AIDS as a Bioethical Challenge: The Context of the 1980s

During the 1980s, the discipline of bioethics in Europe and the USA was confronted with challenging questions raised by the outbreak of the Acquired Immune Deficiency Syndrome (AIDS). This new epidemic is usually acknowledged as the most significant new disease to emerge since bioethics was born (Schuklenk , 127). It became clear that AIDS has important social and ethical dimensions such as stigmatization, discrimination, counseling, care, and health promotion. In order to meet these biomedical and bioethical challenges posed by AIDS, hundreds of conferences and meetings were held. The series International AIDS Conference (IAC), the world's most attended conference on HIV and AIDS, started in 1985 in Atlanta, Georgia, USA ().

Also during the 1980s, the discussions on bioethical questions within the Islamic tradition were undergoing a significant shift. Before this date, Muslim religious scholars (‘ulamā’) used to address these questions through fatwas issued on an individual basis. The ‘ulamā’ soon recognized the complex nature of bioethics and the specialized knowledge of modern biomedical sciences required for addressing specific bioethical questions. However, the overwhelming majority of contemporary Muslim religious scholars are trained neither in biomedical sciences nor in the Western languages in which the up‐to‐date scientific studies are available. It became clear to these ‘ulamā’ that collaboration with biomedical scientists has become inevitable. In the terminology of Islamic law, this collaboration between these two groups is known as collective legal reasoning (ijtihād jamā‘ī) in which formulating an Islamic viewpoint on a specific issue is not the prerogative of religious scholars alone. This collective ijtihād started to assume an institutionalized form during the 1980s with the establishment of organizations such as the Islamic Organization of Medical Sciences (IOMS), established officially in 1984, the International Islamic Fiqh Academy (IIFA), established in 1981, and the Islamic Fiqh Academy (IFA), established in 1977 (Ghaly , 7–8).

Muslim religious scholars and biomedical scientists, who engaged in the process of collective ijtihād, showed keen interest in construing an Islamic bioethical vision on the AIDS pandemic. Already during the 1980s, Islam and AIDS was the topic of a few papers submitted to the third, fourth, and fifth international conferences on “Islamic Medicine,” held by the IOMS respectively in 1984, 1986, and 1988 (Wahdān ; Walī and al‐‘Awaḍī , 324–26). Between 1991 and 1995, five large‐scale expert meetings were held to discuss Islamic perspectives on HIV/AIDS (Table ). The Regional Office for the Eastern Mediterranean (EMRO) affiliated with the World Health Organization (WHO) convened a symposium, below referred to as the EMRO symposium, in Alexandria, Egypt, during the period September 9–10, 1991. Religious scholars and specialists in law and in medicine participated in this symposium. A summary of the proceedings was published in both Arabic and English (Munaẓẓamat ; World Health Organization ). The IIFA discussed the same issue in two consecutive sessions, namely the eighth session held in Brunei during the period June 21–27, 1993 (Majallat , 209–302) and the ninth session held in Abu Dhabi, United Arab Emirates during the period April 1–6, 1995 (Majallat , 387–698). The most detailed discussions on this topic took place in the international symposium entitled Ru'ya Islāmiyya li al‐mashākil al‐ijtimā‘iyya li maraḍ al‐īdz (AIDS‐Related Social Problems: An Islamic Perspective), which was organized in Kuwait by the IOMS, in collaboration with the IIFA and the EMRO, during the period December 6–8, 1993. The full proceedings of this symposium, below referred to as the IOMS symposium, was published in Arabic in 1994 (‘Awaḍī and Jundī ) besides a summary published in both Arabic and English in 1995 (Awaḍī and Jundī ,b). The IOMS secretary general assistant, Aḥmad al‐Jundī, presented a detailed report of this symposium during the ninth session of the IIFA (Jundī , 523–81). The latest of these five meetings was organized by the Islamic Fiqh Academy in India (IFAI), as part of its eighth session, during the period October 20–24, 1995. According to the final statement of this meeting, both Muslim proficient physicians and religious scholars participated in the proceedings of this seminar. An English summary of the proceedings of this seminar was published in 2005 (Islamic Fiqh Academy [India] , ).

