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Aids - Related Social Problems - An Islamic Perspective

Rights and Obligations of Infected Spouses

Education for girls, as in this school in India, is one of the main strategies for improving women's status and making them less vulnerable to HIV infection.

I. The importance of marriage for the protection against AIDS: World-wide studies have shown that permissive illicit sex among homosexuals and heterosexuals plays a major role in the spread of infection with the AIDS virus.

This is more so among prostitutes and their clients who are also more prone to contracting other sexually transmitted diseases.

This makes the case for curbing promiscuous sexual relations and for preserving and enhancing the role of marriage in society. Islam has very resolutely taken this line and considers all threats against marriage as threats against society as a whole.

In describing the believers, the Quran says: "And they are those who restrain their carnal desires, except with their wives and slavegirls, for these are lawful to them. Those who seek beyond this are transgressors."(al- Mu'minoon: 5-7). The issue of slavery does not exist any more and is only of historical importance.

Illicit sexual relationships have been roundly condemned in the Quran, and verse 2 of surah an-Noor, quoted above, lays down severe punishment for such activity. As quoted earlier, it says:"Each woman or man who engages in illicit sexual acts shall be given a hundred lashes. Let no pity for them dissuade you from obeying God's commands, if you truly believe in God and the Last Day; and let their punishment be witnessed by a group of believers."

A married adulturer or a sodomist (active or passive) deserves even harsher punishment, that, upon the proof of four witnesses, might amount to capital punishment.

The Quran describes marriage as a protection for the individual, as stated in verses 24 and 25 of surah an-Nisa'.

Islam promotes and encourages marriage because it is the best and most honourable way to guarantee satisfaction of the human sexual desire and provide the healthy and proper environment for raising children. God says in the Quran: "We have sent forth other messengers before you (Mohammad) and given them wives and children." (al-Ra'ad: 38). Prophet Mohammad is quoted as saying that God's messengers share four main traditions, one of them was marriage. He was also reported to have said: "Life is but a fleeting period of worldly enjoyments and the best source of enjoyment in it is a good wife."

Marriage is considered a religious duty in Islam. Prophet Mohammad is reported to have said: "A good wife is a gift from God and fulfils half of a man's religious obligations. Let him see to the other half himself."

Marriage preserves one's moral integrity and prevents men and women from having to seek sexual pleasure illicitly. It is therefore something that people should appreciate and thank God for. God says in the Quran: I!And of His signs is that he created for you spouses of your own ilk, that you might seek comfort with them, and He created love and kindness between you and them." (ar-Room: 20) The Quran also praised those who: I!Say, 'Lord, give us joy in our wives and our children.' I! (AI-Furqan: 74)

God instructed the Muslim community to ensure that single women should find suitable husbands easily. The Quran says: "See to the marriage of those among you who are single and those of your male and female slaves who are pious. If they are poor, God will enrich them out of His bounty. God is munificent and all-knowing."(an-Noor: 32)

In Islam, polygamy has been allowed as a safety measure in situations that carry the threat of illegal or illicit means for sexual satisfaction. The Qur'an says: "lf you fear that you cannot treat orphans with fairness, then you may marry women who seem good to you: two, three or four of them."(an-Nisa': 2) This has been interpreted as saying to the Muslims that they should be as weary of illicit sexual relations as they are of illegally exploiting orphaned members of the community.

Protecting the marriage: Islam has laid down a series of hygienic measures and regulations aimed at ensuring the well-being and preservation of the institution of marriage. These touch on all aspects of the relationship, including the most intimate, such as sexual intercourse during menstrual periods. God says in the Quran: "They ask you (Mohammad) about menstruation. Say, 'It is an indisposition. Abstain from being intimate with women during menstruation and do not go to them until they are clean again. Once they are clean you may have intercourse with them in the way God has enjoined on you. God loves the repentant and those who strive to keep themselves clean."(al-Baqarah: 222)

Quranic verses also point in no uncertain terms to the fact that sexual intercourse must involve that part of the female which leads to conception and procreation. God says: "your women are the repository of your seed: have intercourse with them, then, however you wish," (al-Baqar- ah: 223) and: "Once they are clean (of menstrual blood) you may have intercourse with them in the way God has enjoined on you." (al-Baqar- ah: 222) The main point of these statements is that married couples must refrain from sexual intercourse during menstruation and must avoid sodomy in their sexual relationship.

The importance and wisdom of these instructions become even clearer today in the light of medical evidence pointing to the role of blood and sod- omy in the transmission and spread of the AIDS infection.

