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Changing Role of AIDS Prevention
According to this view, the doctor's job as a scientist is to heal and treat. If the patient needs moral and spiritual guidance, he should go to the mam or sheikh. If he chooses to endanger his life with risky sexual behaviour or drugs, it is his own personal guarded business. The doctor or medical practitioner can only inform him about the harm that can befall him, but it is not his job to change his worldview or his ethical and spiritual conceptions.
It is really heartening to see that the powerful wave of Islamization has already engulfed the young generations of doctors. In most Islamic countries, the medical schools are the most respon- sive to Islamic movement activities and Islamic medical associations have sprung up everywhere; from the United States and Canada to South Africa, and from the Arab World to Pakistan and Malaysia. It is to these doctors who broke the chains of mental slavery to the sec- ular, non-judgmental Western role model that I wish to speak.
I strongly urge them not to belittle the role they can play in changing the attitudes of their patients and friends so that they may have a better life with ha/a/ and safe heterosexual relationships and a drug-free, blessed existence. The very same kind of spiritual advice given in a few words by a dedicated, white-coated doctor can be much more effective than hours of preaching by a turbaned sheikh in traditional garb. Such a Muslim physician can really impress his young patients and change their attitudes not only because of the much needed help which he gives them, or because of his esteemed social status, but also because of his ability to speak on religious issues in a 'scientific' manner and to talk about science from a spiri- tual perspective. The cognitive and emotional aspects of the twor fields support each other like the pillars of a building. !
Such doctors and specialists should not limit their Islamically oriented prevention endeavours to the few patients and clients whom they meet in hospitals and clinics. They must shoulder the responsibility of propagating their mission through public lectures and media. A dynamic and moral approach of this nature would bring about much better results than the limited Western gospel condoning condoms, clean syringes, and the avoidance of risk' groups.
Of course, I am not saying that there is no place for condoms and clean syringes in an Islamic prevention strategy; what I am asserting is that a condom should not "condone" promiscuity, and' syringe sterilisation should not be a justification for drug use. Muslim doctor should wisely and sympathetically advise his and clients against all forms of zina or fornication and liwat homosexuality. Using the proper Islamic terminology will expose the ugliness of the sexual practice. The Muslim doctor can use positive encouragement toward a happy matrimony or a healthy life free of drugs or the negative consequences ofAfDS and other sexually transmitted diseases.
Above all, he should not shy away from talking about the importance of God's pleasure and displeasure in this world and the hereafter. It is only after such advice that the issue of condoms can be discussed. Clients are to realise that using a condom is a prophylactic measure of a last resort, used when one's animalistic soul becomes too powerful to deter one from sinful behaviour. Hence the condom should be pushed back from the front line of prevention.
The use of condoms from an Islamic perspective:
A number of Muslim scholars and organisations from Algeria to Indonesia have spoken and written very strongly against the use of condoms, describing the practice as unlslamic and as an invitation to promiscuity. Some influential Muslim scholars have even suggested that their use should be totally deleted from any Islamically ori- ented prevention program. For example, Hasan Basri, the Chairman of the influential Indonesian Ulemas Council~ was quoted by AFP (August 4, 1995) as saying that the Council opposes campaigns which advocate the use of condoms to prevent the spread of the AIDS virus. He described this as an open invitation to promiscuity. He suggested that condoms be sold only to married people who prove their marital status by showing their marriage certificate at the counter!
I strongly bel ieve that such an extreme position is neither rational and practical nor is it Islamic in approach. With all the risks that we have detailed about condoms in the fast chapter, there is unmistakable evidence that, if used properly, they can be of help in warding off HIV infection. We have criticised the common unfounded belief that they can offer full protection. They do not, even if used correctly, but there is no doubt that they are much better than wearing nothing. It is unfortunate that the flood of information equating "safe sex" with the use of condoms have wrongly convinced many that by wearing one, a person can take any risks. The media has helped in perpetuating such a hazardous belief. For example, the title of an article on condoms printed in large letters by Malaysian newspaperThe Sun (September 7, 1995) reads: "In the age of AIDS, a condom can be the only thing that comes between you and a death sentence".