Concerning the participants and the papers presented in these meetings, there is also considerable overlap. Although the session held by the IFAI in 1995 took place in India, far away from the Middle East where the majority of the expert meetings on AIDS were held, the participants in this session were not completely detached from their counterparts in the Arab‐speaking world. The Syrian religious scholar Wahba al‐Zuḥaylī participated in this session as the chief guest (Islamic Fiqh Academy [India] , 39). Al‐Zuḥaylī is affiliated with the IIFA as expert (khabīr) and he participated in the eighth and ninth sessions of the IIFA during which AIDS was extensively discussed. He also participated in the IOMS symposium and presented a paper on the criminal liability of the AIDS patients (al‐Zuḥaylī , 169–77). Thus, the ideas of al‐Zuḥaylī, and possibly also those of his colleagues in the Middle East, have been introduced to the participants in the IIFAI seminar in India.

Based on the great number of participating religious scholars and biomedical scientists in these expert meetings and the papers they submitted, one can conclude that there is hardly any other bioethical issue that received such attention in the field of contemporary Islamic bioethics through the mechanism of collective ijtihād. However, available Western scholarship on Islam and AIDS has hardly paid any serious attention to the proceedings of these meetings. Some of the available studies just made reference to the final recommendations and resolutions of these meetings. For instance, in his Islamic Bioethics: Problems and Perspectives, Dariusch Atighetchi dedicated one of the shortest chapters in the book to AIDS. In this chapter, he made various references to the resolutions adopted by the IIFA during the eighth and ninth sessions and also to the recommendations of the IOMS symposium. However, Atighetchi did not consult the published proceedings but based his writing on English translations of the IIFA resolutions and IOMS recommendations which were available on the Internet (Atighetchi , 201, 207, 208, 209). Islam and AIDS: Between Scorn, Pity and Justice, one of the rarely available anthologies in English dedicated to this topic, did not even refer to any of the above‐mentioned expert meetings (Esack and Chiddy ). It is to be noted that some of the well‐known works on Islam and biomedical ethics did not pay any attention to the topic of AIDS at all (Brockopp and Eich ; Sachedina ). That is why the medical anthropologist Marcia Inhorn called for broadening the focus of current research on Islamic bioethics by including “some of the other pressing but seriously underemphasized issues of moral/ethical concern in the Muslim world. These would include, inter alia, the global pandemics of HIV/AIDS” (Inhorn , 255).

This study is meant to fill in this glaring lacuna in the field of contemporary Islamic biomedical ethics. Proceedings of the eighth and ninth sessions held by the IIFA and the IOMS symposium will be the main focus of this study. References to the other expert meetings will be made whenever relevant. For the sake of systematic presentation of these lengthy and sophisticated discussions, this study is divided into two consecutive parts. This article constitutes the first part of this study and it handles the contribution of the biomedical scientists. The following article will focus on the deliberations of Muslim religious scholars.

Main Questions and Methodological Remarks

The topic of AIDS shows the intriguing relationship between science and religion in the field of contemporary Islamic bioethics. The proceedings of the aforementioned expert meetings clearly showed that the domains of science and religion are highly interwoven and that there is a certain overlap between the roles played by the specialists in each domain. On the basis of the published proceedings of these expert meetings, I argue that the role played by the participating biomedical scientists in the collective religio‐scientific discussions on HIV/AIDS was three‐dimensional. These three dimensions will be elaborated below in three distinct sections: (1) biomedical information, (2) human rights discourse, and (3) religio‐ethical enquiry. Religion was never disconnected from science in any of these dimensions. However, one will easily notice that the direct engagement of biomedical scientists in the very process of religio‐ethical analysis or interpreting the Islamic scriptures (ijtihād) increasingly proceed from the first section to the second one and reaches its climax in the third section.