Sexual activity within marriage is encouraged as healthy and praiseworthy. It has been reported that when Prophet Mohammed said to his companions that: "When a man goes to his wife they will earn a reward from God," someone asked him: "How come? Do we earn a reward for satisfying our desires?"Mohammad replied: "Yes, indeed. For, if you were to do so unlawfully you would be punished. Likewise, when you satisfy your desire by lawful means you shall be rewarded."

The woman has an equal right to sexual gratification as the man. No husband should deprive his wife from sexual enjoyment or satisfaction, even if he were abstaining for religious reasons. Prophet Mohammad said to one of his companions: "Do I hear that you fast every day and pray all through the night?" The man replied: "Yes." The Prophet said: "Do not do that. Fast some days and pray through some nights. You owe cer- tain rights to your body and your eyes, as well as to your wife."

Marriage involving AIDS carriers:

We have seen that marriage can be the best means of protection against the spread of AIDS. It must, therefore, follow that it should not in any way be allowed to become a means for transmitting the syndrome.

Anyone who knows that he or she are an AIDS carrier must not enter a married relationship with a healthy person without disclosing to them the facts of their situation in advance, so as to make an informed decision since the marriage will lead to the risk of infection. Transmitting the disease is criminal and hiding the fact of being a carrier would be fraudulent. Both acts are objectionable from the Islamic point of view.

The obligation to take the HIV test: It might be necessary, in view of the dangers and risks involved, that those intending marriage should take the HIV test to establish their freedom of infection. The authorities would be within their right to impose such tests as a condition of the marriage contract, on the basis of protecting the public good; either spouse has the right to demand testing the other. Islamic law allows the annulment of the marriage if one of the spouses is subsequently discovered to be carrying the virus.

Should an infected couple be allowed to marry?

Infected couples should be allowed to marry each other, whether they choose to use a condom during sexual intercourse or not. But since the risk of passing the virus from the mother to her baby is high, such couples should take extra precautions to prevent conception,

The right to sexual intercourse among infected spouses:

Islamic law stipulates that sexual intercourse is an essential condition for the validity of marriage. It is a right to which both spouses are equally entitled within their married relationship. For either spouse to refrain from sexual activity without a reason, is an offence. In the case of the wife refusing sexual intercourse, the husband is encouraged to try and dissuade her, otherwise she would forfeit her right to maintenance and the husband has the right to divorce her or apply for judicial separation. In both cases, the wife would forfeit her rights ensuring upon divorce.

Prophet Mohammad is reported to have said: "A wife would not fulfil her duty towards God until she has fulfilled her duty towards her husband. When he desires her, she should oblige."

If the husband takes an oath to refrain from sex with his wife, he should be given a grace period of four months within which to change his mind and undertake not to resort to such behaviour. However, if after that period he persists, the wife would be entitled to a divorce with her full divorce rights. The Quran says: "Those that renounce their wives on oath must wait four months. If they change their minds, God is forgiving and merciful; but if they decide to divorce them, know that God hears all and knows all." (al-Baqarah: 226, 227)

If either spouse refuses sexual intercourse due to a defect in the other one, a judge can rule that they should be separated. If the defect is permanent or incurable they can be divorced. If it is curable or temporary, the judge rules for a grace time to be allowed for reconciliation, and if this cannot be achieved the couple are separated or divorced.

Based on the forgoing argument, if one of the spouses is an AIDS patient, the other can refuse sexual intercourse, since this has been medically established to be the major factor in the transmission of the AIDS virus.

If the healthy spouse agreed to sexual intercourse, then adequate precautions must be taken to reduce the risk of infection and conception.

In the case where both spouses are infected the use of protective meth- ods, by both the husband and the wife, would still be recommended in order to prevent the infection being repeated, since the AIDS virus mutates inside the body and repeated infection co,uld accelerate the development of the disease.

The right of a healthy spouse to divorce:

1. Medical opinion:

The risk of infection between married couples is very high, especially if the carrier refuses to use protective methods such as condoms. The probability of transmission of the virus from the husband to the wife is greater than the other way round, because a man's seminal fluid contains larger numbers of the virus and remains longer within the woman's body. This must be added to the risk of perinatal infecting if pregnancy occurs.

Two other factors must be borne in mind. Firstly, a man's sexual ade- quacy, which is important for the stability and continuity of the marriage, is severely hampered in those infected with the AIDS virus. This is made worse by the need to use a condom on every occasion and all through sexual intercourse although the use of a condom is permissible with the wife's consent, if she does not give her consent, it could constitute a basis for divorce.

Secondly, the use of a condom during sexual intercourse to prevent transmission of the AIDS virus prevents child-bearing, which is a prime purpose of marriage. This again could constitute a basis for divorce.

