously conservative societies (like the ones
present in the Middle East) have a significantly lower rate of HIV prevalence
due to stricter attitudes regarding sexual intercourse and relations. For
example, male circumcision is required by both the Jewish and Muslim
religions, and in spite of this, it has been increasingly promoted as a
protective measure against HIV in many African communities regardless of
their religions. In an analysis of data that covered over 100 countries, male
circumcision was strongly associated with a decreased risk of HIV and
cervical cancer among individuals practicing heterosexual forms of sex
(Drain et al 9). In addition, plenty of evidence was presented in the literature
review that showed that the strict religious attitudes that govern sex also
have a significant effect on the sexual activity of individuals and thus can

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affect the HIV transmission rates. In summary, it was found that an increase
in the religiosity of an individual generally led to a decrease in the risk of HIV
infection. Furthermore, cooperative religious institutions that included a
range of different Christian, Jewish and Muslim affiliations have been shown
to have a significant role in raising awareness about HIV/AIDS and therefore
contributed to prevention efforts among their congregations (Nunn et al. 6).
This is highly important as it plays a critical role in reducing the stigmas
surrounding this disease, which in turn will allow affected individuals to be
more comfortable with seeking medical treatment even in more conservative
societies.
On the other hand, certain religious attitudes can only be conducive to
creating an environment that facilitates an increased rate of HIV
transmission. Examples of such attitudes include the papal declaration that
condoms are inefficient and do not protect from HIV infection (Pope tells
Africa condoms wrong), and the beliefs still widespread in many Muslim
societies that still believe that AIDS is an exclusively gay disease and that
heterosexuals are thus unable to be infected. Such statements are not only
irresponsible and inherently false, they are also very dangerous as people
who listen to them will have a much higher risk of contracting the disease
due to simply being misinformed.
In addition to these problematic attitudes, particular religious practices
can also be important factors that contribute to the increased rates of HIV

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transmission and infection. For example, male circumcision has been

commonly put forward as a measure that offers some protection against HIV
infection (as previously mentioned), and as a result it has been widely
promoted and implemented in sub-Saharan Africa, which has been the region
most heavily affected by the HIV/AIDS epidemic. In contrast, circumcision of
females (more properly referred to as female genital mutilation), was found
to significantly increase susceptibility to HIV due to improper sterilization of
the surgical instrument used to carry out the procedure (Health
Complications of Female Genital Mutilation). Furthermore, a new
phenomenon has been observed where circumcised African men are more
likely to catch and transmit HIV due to their erroneous belief that their
circumcision provides them with full immunity rather than partial protection.
Moreover, it is important to differentiate between two terms:
prevalence and rates of transmission. According to the National Institute of
Mental Health (NIMH), prevalence is defined as the proportion of individuals
in a population that have a specific disease in a particular time period (What
is Prevalence?). Middle Eastern societies have generally had a low
prevalence of HIV due to a range of factors that have been previously
discussed. In contrast, the rate of transmission is how fast an infection is
spreading in a population, and although the current prevalence of HIV in
Middle Eastern societies is low, the rates of transmission are practically skyrocketing, especially among at risk groups such as prostitutes, intravenous
drug users and men who have sex with men (Setayesh et al). According to

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Setayesh et al, there are only two places in the world where HIV transmission
rates are still increasing: the Middle East (+52%) and North America (+4%).
This number is projected to increase due to the taboos that prevent at risk
groups from seeking medical help. In addition, the preventative measures in
place that have worked so well in Western societies would be near-impossible
to implement in the Middle East. For example, the provision of clean needles
for intravenous drug users (which has slashed transmission rates elsewhere)
would only be seen as encouraging sin, while health screening of
prostitutes would require the acknowledgement of sex workers and
recognition of their rights in the first place, which is not at all a feasible
demand for religious societies, where all forms of extramarital relations are
viewed as evil. Men who have sex with men are perhaps the most in danger
at risk group because of societal taboos that prevent them from even coming
out or seeking treatment (HIV/AIDS in MENA). In addition, gay men are often
forced into heterosexual marriage, which can result in transmission of HIV
and other STDs to their unsuspecting wives (Hill and McVeigh). The Middle
East is also one of the few regions in the world with increasing death rates
due to HIV/AIDS, mostly due to the lack of availability of antiviral treatment.
It can be seen that there are a variety of factors that influence how
closely involved religion is in the rate of HIV transmission and infection.
Plenty of evidence has been provided to show that religious beliefs, when
stemming from the individuals themselves, offer a protective benefit in that
they encourage abstinence from any sexual activity outside of marital