The main questions to be addressed by this article are: What did Muslim biomedical scientists contribute to the collective religio‐scientific discussions on Islam and HIV/AIDS? What kind of information did they communicate to the Muslim religious scholars? How did the global discussions on the ethico‐socio‐political aspects of HIV/AIDS influence the structure of their contribution? Before presenting information relevant to these questions, two introductory remarks are due. The first remark is about the names and affiliations of the biomedical scientists who submitted papers to the aforementioned expert meetings. The second remark is meant to contextualize these biomedical scientists’ contribution within the broad framework of the collective ijtihād in contemporary Islamic bioethics.

Concerning the first remark, four biomedical scientists were invited to write papers for the aforementioned expert meetings. The two papers submitted to the eighth session of the IIFA in 1993 were respectively penned by Muṣṭafā Abū Lisān and Muḥammad ‘Alī al‐Bār (Abū Lisān , 209–23; Bār , 225–41). Abū Lisān is an expert in medical laboratory sciences in London, vice‐president of the Arab Federation of Clinical Biology (AFCB), and the former secretary general of the Arab Federation of Clinical Chemistry. To my knowledge, Abū Lisān did not participate in any other meetings held by these religio‐scientific organizations. On the other hand, Muḥammad ‘Alī al‐Bār is a regular participant in these meetings and authored tens of papers in this field. Al‐Bār was presented as the consultant of Islamic medicine in King Fahd Centre for Medical Research. He is currently the director of the Medical Ethics Center affiliated with the International Medical Center, Jeddah, Saudi Arabia. Al‐Bār also presented a paper during the ninth session of the IIFA. The paper took the form of an extended document (wathīqa) summarizing the preceding discussions on Islam and AIDS, especially those which took place during the eighth session of the IIFA and the IOMS symposium (Bār , 583–651). Muḥammad Haytham al‐Khayyāṭ and Muḥammad Ḥilmī Wahdān, both affiliated with the EMRO, the WHO, presented their joint paper during the IOMS symposium (Khayyāṭ and Wahdān , 59–72). Al‐Khayyāṭ is by no means a new face in these collective religio‐scientific meetings. Besides his position as the vice‐director of the EMRO, al‐Khayyāṭ is also member of the academies of Arabic language in Damascus, Baghdad, Amman, and Cairo. Wahdān is the director of the Disease Prevention and Control Department (WHO, EMRO). He also participated in other collective religio‐scientific meetings. For instance, he submitted a paper on AIDS to the IOMS fifth international conference on “Islamic medicine” held in 1988 (Wahdān , 413–24). He also submitted a paper during the aforementioned EMRO symposium on the epidemiology of AIDS and sexually transmitted diseases (Munaẓẓamat , 34).

As far as the second remark is concerned, one needs to bear in mind that the collaboration between biomedical scientists and religious scholars (science and religion) is one of the pillars of the collective ijtihād in the field of Islamic bioethics. The normal course of events is that biomedical scientists would take care of the scientific side of the topic (biomedical information). On the other hand, religious scholars would be responsible for integrating this biomedical information into their religio‐ethical analysis of the relevant Islamic scriptural texts. However, as I already noted elsewhere, it is not accurate to think that the process of collective ijtihād always works in the same way, with well‐identified distinct roles attached to each group (Ghaly , 8–10; Ghaly , 176–79). Usually, the nature of the topic under discussion, educational package (biomedical scientists with some grounding in Islamic religious sciences or religious scholars who might have access to biomedical sources), and personal interests of the participants in the ijtihād process are usually determining factors in identifying the roles that some biomedical scientists or religious scholars play.