Ibn al-Qayyim, the renowned Islamic scholar, pointed out that annulment of marriage can take place as a result of any defect which incurs the dissatisfaction of the other spouse and does not realise the basic aims of intimacy and love be1ween the married couple. Accordingly, the objecting spouse must be given the choice to annul the marriage.

This opinion was also attributed to Ibn Shihab az-Zuhari, who said:

"Marriage can be annulled for incurable illness".

The famous judge, Shurayh, is also quoted as saying: "deception in marriage is illegal."

Ibn al-Qayyim reported that the second Khalifah, Omar ibn al-Khattab, had ordered an infertile man, who had married a woman without telling her of his disposition, to tell her and give her the choice of leaving him.

Ibn AI-Khattab's ruling is consistent with the fact that a main purpose which both spouses are seeking out of the marriage is having children and raising a family. The absence of this could render the whole marriage unworkable. These factors have been recognised by the laws in many Muslim countries.

The situation remains the same whether the deficiency, to which the other spouse objects, existed before or after the marriage.

This applies to AIDS, especially that AIDS is a killer disease posing the most horrendous threat.

The right of the healthy spouse to separation or divorce: From the argument so far, either spouse has the right to ask for separation from another who is an AIDS carrier. This is because the disease is con- tagious and is transmitted chiefly by sexual intercourse. This remains true whether the infection occurs before or after the marriage.

In case the wife is the carrier, the couple are separated and the wife does not receive the entitlements of a divorced wife. The husband has the right to full reclaim of the dowry he had paid, or its equivalent if the marriage had already been consummated.

If the husband is the carrier, the couple may divorce and the wife receives her deferred dowry and the muta'ah, or compensation,due to a divorce.

If deception or fraud is committed by the infected spouse by not disclos- ing his or her ailment, the culprit would be liable to punishment as explained earlier.

Abortion among AIDS sufferers:

1. Medical opinion: Scientists are not yet agreed on whether AIDS can be diagnosed in a foetus during the first four months following conception. As mentioned earlier, the rate of infection during pregnancy in not more than 10%. As medical science gets closer to making a positive diagnosis at the earlier stages of pregnancy, there could be a justification for aborting the foetus during the period allowed by Islamic law. This remains to be the case in the light of our knowledge that there is no effective cure for AIDS, but this must change if such a cure is found.

However, abortion may in general be recommended on grouds of the mother's health. Pregnancy, as mentioned earlier, is one of the factors that reduce the incubation period of the AIDS virus and accelerate the development of the disease. A woman's health becomes more vulnerable during pregnancy, which could justify abortion as a precaution to preserve the mother's health and save her life.

2. Islamic opinion:

Children as assets:

Children are greatly valued by their parents. They are an essential part of enjoyment and happiness in this world. God says in the Quran: "Wealth and children are the adornments of this life." (al-Kahf: 46) He also says: "God has given you spouses from your own ilk, and of your spouses He gave children and grandchildren. He has given you of all the good things." (an-Nahl: 72)

Islam encourages procreation and attaches value and respect to children from the moment of conception. This is shown in the concession not to fast during the month of Ramadhan, given to pregnant mothers. If a pregnant woman incurred a legal capital punishment, this cannot be carried out until she gives birth to avoid harming the baby she is carrying. Unborn babies, including those conceived out of wedlock, must not be harmed in any way.

Islamic law, based on Quranic statements already quoted, has stipulated specific punishments for killing or causing an unborn baby to die or to come to harm.

Historical schools of thought with respect to abortion:

This can be summarised in the following points:

1. If a mother's life is threatened as a result of the pregnancy, a foetus is aborted regardless of its age.

2. If the mother is not in danger, it would be unlawful to abort the baby after 120 days of conception, the age of ensoulment. to develop into a full human being. The Prophet Mohammad is quoted as saying: "The human being begins life in the mother's womb as a germ for forty days. The germ turns into a clot during the following forty days, the clot intQ a lump of flesh during the following forty days. Then an angel is sent to blow the spirit into it and note down its means of living, its life-span, its actions and its fate, whether good or bad." These stages of feotal development are also given in the following Quranic verses: "We first created man from an essence of clay: then made him a living germ in a safe enclosure (the womb). The germ We made a clot of, and the clot a lump of flesh. This We fashioned into bones, then clothed the bones with flesh and then brought him forth as another creation. Blessed be God, the noblest of creators." (al-Mu'minoon: 12- 14)

3. The Hanbali school of Islamic law are of the opinion that forty days is the critical point at which a foetus is fully formed, and do not allow abortion after that age .

