United Press International - July 11, 2005
Lydell C. Bridgeford

By 1986 the Persian Gulf states and most Muslim nations in North Africa and South Asia had identified HIV/AIDS cases in their countries, said Laura M. Kelley, author of a report on the disease in the Muslim world. Yet two decades later, "very few (Muslim nations) have mounted maximum programs that control the spread of the disease," said Kelley, who with co-author Nicholas Eberstadt is a researcher at the American Enterprise Institute, a think tank in Washington.

One reason for the lack of social services to deal with the epidemic in the greater Islamic expanse stems from officials framing public-health issues through the prism of the Quran -- which is not only a religious text, but also "a source of law ... and an arbiter of social behavior," said Kelley, an independent researcher specializing in infectious diseases.

"We're obviously at risk ourselves of making generalizations about such a huge swap of humanity," Eberstadt said. "Understand that we understand that, if you deal with a fifth of the human population, you got a huge amount of variation," he added.

Kelley and Eberstadt made their remarks at a panel discussion on AIDS and Islam last week. Their report, "Behind the Veil of a Public Health Crisis: HIV/AIDS in the Muslim World," was released last month. They defined a Muslim country as any nation where 40 percent of the population practices some form of Islam.

"What we both see is a somewhat lazy and dangerous argument ... that Islamic values are an inoculation against the risk of HIV," Eberstadt said, "and we do hear that even sometimes in the public health community of (Sub-Saharan Africa), he added. "The task before us is to make sure this is not the model of an Islamic future in other parts of the world."

By addressing such taboo topics as adultery, prostitution, homosexuality and intravenous drug use, some conservative Islamic governments see this as condoning the behavior, Kelley said, adding that the behaviors that spread HIV are present in Islamic countries but often unacknowledged and unchecked by the governments.

"Absence of evidence is taken as absence of the disease," she said.

Kelley and Eberstadt said they think the current low HIV rates in the pan-Islamic region -- particularly the Persian Gulf states and North Africa -- are understated and that when officials begin making a good-faith effort to survey high-risk groups, the rate will be much higher.

The Joint United Nations Program on HIV/AIDS, known as UNAIDS, estimates that nearly 1 million people are infected with HIV in North Africa, the Middle East and predominantly Muslim Asia.

UNAIDS estimates that in 2004 up to 420,000 people in Mali, 180,000 in Indonesia, 150,000 in Pakistan and 61,000 in Iran had contracted HIV/AIDS.

"Bear in mind that the UNAIDS estimates are a work of not only science, but also of art and finally of politics," Eberstadt said. He noted that Afghanistan, Turkey and Somalia -- all of which have large at-risk populations -- failed to submit HIV statistics for the report.

"The published UNAIDS figures ... represent the confluence of factors that include the political negotiations between the governments in question and UNAIDS," Eberstadt said, "so treat them with the care they deserve."

He said the Muslim nations that are making a concerted effort to address the deadly disease include Bangladesh, Malaysia, Indonesia and Iran.

It is often a challenge to obtain HIV statistics from developing countries, including Muslim states, said Timothy Fowler, an AIDS data expert with the international program center at the U.S. Census Bureau.

The center, which collects and reviews international HIV figures for its surveillance database, not only culls information from UNAIDS and public health journals but also tracks down data from newspapers and international AIDS conferences, said Fowler, who recently returned from the International Congress on AIDS in Japan.

"Probably a good 50 percent of the data that is presented at conferences never sees the light of day," Fowler told United Press International, explaining why he and colleagues often attend such conferences to add to the available database on HIV/AIDS.

"We hope to take away the successful lessons we learned in Botswana and apply them to Muslim states," Anthony Carroll, a consultant with Merck, told UPI.

Kelley and Eberstadt recommended that Muslim states, many of which are developing countries -- where AIDS is exacerbated by high poverty rates and inadequate health systems -- mount aggressive HIV/AIDS surveillance, education and prevention programs.

"What is happening in (Sub-Saharan) Africa today ... will be happening in the Muslims world," Kelley told attendees. "The problems and issues are exactly the same. People have to understand the ground truth as to what is going on in their country."

Eberstadt said he and Kelley "encourage the U.S. government to think about the way in which HIV prevention polices can be a bridge for engaging with different Muslim populations around the world, where the United States may not in fact be the flavor of month these days."

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Lydell Bridgeford is an intern for UPI Science News. E-mail: sciencemail@upi.com
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