Islamically, the use of condoms can be viewed within the general law of fiqh or jurisprudence of ikhtiar akhaffa-dararain, or choosing the lesser of two evils. I personally believe that if we apply this rule, on which there is general consensus among Muslim jurists, we would make the use of a condom obligatory for a fornicating Muslim who has some reason to expect HIV infection from his promiscuous practice. Fornication is a major evil, but exposing another, though that person may be a companion in fornication, is definitelya much greater evil.
According to Muslim jurists, there is a hierarchy of evils, and if one is forced, one should choose the least harmful. Losing one's faith and religion is the worst of all catastrophes, followed by losing one's life. Next is the evil of losing one's mind, and then the loss of fortune. Lastly comes the issue of one's'irdh which concerns one's actual detestable deeds, like fornication, with respect to one:s self or family. A Muslim who fornicates has every possible chance of repenting, and his earlier sins would be changed to good deeds, as the Holy Qur'an states.
How to Islamically combat homosexuality?
Though we mentioned homosexuality in the previous section where we discussed some of the practical ways of Islamically fighting promiscuity, I feel it is necessary to consider it in more detail because of its major role in the AIDS pandemic. We have already devoted a short chapter to exposing Western modernity's enticement to anal sex, and we have pointed out the role of gay bizarre practices in the development and possible mutation of HIV. It is unfortunate that some of the Western views justifying homosexuality on biological and social grounds are reiterated by Westernised Muslim doctors and psychologists and publicly repeated by the media. Muslim societies are unaware of the serious consequences of entertaining such views.
Male homosexuality is practised to a greater or lesser degree in different Muslim countries; more in some Asian than African Muslim societies. However, it is performed in a concealed manner i as a shameful sin. As they grow older, most homosexuals repent and , settle with their wives. That is why hofT1osexuality can still be banned and successfully combatted along Islamic preventive measures. Accepting justifications for being gay, as modern Westerners do, can have detrimental results with respect to these religious attitudes. It will be a gradual downhill descent to Western modernity's propaga- tion of homosexual marriages and the destruction of the powerful Muslim family unit.
It is really lamentable to report that many Muslim colleagues in psychology and psychiatry have identified with the Western model' provided by their American and European professors to the extent that some of them, even in Islamic conferences, shamelessly condone sinful gay sexuality. When this issue was once raised in one of 1 the meetings of the Islamic Medical Association of Malaysia to which was invited, an old Asian psychiatrist boldly said that being gay is simply a variant, victimless sexual preference that is often biologically determined, and that he does not see any reason to treat it. He stated that the best advice he generalfy offers to his patients is just to accept it and enjoy it.
Such opinions are obviously un-Islamic. As I already stated, they convey a very contradictory and unjust picture of God. If homo- sexuality is biologically determined, then it is God whp created this 'preference' in gays. If He then punishes them with mass destruction, as in Sodom, or severe sanctions, as in IslamicShari'ah law, ; then no action can be more unjust than that. Western Christian , thinkers and some high-ranking members of the clergy, as we have detailed earlier, have tried to resolve this problem by first declaring ; that homosexuality is neither sinful nor evil, and from this they proceeded with their second interpretation that God wanted some of His slaves to be gay and so He genetically created the in this archetype. This paved the way for authors such as Scott Pec to go a few steps further by impertinently confusing promiscuous s x with Divine spir- ituality, asserting, as we have already stated, that this sinful rela- tionship is blessed and "orchestrated by angels off in the wings" (Scott Peck, 1993, p. 227).
Islam still has a strong grip over the hea s and minds of its followers, so such a condoning Western approach to "just enjoy your disposition" is utterly out of cultural tune and w'll almost certainly be of either little or no temporary help, or even c use psychological damage to the guilt-laden gay Muslim patient wh cis eager to get rid of his culturally and religiously shameful and isreputable habit. Therapists who unthinkingly adopt a modern Wes ern stand are generally out of touch with the real agony of a ho osexual in a con- firmed heterosexual Islamically oriented society. His 'orientation' is seen as scandalous by his family members, as di honourable by his colleagues, and as hateful by the young generatio of contemporary Islamic revivalists, even though they may be his a n adolescent children. Biological rationalism to such persons can only confuse their tragic situation, So it is of paramount importance a AIDS prevention that this Islamic attitude sh0uld not be weake ed by erroneous hereditary justifications for homosexuality.
