Inter Press Service - December 16, 1998
Dev Raj

"Imams are better for the job than politicians because they have to set a good example of moral behavior in daily life," says Nurul Islam, national professor and founder of the Islamic Medical Mission (IMM).

"Anyone who offers prayers five times a day cannot be bad. Besides imams have lot of spare time and it is one way of using their underutilised manpower," Islam said.

With financial support from the United Nations Development Programme (UNDP), the IMM has begun training imams to impart anti- HIV instruction, along with routine sermons and ministrations, to the million-strong faithful in this country. The project has the blessings of Prime Minister Sheikh Hasina Wajed although she and her Awami League party profess secularism and regard religious orthodoxy as a creation of the country's past military dictators.

"They (military regimes between 1974 and 1996) rehabilitated fundamentalistic groups in order to establish political power - it is now a serious problem," Hasina told visiting foreign journalists last week.

But Hasina said she could see no reason why the country's 200,000 imams should not do their bit for a new drive to create awareness against HIV using their influential religious platform.

The IMM is currently training its fourth batch of 50 imams and plans to train up another 15 as part of a larger programme to give basic medical training to religious leaders enabling them to act as "barefoot doctors."

Training imams, who are a law unto themselves in this country is no mean task, says Dr Halida Khandaker, one of the trainers. "Talking about sex is taboo to them and they find it embarrassing to discuss the details of HIV transmission," she says.

Dr Khandaker who is the director of Confidential Approach to AIDS Prevention (CAAP) a non-governmental organisation (NGO) said typically she found each new batch reacting rigidly at first but then easing up by the end of the three-day course.

"The imams harbour many misconceptions. They say that homosexuality is sin. And many did not want to believe that HIV existed in the Arab countries (regarded as holy lands)," Dr Khandaker says.

Bangladesh has only 102 known cases of HIV but most of these were acquired and even detected in West Asia, says Prof Nazrul Islam, head of virology at the Bangabandhu Medical University here.

Typical is the case of 20-year-old Mukti, one of his patients who acquired HIV in Bahrain and was deported to Bangladesh after she tested positive during a routine medical examination.

Last month, Mukti became the best known HIV case in the country when she addressed a meeting jointly organised by the Foreign Investors Chamber of Commerce and Industry (FICCI) and UNAIDS.

Labour export is a major dollar-earner for cash-starved Bangladesh which sends some 200,000 of its citizens abroad each year - mainly to do menial and unskilled jobs in oil-rich West Asia.

Women who go to the Arab countries seeking employment risk sexual exploitation. Earlier this year the government banned the export of nurses but later lifted it because of unemployment and hardships at home.

As for male expatriates, they compensate for prolonged absences from home by turning to commercial sex workers (CSWs) or taking to homosexual practices. "I tell men who go to the Arab countries not to have sex with prostitutes and to avoid homosexual acts," said Md. Amirul Islam, the imam of a mosque in Manikgang district, 80 kms from Dhaka.

IMM's Islam is convinced that the spread of HIV around the world is the result of people going astray from religion and morality. "By spreading the teachings of Islam, imams automatically help AIDS prevention because in Islam there is no afterworld for those who indulge in extramarital sex," he said.

According to him the concept of perdition in Islam actually helps. "The aim is to draw a dangerous picture of AIDS that it invariably leads to death."

One teacher of imams at the IMM Prof A. Wadud of the skin and venereal diseases department at the Bangabandhu Medical University agrees with Islam. "HIV is less common in countries where religion is strong," he argues.

The imams do not directly promote the use of condoms but advocate its use by married couples where one of the partners is suffering from a venereal disease. "I would recommend the condom to anyone who comes to me with syphilis or gonorrhea so that he would not pass the disease to his wife," says Hafez Mohammed Abdul Hakim, imam of a mosque in the Mirpur area of dhaka.

"I also warn male congregants that vaginal fluids are the source of many infections including viral hepatitis," Hakim said.

As for instructing women who are more vulnerable, Hakim said he expected them to receive knowledge on HIV and its prevention from their husbands.

Whatever the merits or shortcomings of the IMM programme imams are the country's best defence against disease in poverty-ridden rural Bangladesh where few qualified doctors care to practice.

"Villagers in many areas of Bangladesh have never seen a qualified doctor but every villager has seen an imam," Islam said adding that there are no villages without a mosque and no mosques without an imam or two.

Under the IMM programme, the imams are trained to dispense 45 different drugs given by the government for free distribution. "The drugs are approved by the WHO for use in villages and are safe even in unsafe hands," Islam said. Although official figures maintain that there have only been 102 cases of HIV so far, experts believe that the actual number of infections could be as high as 50,000 or even more.

Prof Nazrul Islam says all the elements for a "wildfire epidemic" are present in Bangladesh including high-risk behavior among youth, intravenous drug use, unscreened blood transfusions and poor awareness.

Proximity with known global hotspots for HIV such as Burma, the north-east of India and Thailand are not encouraging and many believe that government figures for HIV incidence gleaned from unrepresentative surveys are highly misleading. The actual number of infections may even exceed 100,000, says virologist Dr Nazrul Islam. "Just because I put my hand into a pond and caught some fish does not mean they were the only ones in it."

Most worrying, he says is the low level of condom acceptance which he estimates is less than 20 percent among sexually active groups in Bangladesh. "We had meetings with religious leaders on condom use but some of them accused us of promoting promiscuity - some were arrogant," he said.

To compound the problem Bangladesh has a high rate of sexually transmitted diseases (STDs) with surveys suggesting that more than 60 percent of the CSWs carry either syphilis or gonorrhea which greatly increase vulnerability to HIV infection.

But 50 percent of people reporting for STD treatment in Bangladesh are students most of them confessing to having caught the infection from CSWs, Prof Nazrul Islam said.

Imams are no exceptions. "One benefit of the IMM training classes is that quite a few imams are using the opportunity to report for treatment of STDs," Dr Khandaker said. (END/IPS/rdr/an/98)
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