Criticizing the “Western” Model of HIV/AIDS Prevention

The participating biomedical scientists in the aforementioned expert meetings sketched a specific model of HIV/AIDS prevention and gave it the label of “Western model,” in their eyes a model inspired by and based on moral and sexual values promoted by Western philosophies and cultures. They explained that most AIDS specialists and organizations argue that it is a human rights–friendly model, which can provide a good balance between respecting the human rights of AIDS patients on the one hand and maintaining public health on the other hand. According to this model, HIV/AIDS transmission through sexual contact can be effectively curbed by the distribution of information on safe sexual behavior through the use of condoms. Preventive measures such as banning same‐sex sexual acts or imposing constraints on extramarital sexual relationships would be seen within this model as unjustified infringement upon the human rights of these groups. As for the injection drug users (IDUs), an HIV/AIDS high‐risk group, this model advises them to use disposable syringes and not to share them with others or, even better, to change to sniffing or swallowing of drugs. Some of the biomedical scientists also related their personal experiences with this model. Adnān Ṣaqqāl spoke about a poster he read in Los Angeles which advised people to take just one sexual partner and to use condoms. The IDUs were advised to use sterilized syringes and not to reuse them. The participating biomedical scientists stated that this model has been promoted not only by the USA and Europe but has also been adopted by the WHO (‘Awaḍī and Jundī , 12, 528; Bār , 589, 596, 607, 614, 618).

The biomedical scientists criticized this model on more than one ground. First of all, they argued that it is not a morality‐based model and that is why it is not inclined to impose any restrictions on the sexual practices of people. According to this model, sex can always be practiced as long as it is done “safely” and high‐risk behavior is avoided and thus the consistent use of condoms is always encouraged. Al‐Bār, together with many other biomedical scientists such as the Egyptian dermatologist Ibrāhīm al‐Ṣayyāḍ and the late Egyptian and USA‐based gynecologist Ḥassān Ḥatḥūt, stressed that the use of condoms cannot be equated with safe sex and that people in general, and Muslim religious scholars in particular, should not get the false impression that condoms are foolproof. Al‐Ṣayyād said that he consulted scientific works dedicated to the topic of AIDS and women and they all agreed that using condoms does not completely guarantee safe sex. During sexual intercourse, the vaginal fluids can touch the pubic region that might have been scratched while shaving the pubic hair. In this case, the male partner can contract the AIDS virus from his HIV‐infected female partner even if he was using the condom. Al‐Ṣayyād also added that the manufacturing companies evaluate the effectiveness of condoms on the basis of tests conducted in ideal situations that can hardly be achieved in reality. Thus, al‐Ṣayyād concluded, this alleged “safe sex” model should not be adopted by the Islamic countries (‘Awaḍī and Jundī , 80, 109, 528).

In the light of these negative remarks about the WHO as an international organization and its standpoint toward using condoms as an AIDS preventive measure, al‐Khayyāṭ and Wahdān had to respond. During the IOMS symposium, they were representing the EMRO which is affiliated with the WHO. As mentioned above, in their paper submitted to the IOMS symposium, they said that using condoms can be an extremely effective method of preventing exposure to HIV during sexual intercourse. Al‐Khayyāṭ distanced the EMRO from the “safe sex” model. He said that the WHO does not adopt a unified vision in this regard. He couched the position of the EMRO in the following words: “The EMRO that we represent here has no relation whatsoever with the so‐called safe sex [practiced] out of wedlock. We neither study nor legitimize such immoral relationships so that we can make it eventually safe. We can never think of such things and thus we do not discuss safe and unsafe sex. But we try to find solutions for some of the emerging problems that hit us because of the risks coming from the West and the [sexual] relationships there or because of the mistakes committed by our [Muslim]mates.” Al‐Khayyāṭ enhanced his words about the EMRO position with a concrete example he related about Ḥusayn al‐Jazā’irī, the EMRO regional director. Al‐Jazā’irī was invited to a symposium in India. The participants in the symposium were recommending the usage of condoms as a preventive measure and they were about to endorse this vision. However, al‐Jazā’irī objected to this vision and showed them how fanciful it is. According to al‐Khayyāṭ, he asked the participants in the conference how such a vision can applied in a country like India, with around one milliard people. If India wanted to use this preventive measure, can you imagine how many condoms will be needed then? al‐Jazā’irī wondered. As for their reference to the use of condoms as an effective preventive measure in the paper they authored, al‐Khayyāṭ and Wahdān clarified that they were looking for a way to protect an innocent wife from contracting the AIDS virus through her HIV‐infected husband. This preventive measure need not necessarily be 100% safe but people need to look for the best possible option. The Egyptian physician ‘Iṣām al‐‘Iryān also stressed this point and said that the use of condoms should not be approached with such sensitivity. The context of the discussions here, al‐‘Iryān explained, are different from that of parallel debates in the West where they promote for the so‐called “safe‐sex condom.” In the Muslim world, however, the focus is on a married couple, one of whom is infected with HIV/AIDS. If it is really proven that the condom is an effective preventive method, then Muslim religious scholars can conclude that divorce is not inevitable in this case (‘Awaḍī and Jundī , 80, 86, 90, 109, 528–29).