As we have already stated, homosexuality s not in the genes; it is a treatable disorder. It is very essential for the Islamically orient- ed psychiatrists, psychologists, and other specia ists to familiarise themselves with the current scientific literature which invalidates the claims of the heredity of homosexuality, It may e helpful if I simplify some of the main arguments for the enviro mental aspects in the development of gay behaviour. If homosexuality were biologically determi ed it would have I been practised in all countries of the world. H wever, as is well known, in some communities and tribes in Africa and other parts of the world, homosexuality is totally absent or so rar that rural inhabitants may get the shock of their lives when the pr ctice is described to them! The pre-lslamic Arab tribes had not even heard about homosexuality. It has been documented that the third caliph of the Prophet Muhammad, 'Omar ibn al-Khattab, stated that before the Holy Qur'an revealed to them the story of the Prophet Lot and his homosexual people, they could not have imagined that a man could ejaculate into another man's rectum.
The Qur'an clearly states that the townsfolk of Sodom were the first people on earth to adopt a homosexuat lifestyle. It is thus a learned practice in which the deviant person voluntarily allows his 'libido' to flow in the wrong tributary. Just as different peoples in various cultures of the world learn to have distinct and sometimes contradictory, standards of beauty in their women, and just as these peoples learn different ways of heterQsexually enjoying these pleasurable attributes, a group of deviant persons learn to restrict their eroticism to their own sex.
A female's bare breasts are sexually stimulating to Westerners and to many other cultures, but to men in some tribes in South Sudan and Indonesia they are simply a couple of baby milk bottles, so women do not even bother to cover them up. And though kissing is quite common in most cultures, it is considered a disgusting practice by the Thonga of Africa. As Rathus reports, "they could not understand why Europeans "ate" each others saliva and dirt when they saw them kissing" (1983, p. 18). In contemporary Mauritania, and in the Arab Northern Sudan of the thirties and forties, obesity was greatly appreciated as one of the major attributes of female beauty. An attractive, very fat, dark woman with facial scars was an idol of Sudanese men's attraction. These standards of beauty are being greatly revised as modernity's television, cinenJa and media are gradually showing their influence. However, those who still live away from modern dominance such as Bedouins and desert Arabs still adhere to their old norms of female beauty. One such desert Arab chief, listening to a visiting Westernised acquaintance describe a white beauty queen as having stunning blue eyes, blonde hair and a thin slender body, asked his enchanted guest in wonderment whether he was describing a woman or a cat! Another argument ascertaining that homosexuality is a learned habit is the fact that it is more common in places where large groups of males have no choice but to I ive away from females for long periods of time. As is well known, homosexuality multiplies rapidly in prisons, the army, the navy and boarding houses of male students in remote public schools. This phenomenon is augmented when the society of such trapped males does not have strong religious and social prohibitions against homosexuality, or when they are influenced by a forceful role model who engages in gay practices.
It is obvious to any reasonable scholar that the Western gay liberation movements and the scientists who back them are staging all this hereditary balderdash to support their cause. Otherwise, why do we not hear of a genetic link to pedophilia or sexual relations with children, nor bestiality, in which the deviant uses an animal for a sex partner. Certainly, the difference between heterosexuality compared with sexual relations with animals and children is much greater than the difference between it and homosexuality. This should have pre- sented a more convincing justification for genetic aetiology. However, no group has taken such a stand since animals cannot speak for themselves and pedophilia is against the law!
Thus, homosexuality is a learned sexual preference, and it can be unlearnt in the same way that people learn to develop new standards of beauty 'in their women or easily learn new deviant sexual behaviour by viewing perverted blue films (Daux & Wrightsman, 1984). When the client is highly motivated and determined to rid himself of this sinful behaviour, a few sessions of Islamically oriented behaviour and cognitive therapy do not generally fail to shift his eroticism to heterosexuality.
In my own practice of more than thirty years, I do not remember having any such highly motivated patient who has not changed to heterosexuality and developed a negative attitude to his earlier practice, or who has at least developed a positive sexual approach to women and was able to get married and enjoy an intimate relationship with his wife. The ery few homosexuals who had not benefitted from my therapy wer either those who were not motivated or those shy submissive ones ho were unable to rid themselves of the : influence of bad compan .That is why I believe that Islamic assertiveness training is a ve y important ally to the therapy of homo-sexuality.
