Paper: Islam and HIV related social services in Malaysia
Title : Islam and HIV related social
services in Malaysia
Year : 2017
Researchers : Stacey A. Shaw, Rumana Saifi, Sin How
Lim, Shaikh M. Saifuddeen & Adeeba Kamarulzaman
Reference :
Stacey A.
Shaw, Rumana Saifi, Sin How Lim, Shaikh M. Saifuddeen & Adeeba Kamarulzaman
(2017) Islam and HIV related social services in Malaysia, Journal of Religion
& Spirituality in Social Work: Social Thought, 36:1-2, 133-145, DOI:
10.1080/15426432.2017.1300078
Abstract
We review HIV prevention
and treatment efforts involving Islam in Malaysia. The Department of Islamic
Development Malaysia (JAKIM) conducts HIV-related workshops with Muslim leaders
and lesbian, gay, bisexual, and transgender (LGBT) communities. A methadone
maintenance treatment (MMT) project was imple- mented in a mosque in Kuala
Lumpur, incorporating religious and social supports alongside provision of
health services. Additional services including premarital HIV testing are
discussed. Islamic values point to the need for compassion, nonjudgment, and
taking action to improve lives, while reluctance to support harm-reduction
strategies among sexual minorities highlights the important role of community
advocates and social workers within nongovernmental organizations.
Important Quotation
Background
Malay
and Islamic culture and norms may impact on HIV prevention and treatment
culture in Malaysia, the setting is similar with Palembang, Indonesia.
In Malaysia, like other Southeast Asian countries, religion is
deeply embedded in political and social realms. As in Indonesia and Iran, harm
reduction approaches serving PWID have received higher levels of support in
Malaysia than have programs serving female sex workers (FSW) and MSM
(Kamarulzaman, 2013)
Like other Muslim majority countries, increased attention to HIV
nationally has been coupled with prejudice stemming from moral views regarding
HIV (Kamarulzaman, 2013
Kamarulzaman, A. (2013). Fighting the HIV epidemic in the
Islamic world. The Lancet, 381, 2058–2060. doi:10.1016/S0140-6736(13)61033-8
Major gaps in national responses to HIV prevention remain, where
few Islamic countries specifically attempt to engage PWID, MSM, and FSW
(Abu-Raddad et al., 2010)
Abu-Raddad, L. J., Akala, F. A., Semini, I., Riedner, G.,
Wilson, D., & Tawil, O. (2010). Characterizing the HIV/AIDS epidemic in the
Middle East and North Africa: Time for strategic action. Washington, DC: World
Bank. Retrieved from
The Malaysian government policy to address HIV is informed both
directly and indirectly by Islamic conceptions of life and relationships
(Barmania & Aljunid, 2016)
Barmania, S., & Aljunid, S. M. (2016). Navigating HIV
prevention policy and Islam in Malaysia: Contention, compatibility or
reconciliation? Findings from in-depth interviews among key stakeholders. BMC
Public Health, 16(1), 524. doi:10.1186/s12889-016-3247-y
The connectivity of Islam to HIV prevention and treatment
efforts in Malaysia has relevance for helping professionals who work with
religious individuals, who work within religious contexts, or who seek to
understand linkages between religion and health. This article examines
experiences, successes, and challenges of religiously based efforts to fight
HIV in Malaysia. We review published and unpublished literature regarding HIV
prevention and treatment efforts involving Islam in Malaysia. Findings from the
present study have implications for global efforts to address HIV within
Islamic and other religious communities
RELIGION AND HIV
As a social, cultural, and political factor, religion impacts
the way in which communities understand and respond to HIV (Baral et al., 2013
Baral, S., Logie, C. H., Grosso, A., Wirtz, A. L., & Beyrer,
C. (2013). Modified social ecological model: A tool to guide the assessment of
the risks and risk contexts of HIV epidemics. BMC Public Health, 13(1), 482.
doi:10.1186/1471-2458-13-482
; Hasnain, 2005
Hasnain, M. (2005). Cultural approach to HIV/AIDS harm reduction
in Muslim countries. Harm Reduction Journal, 2(1), 1.
doi:10.1186/1477-7517-2-23
; Zou et al., 2009
Zou, J., Yamanaka, Y., John, M., Watt, M., Ostermann, J., &
Thielman, N. (2009). Religion and HIV in Tanzania: Influence of religious
beliefs on HIV stigma, disclosure, and treatment attitudes. BMC Public Health,
9(1), 1. doi:10.1186/1471-2458-9-75
).