4. Some scholars are known to disallow abortion once fertilisation takes place in the womb. Among them are the following:

a) Mohammad Abu Hamid AI-Ghazali (12th century), differentiates be- tween the withdrawal method, coitus interruptus, and abortion by contraception saying that the former is done against a being that is already in existence. This existence, he adds, begins with the fertilised egg ready to continue life, and to destroy the egg would be a crime.  As the egg develops further the offence becomes proportionately greater.

He compares the withdrawl method of contraceptive as withdrawing from a contractual agreement before signing the contract, while the destruction of a fertilised egg is comparable to withdrawing after signing, which would constitute a breach of contract.

b) Some Hanafi scholars do not allow abortion once fertilisation takes place. They also argue that a fertilised egg is an entity already bound for life.

c) The Maliki school argue that once the sperm unites with the egg in the womb, it could not be destroyed even before the 40-day period. Accordingly, they consider abortion at any later time as murder.

Thus, we find that Islamic law scholars and medical experts are in agreement over the fact that fertilisation of the mother's egg implies life, and that life must be regarded as sacred.

d) Some experts call the earlier stage of feotal development as the 'ani- mal life' stage and that after the 40-day threshold as the 'human life' stage.

Important questions

First: can an AIDS-infected foetus be aborted?

Expert opinion affirms the high risk of transmission of the AIDS virus from the mother to the unborn baby, especially during delivery. It is not yet established, however, that a foetus can become infected during the first 120 days of its life, or afterwards. The question then arises whether abortion is allowed, knowing that no effective cure from AIDS exists as yet?

The majority opinion seems to favour the view that abortion within the first 120 days is not permissible. A fertilised egg is a living creature and the initial building block of a fully developed human being. Any threat to this creature is a threat against a human life. There are experts who merely recommend, but do not insist, that abortion within this period is not permissi- ble.

If infection is confirmed after 120 days, the baby cannot be aborted.

This would be comparable to a deformed baby whom it is agreed must not be aborted, and to the AIDS sufferer who should not be deprived of treatment or whose life must not be deliberately terminated.

Second: Should a baby be aborted for the sake of the mother when she is an AIDS sufferer?

If the baby's continued existence in the mother's womb threatens her life, the baby may be sacrificed for the sake of the mother, because the baby's chance of life is much less than that of the mother.

However, if the mother's life is not under threat, but the pregnancy would reduce the incubation period of the virus, the baby should not be aborted, because the mother's plight can be sustained with better health care.

Should an AIDS suffering mother nurse her healthy baby?

1. Medical opinion:

It has already been pointed out that transmission of the AIDS virus through the mother's milk is rare. Nevertheless, according to the majority medical opinion, if the baby has access to an alternative to the mother's milk, feeding on the mother's natural milk should be avoided. If alternatives are not available, it is in the baby's interest to feed on the mother's milk, since the risk of infection by the AIDS virus is much lower than that with other diseases as a result of not feeding on the mother's milk or its substitutes.

If the baby itself, together with the mother, are confirmed as AIDS patients, there is no extra risk in breast-feeding by the mother.

Apart from the husband and wife, who can infect each other during sex- ual intercourse, there is no evidence for the spread of the AIDS virus to other members of the same family. When looking after her children, a mother with AIDS must, naturally, take extra precautions to avoid the trans- fer of her blood to any of the children's bodies.

Otherwise, the psychological and developmental advantages children enjoy when nursed and raised by their own mothers must not be sacrificed when the risk of infection is almost negligible.

2. Islamic opinion: Muslim jurists are agreed that nursing mothers must be free of all infectious and contagious diseases. Medical research has established that the AIDS virus is not transmitted by bodily contact or through the air, and so it does not spread to other members of the family, for it is mainly transmitted during sexual intercourse.

As long as a mother takes the basic precautions of hygiene and health care necessary to prevent transmission of the virus, she would not be considered as a threat to her baby.

Among these precautions is to ensure that her blood, if cut or wounded or during menstruation, does not get into the baby's blood stream or mucous membranes.

Accordingly, neither the mother nor the baby should be deprived of their right to each other during the early crucial stages of development.

Medical research has also established that transmission of the AIDS virus through the mother's milk is extremely rare, since the probability of the virus being found in human milk, saliva, sweat and urine is very small indeed. The risk would only be eminent if the nipples are cut or cracked resulting in bleeding and, hence, blood being taken in through the mouth with the milk by the baby.

It would, therefore, be inappropriate to deprive the mother and her baby from the obvious physiological and psychological advantages of breast-feeding and proper nursing, on the basis of a negligible risk against which precautions can easily be taken. It is important, however, that the mother does not feed her baby if her nipples are cracked or bleeding.

Generally, Islamic teachings recommend that AIDS sufferers be treated as ordinary members of the family and society in order to alleviate their suffering. This is also the advice of modern international health bodies.