This is particularly so with regard to receiving homosexuals in a traditional Islamic envi onment. They often suffer from feelings of inferiority and demorali ation. Together with assertive therapy, such patients need the supp rt of Islamic societies and groups which can restore their self confid nce and respect. It is important for such receiving homosexuals to now that Islam does not differentiate ? between the receptive and insertive homosexuals. They are both equally grave sinners. It is only a widely-held misconception among Muslim societies to perman ntly stigmatise the receptive, even if he stops his gay practice, sinc he takes the role of the woman, while forgiving the insertive if he atones because he has not changed his masculine role!
It is advisable that t e Muslim psychologist should start with " cognitive therapy to help ga Muslims positively change the way they perceive themselves in rela ion to God, to their society and to Islam as a way of life. After the unselled achieves a reasonable level of positive thinking and spiritual motivation, aversion therapy involving psycho-spiritual sensitisati n, such as shaming or development of guilt feelings, can be used. Aversion therapy may also include phys- ical techniques like electri shocks and noxious smells associated with homosexually-activate imaginal scenes, memories, or pictures. This therapy can be very eff ctive in eliminating homosexual impulses, or at least in reducing their potency. Positive psycho-spiritual reinforcement coupled wit heterosexual scenes in which the patient sees himself enjoying the leasures of a married life in which he secures the pleasure of God and is fully accepted and respected by his elders and friends are a must in concluding each therapeutic session. Islamically oriented s stematic desensitisation, combining elements of cognitive therapy, can also be of great help.
I accordingly call on my Muslim colle gues not to adopt Western modernity's psychiatric approach cond ning gay practices with their Muslim patients who are desperately s eking their help. It is unfortunate that modern psychiatry and clinic I psychology have given up the treatment of homosexuality as a di order or deviance. As early as the late sixties, Western psychiatrist and psychothera- pists started to lose interest in this field, ironicaIly, at the time in which behaviour therapy had just come up with few very successful methods and techniques of treatment. They had sensed the general tendency among Western professionals and governments to cease considering homosexuality as a deviance, di order, or offence.
Accordingly, reseflrch money and efforts were di ected towards less important aspects. Young Muslim specialists, therefore, may complete their psychiatric or clinical psychological studies without receiving any training in this area. Hence I woluld advise Muslim therapists that if they do not know how to heir Muslim gays who want to change, they should frankly tell them that and should refer them to those who can help them. But to explain away homosexuality as an inherited orientation to be enjoyed ithout guilt, either because the therapist has been brainwashed or because he or she wants to conceat his inability to cope with such disorder, is to my mind a serious sin and an unforgivable offence t the patient.
The reader may feel that instead of talking about comprehensive strategies of prevention I have unnecessarily dwelled upon limited therapeutic issues. I have intentionally done that. Learning how to change attitudes and behaviours of individual ersons in the clinic gives such specialists insight into the dynamic of public prevention by combining the cognitive with the affective and spiritual aspects. The inability to achieve this combination as I will show later when I discuss education, is the main reason for the failure of public awareness prevention campaigns in changing attitudes in different parts of the world.
I strongly believe, after long experience Jith Muslim psychiatrists and psychologists, th~t unless they become fully aware of their changing role in the micro I therapeutic setting of their clinics, they cannot offer Islamic practidal help at the preventive macro level. With a changed Islamic attitude towards therapy, psychiatrists, psychologists and other mentfl health specialists should be able to cooperate with AIDS prevention bodies to launch a dynamic, effective program. Though this program ideally aims at eradicating the pathological consequences lof homosexuality and promiscuity and drug intake, everybody knfws quite well that no society on earth can be completely cleansed from these evils. What one can hope for is to reduce their practice to a level below the 'threshold' for epidemic sexually transmitted diseases and AIDS.