Religious organizations may play a role in promoting HIV
prevention (Francis & Liverpool, 2009
Francis, S. A., & Liverpool, J. (2009). A review of
faith-based HIV prevention programs. Journal of Religion and Health, 48(1),
6–15. doi:10.1007/s10943-008-9171-4
; Garcia & Parker, 2011
Garcia, J., & Parker, R. G. (2011). Resource mobilization
for health advocacy: Afro-Brazilian religious organizations and HIV prevention
and control. Social Science & Medicine, 72(12), 1930–1938.
doi:10.1016/j.socscimed.2010.05.010
; Green, 2003
Green, E. C. (2003). Faith-based organizations: Contributions to
HIV prevention. Washington, DC: TvT Global Health and Development Strategies,
Synergy Project.
; Maulana et al, 2009
Maulana, A. O., Krumeich, A., & Van Den Borne, B. (2009).
Emerging discourse: Islamic teaching in HIV prevention in Kenya: Short report.
Culture, Health & Sexuality, 11(5), 559–569. doi:10.1080/13691050902792771
) and spirituality is a component of coping among some people
living with HIV (Koenig et al, 2012
Koenig, H., King, D., & Carson, V. B. (2012). Handbook of
religion and health. New York, NY: Oxford University Press.
Maman et al, 2009
Maman, S., Cathcart, R., Burkhardt, G., Omba, S., & Behets,
F. (2009). The role of religion in HIV-positive women’s disclosure experiences
and coping strategies in Kinshasa, Democratic Republic of Congo. Social Science
& Medicine, 68(5), 965–970. doi:10.1016/j.socscimed.2008.12.028
; Pargament et al, 2004
Pargament, K. I., McCarthy, S., Shah, P., Ano, G., Tarakeshwar,
N., Wachholtz, A., … Duggan, J. (2004). Religion and HIV: A review of the
literature and clinical implications. Southern Medical Journal, 97(12),
1201–1210. doi:10.1097/01.SMJ.0000146508.14898.E2
). However, the role of religious organizations in caring for
people with HIV has been limited (Agadjanian & Sen, 2007
Agadjanian, V., & Sen, S. (2007). Promises and challenges of
faith-based AIDS care and support in Mozambique. American Journal of Public
Health, 97(2), 362–366. doi:10.2105/AJPH.2006.085662
; Watt et al, 2009
Watt, M. H., Maman, S., Jacobson, M., Laiser, J., & John, M.
(2009). Missed opportunities for religious organizations to support people
living with HIV/AIDS: Findings from Tanzania. AIDS Patient Care and Stds,
23(5), 389–394. doi:10.1089/apc.2008.0195
; Westh & Noordien, 2008
Westh, J., & Noordien, F. (2008). The positive Muslim’s
approach to stigma, HIV, AIDS, and PLWH. Exchange on HIV/AIDS Sexuality and
Gender, 2, 7–9.
) and religious beliefs may contribute to stigma and
discrimination (Mbonu et al., 2009
Mbonu, N. C., Van Den Borne, B., & De Vries, N. K. (2009).
Stigma of people with HIV/AIDS in Sub-Saharan Africa: A literature review.
Journal of Tropical Medicine. doi:10.1155/2009/145891
)
Religion may be associated with both risk and protection for
acquiring HIV among Muslims (Hasnain, 2005
Hasnain, M. (2005). Cultural approach to HIV/AIDS harm reduction
in Muslim countries. Harm Reduction Journal, 2(1), 1.
doi:10.1186/1477-7517-2-23
).
HIV-related messages presented within religious settings may
promote abstinence and fidelity, where leaders may not discuss or accept condom
use outside of marriage (Ansari & Gaestel, 2010
Ansari, D. A., & Gaestel, A. (2010). Senegalese religious
leaders’ perceptions of HIV/AIDS and implications for challenging stigma and
discrimination. Culture, Health & Sexuality, 12(6), 633–648.
doi:10.1080/13691051003736253
) nor acknowledge a wider range and combination of behavioral
strategies necessary to address the HIV epidemic (Coates et al., 2008
Coates, T. J., Richter, L., & Caceres, C. (2008).