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relations (Gerbi et al 5). This in itself will significantly reduce HIV

transmission rate as abstinence is the only contraceptive method with a zero
risk of infection by HIV and any other sexually transmitted diseases (Bogart
et al 1078). Religious institutions that understand the mechanics of HIV/AIDS
and its dangers can play an essential role in raising awareness about to
effectively prevent transmission. Religious practices such as male
circumcision also offer partial but significant protection against infection by
HIV/AIDS when discussed in a heterosexual context only, as the benefits of
circumcision were negligible in preventing HIV while engaging in homosexual
activities or injecting intravenous drugs (Wamai et al 6).
Despite this, religion has also been blamed for much of the
misalignment and hate directed towards HIV positive individuals, as some
religious doctrines can be interpreted in a way that greatly stigmatizes the
disease. Moreover, some religious practices have been found to increase the
incidence of HIV/AIDS, such as female genital mutilation (Health
Complications of Female Genital Mutilation). The strict religious attitudes
towards sex has previously been cited as somewhat beneficial in that more
religious individuals were less likely to engage in sexual behaviors classified
as risky. However, this only applies to situations where the individuals
themselves are convinced of these beliefs and are actively practicing their
religions and adhering to the rules and regulations set by them (Agardh,
Tumwine, and Ostergren 1). In reality, these strict and inflexible attitudes
towards sex often create a society and an environment where sex and any

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discussion pertaining to it is taboo. Consequently, less religious individuals

might find themselves engaging in secretive and risky behavior without
being appropriately informed about the consequences of such actions.
Furthermore, at risk groups such as prostitutes, homosexuals and
intravenous drug users are also the groups that are most frowned upon and
shunned by society (Abu-Raddad et al 1). This makes it increasingly difficult
and in some cases life-threatening for these individuals to seek medical
treatment or screening due to fear of retribution. As a result, this directly
leads to increased rates of HIV/AIDS transmission and infection due to
inability to know if a person is HIV positive and subsequent inability to seek
treatment without fear of harassment or punishment. Such at risk individuals
could serve to further propagate the disease due to simply not knowing that
they are HIV positive.
In conclusion, it can be seen that the contribution of religion to
lowering the incidence and transmission of HIV/AIDS is a complex,
multifaceted issue. There is no denying that conservative societies have a
lower prevalence of HIV/AIDS, and this could very well be in part due to
religious teachings and doctrines. However, this currently low rate of HIV
prevalence in Middle-Eastern societies and conservative societies at large is
not a life-long, guaranteed state just because individuals are more religious.
As previously mentioned, statistics have shown that HIV/AIDS is increasing at
a very worrisome rate, and that the MENA region has the highest rate of new
HIV infections. As a result, these conservative societies have to adapt with

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the changing times and encourage their governments to enact a series of

measures that would lead to an increase of awareness of HIV /AIDS, its
modes of transmission and the preventative measures that must be taken to
safeguard against infection.
Finally, the answer to the research question is that the application of
religion in conservative societies indeed has offered a sort of protection
against the spread of HIV/AIDS as long as the people belonging to that
religion continued to actively practice its rules regarding sexual relations and
thus practice abstinence outside of marriage. However, in the face of
increasingly secular and irreligious societies world-wide, religion will no
longer have the effect it previously had in protecting people from STDs and
more specifically HIV/AIDS, as its rules will no longer be practiced or
followed.

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