HIV and the germsl of other sexually transmitted diseases flourish and mutate in societies in which rampant fornication prevails, whether among the homosexuals of San Francisco, who were probably the developers of the pandemic, or the prostitutes of: Thailand who have recently succeeded in creating a new strain of HIV that is particularly harmful to females. Limited fornication secretly practised in a comparatively morally clean environment is not expected to result in epidemic sexually transmitted diseases.
Out of the closet or back into it?
So what such a prevention program hopes to achieve is to put Islamically unsanctioned sefual practices back into the darkness of the 'closet' and not, as We$tern modernity does, to take out of the ,closet one shocking sexual dffence after another. Publiclyexposing abhorrent sexual behaviour fhich was previously done secretly by a tiny minority of the population will not improve the sexual mores of a society; on the contrary, it] will devalue them. It is not like psycho-analytically 'digging' out the repressed forgotten experiences of a neurotic patient from the: 'darkness' of his unconscious mind. Psychoanalysts claim that suFh a patient will achieve insight and get over his symptoms in spite qf the initial shocking anxiety caused by the unconscious experiences becoming conscious.
Bringing out shocking sexual practices from the darkness of the closet into the light of society with its thrill-seeking media, on the other hand, will only make people get used to! them and eventually' accept their practice until they are publicly njoyed without any shame or guilt. As we have briefly mentioned in chaptertwo, a few decades ago Western modernity took premaritaI sex out of the closet. It soon became the norm; then extramarital sex became an everyday affair; now homosexuality is becoming an acknowledged alternative to heterosexuality. And now the cl set is almost empty, with only pedophilia and incest remaining on i s empty shelves. The latter is halfway out of the closet since it is being discussed in professional journals with a lenient approach bac ed by the increasing statistics of those who commit it. It is on its w y to becoming 'normalised'! An Islamic prevention strategy woul therefore adopt the opposite approach of not only letting sleepin dogs lie, but trying also to put more dogs asleep. A famous saying in Arabic is "fitnah, meaning temptation or enticement, is asleep God curse those who wake it up". ,
Each Islamic country has its unique cir umstances and con- ditions which allow for the spread of promiscui y. It is the responsibility of specialists and other AIDS preventio personnel in each society to identify these factors and boldly combat them with all available means. However, the success of suc an Islamically oriented strategy cannot really be fully achieved b specialists, Islamic scholars and non-governmental committees y themselves. The achievement of the long range goals of prevention can only be accomplished by the full cooperation of fourther institutions and movements. These are the governments of Muslim countries, the media, the school and university education I systems, and the Islamic youth movements. I will discuss the role of each one of these institutions after I present my views on the Isla ic approach to the , prevention of drug intake, since the two issues re naturally linked.
The changing role of Isla ic anti-drug campaigners:
Another important area here the Muslim doctor and other profes- sionals and non-professionals can be of great help in Islamically changing the face of pre ention of AIDS, is that of drug and alcohol intake. First, an effort sh uld be made to rid this proposed anti-drug campaign of the Western conception of "abuse". The ideal ultimate I' aim of an Islamic appro h to alcohol and drugs is not that of preventing abuse but that of stopping intake. The use, or for this matter, , the misuse of the term " abuse" in Western modernity is due to the realisation that total abstinence is unattainable, or at times undesirable, and thus to campai n for it is not realistic or practical. Also trying to stop normal citi ens from the intake of drugs would seem to contradict the Western conception of freedom in a democratic setting. People should be Ilowed to do what they choose to do with their lives. It is only after 'abuse" or excessive use of drugs that problems can. arise and sanctioned authority can interfere. But even then "abuse" IS perceived as a disease to be treated rather than an offenced to be eliminated. This is articularly true of alcohol addiction in spite of all the serious damage which alcohol is causing to Western countries. Szasz (1974, p. 65) brilliantly comments on this inequality in treating different drugs. He says:
Historically, refusal to o t for total prevention of drug intake is also rooted in the fact that A erica had earlier tried to ban alcohol by enforcing the famous laws of the Prohibition of 1919 but utterly failed in the effort and the laws were repealed fter 14 years of striving to make them work. I have already mentioned this in chapter four. I would like to add here that this may explain Szasz's query , about modernity's refusal to treat alcohol on n equal footing with other drugs. American Government committees which studied the reasons behind this failure agreed that the sudd n enforcement of the laws and the lack of moral, spiritual and educ tional efforts to prepare the public for the prohibition was the major cause (Badri, 1976). This tragic miscarriage has ever since stood as a deterring example for any Western wide-scale campaig for total abstinence from drugs and alcohol, and hence the use of the milder term, "abuse" as opposed to "normal use" or "social drinking".