Behavioural strategies to reduce HIV transmission: How to make them work
better. The Lancet, 372(9639), 669–684. doi:10.1016/S0140-6736(08)60886-7
). Additionally, rejection of homosexual relationships, drug
use, and sex work pose difficulties for enabling dialogue and exploring
protective programs among key at-risk populations. While some religious leaders
view HIV infection as a result of deviation from religious guidelines, other
leaders consider they have a role in responding to the epidemic and assisting
those who are infected (Ansari & Gaestel, 2010
Ansari, D. A., & Gaestel, A. (2010). Senegalese religious
leaders’ perceptions of HIV/AIDS and implications for challenging stigma and
discrimination. Culture, Health & Sexuality, 12(6), 633–648.
doi:10.1080/13691051003736253
). As the practice of religion varies by place and context, so
does the approach to discussing sexuality.
Discussion
Islamic beliefs and values can align
with social work values to promote HIV risk reduction in community, religious,
and healthcare settings, as well as in the development of health and social
policy concerning key populations who are Muslim, with implications for
non-Muslims as well.
Drawing from the Quran and the Sunnah,
principles regarding the importance of protecting and preserving faith, life
(which includes dignity), intellect, progeny, and property, Islamic
perspectives coincide with the desire of public health/social work
professionals to reduce harms and promote protection (Saifuddeen,
Rahman, Isa, & Baharuddin, 2014Saifuddeen, S. M., Rahman, N. N. A., Isa, N. M.,
& Baharuddin, A. (2014).
Basic principles derived from the Sharia
such as, “no one should be hurt or cause hurt to others,” “a
lesser harm may “necessities overruling prohibition,” be
tolerated in order to eliminate a greater harm,” “harm must be treated
and benefits must be brought forth,” “public interest takes priority over personal interest,”
and “looking after the general
good” serve as guidelines for HIV prevention and treatment
(Kamarulzaman & Saifuddeen, 2010.)
Saifuddeen, S. M., Rahman, N.
N. A., Isa, N. M., & Baharuddin, A. (2014). Maqasid
al-shariah as a complementary framework to conventional bioethics. Science and Engineering Ethics, 20(2), 317–327. doi:10.1007/s11948-013-9457-0
2010Kamarulzaman, A., & Saifuddeen, S.
M. (2010). Islam and harm reduction. International Journal of
Drug Policy, 21(2), 115–118. doi:10.1016/j.drugpo.2009.11.003
National-level attention is needed toward religiously informed attitudes
that inhibit and promote access to HIV prevention information and services
(Tham & Zanuddin, 2014)
Tham, J. S.,
& Zanuddin, H. (2014). Religion and media: A case study
of Utusan Malaysia’s response to HIV/AIDS. Journal of Media &
Cultural Studies, 29(1), 121–133. doi:10.1080/10304312.2014.964176[Taylor & Francis Online], [Web of Science ®], [Google Scholar]).
Where services are provided, Islamic values point to the need for
compassion, nonjudgment, and taking action to improve lives, which coincide
closely with core social work values of human dignity, social justice, and
service.
While Malaysia has integrated a number of harm reduction strategies to
support PWID, attention to MSM and CSW is lacking, in part due to discomfort
with nonheteronormative sexual behaviors and sexuality outside of marriage
(Kamarulzaman, 2013Kamarulzaman, A. (2013). Fighting
the HIV epidemic in the Islamic world. The Lancet,
381, 2058–2060. doi:10.1016/S0140-6736(13)61033-8[Crossref], [PubMed], [Web of Science ®], [Google Scholar]). Research is needed that examines the influence of religiously oriented
programs such as trainings with religious leaders and retreats with at-risk communities.
Research regarding the perspectives of MSM, CSW, PWID, and others affected by
HIV toward religion as a component of services is also essential. Religious
leaders hold an influential position from which to introduce notions of
acceptance and health promotion (Mahajan et al, 2008Mahajan, A.
P., Sayles, J. N., Patel, V. A., Remien, R.
H., Ortiz, D., Szekeres, G., & Coates, T.
J. (2008). Stigma in the HIV/AIDS epidemic: A review of the
literature and recommendations for the way forward. AIDS (London,
England), 22(Suppl 2), S67. doi:10.1097/01.aids.0000327438.13291.62[Crossref], [PubMed], [Web of Science ®], [Google Scholar]), and their attitudes toward sexual minorities may promote or suppress the
tolerance of LGBT individuals within an organization as well as influence
policy development and implementation of HIV prevention. In settings influenced
by religious political structures such as Malaysia, it may be difficult to
separate contentious influences of religion or particular religious individuals
from the life-affirming nature of Islam. We encourage social workers and
community health workers to continue advocating for policies and services that
holistically promote health, equity, and respect for al
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