On the other hand, and also from the h storical point of view, Islam has achieved the most successful campa gn that has ever been launched by man against alcohol as an addicting drug when it tackled the difficult, obstinate, Arab society which was famous for being one of the most alcohol saturated countries f its age. The Holy Qur'an took a few years to gradually restrict the intake of alcoholic beverages by first explaining that alcohol has evils and benefits but that its evils are more than its benefits, an then by prohibiting Muslims from offering their five daily prayers when they were drunk, and lastly, by completely banning its intake production, or sale. During these years of gradual prohibition, the earts of Muslims were spiritually softened and their minds convinced with the evil effects of alcohol, so that when the final tahrim or b n was revealed, thousands of the faithful voluntarily threw away their fermented datepalm, honey or grape strong drinks from lar e clay pots and skins until the rocky streets of the holy city of Madi ah ran with little rivers of alcoholic beverages ''as a testimony to the greatest anti-alcoholism movement that humanity has ever wit essed" (Badri, 1976, p. 4). One light-hearted Muslim historian repo ed that on that historic day of final prohibition, the goats of the city of Madinah were seen staggering along the narrow roads, drunk from the alcohol flooding the streets. Historians also tell us t at the whole city-state became abstinent and thereafter, during th whole blessed life of the Prophet in Madinah, only six persons there were caught drunk or drinking, and they were consequently punished (AI-Awa, unpublished Ph.D. thesis submitted to the University o London, 1972). Islamically, the law would not wait for auser to be ome an abuser, since both are equally sinful. Any evidence of intake would sanction punishment. Thus, the spiritually motivated camp ign against drugs and alcohol which strives towards total abstinence in modern Muslim societies would have deep historical and religi us roots.
Some may argue that this extraordinarily successful campaign of Madinah was possible beca se it was carried out by a prophet, or that people at that time were simpleminded and easily led and so it is not repeatable in this age. Some of the evidence which disconfirms such claims comes iro ically from the United States. The Muslim Afro-Americans in their Nation of Islam of the sixties, their Bilalian movement of the sev nties, or their present contemporary groups have clearly shown ho an Islamic spiritually motivated anti-drug campaign can be much more successful than all the modern Western prevention endeavou s. James Baldwin, in his best-selling little book, The fire next time, as beautifully described the agony of the black American addict in he following words:
However, when such miserab e drug addicts convert to Islam and open their hearts to its spiritua anti-drug message, as Baldwin says, their lives suddenly change in a way that all the governmental educational, psychological and welfare insti utions have failed to achieve. The message of Islam, Baldwin stat s:
In his autobiography, Malcolm X elucidates t ese Islamic aspects of the Nation of Islam's phenomenal record of s ccess in healing dope-addiction. He mentions that the New York 77 es had documented this exceptional achievement, saying that a number of American social agencies had actually asked represe tatives of the Muslim anti-drug programs for help in improving thei campaigns (Malcolm X, 1965). Even in Western countries, th religiously oriented Alcoholics Anonymous, which works toward bsolute abstinence, is getting better results than orthodox medical a d psychiatric endeavours.
From my experience with drug and alcohol addicts, I have come to see that, in the vast majority of cases, the so-called reasonable "use" of drugs or social drinking is only a transient stage between abstinence and "abuse". I have also found that the great majority of Muslims who achieve abstinence are motivated by a religious factor (Badri, 1976). Deterioration of health or other economic aspects are much less mentioned as reasons for sobriety. The importance of this deep-rooted spiritual dimension in the hearts of Muslims explains the success of even inefficient and partial campaigns in some Muslim countries simply because the campaigners appealed to Islam. Accordingly, doctors and AIDS prevention practitioners should confidently and strongly launch their Islamic campaign for total abstinence, and should make use of Islamic mass 'ibadata such as that found during Ramadhan, which we have already discussed. This should of course be particularly directed towards injecting drug users, as they are the ones at highest risk of HIV infection.