In his extended document submitted to the ninth session of the IIFA held in 1995, al‐Bār also formulated a lengthy critique for the aforementioned Western model. Al‐Bār argued that AIDS is basically a sexual disease and thus sexual permissiveness and promiscuity are at the root of the AIDS pandemic. According to him, two main groups are responsible for the spread of AIDS worldwide, namely homosexuals and prostitutes. This means that 90% of the AIDS problem can be eradicated if people managed to put an end to these two sexual practices. Al‐Bār also found it unfortunate that most of the decisions adopted by the WHO and other international bodies ignore the significance of chastity, morality, and fidelity as effective measures for curbing the spread of HIV/AIDS. According to al‐Bār, the EMRO did not buy into this policy adopted by the WHO but instead exerted great efforts for the sake of demonstrating the significance of religion, chastity, and early marriage for young people. Al‐Bār mentioned three figures who mobilized these efforts, namely Ḥusayn al‐Jazā’irī, the EMRO regional director and the former Saudi Minister of Health, Muḥammad Haytham al‐Khayyāṭ, and Muḥammad Ḥilmī Wahdān. Al‐Bār also acclaimed the EMRO publication Dawr al‐dīn wa al‐khlāq fī al‐wiqāya min al‐īdz (The role of religion and ethics in the prevention of AIDS). However, al‐Bār added, the WHO stated on the first page of the book that it is not one of its official publications and that the opinions expressed in the publication belong exclusively to the contributing authors. Al‐Bār's interpretation for this statement is that the WHO hereby wanted to distance itself from the content of this publication, despite its overall mild approach. To show practical examples of the WHO policy toward AIDS, al‐Bār made reference to the aforementioned declaration on AIDS and education jointly issued by the WHO, ILO, and EI. He found it strange that the declaration did not state that the HIV/AIDS‐infected schoolchild has to inform the school administration about the disease. However, they do know that this procedure will help the school administration take the necessary measures for preventing the spread of HIV/AIDS transmission. What is even stranger, al‐Bār added, is that the declaration underscored the right of the HIV‐infected person to liberty in sexual practices. According to al‐Bār, such a standpoint means that homosexuals cannot be blamed for practicing homosexuality as long as they use condoms. Al‐Bār had his own explanation for the stubborn insistence prevalent among the advocates of this Western model on defending rights of homosexuals and adulterers. In his view, this model is influenced by specific passages of the distorted Torah (al‐tawrāh al‐muḥarrafa), the holy scripture of the Jews. These passages ascribe immoral sexual practices to a number of the prophets; Lot committed adultery with his two daughters and David (Dāwūd) with his neighbor's wife. Al‐Bār added that these Jews are very powerful nowadays in the media and in all organizations. He mentioned his personal experience during a conference held in 1990 in The Netherlands on the rights of people living with HIV/AIDS. In this conference, al‐Bār was representing the then secretary general of the Muslim World League, ‘Abd Allāh Naṣīf al‐Amīn. Al‐Bār said that he was surprised to know that the organizers of the conference and influential participants therein were Jews. He said that he engaged in heavy debates with them when they tried to issue resolutions in favor of homosexuals and adulterers under the pretext of human rights (Bār , 596, 608–09, 613–14).

Strikingly enough, al‐Bār himself in the paper he submitted to the aforementioned conference in The Netherlands spoke positively about the Bible, “Sticking to religious teaching, whether in the Bible or the Qur'an, can curb the incessant spread of STDs and AIDS.” He also stated that the Qur’ān sometimes required a more difficult standard of proof than the Bible before the punishment assigned for sexual transgressions can be applied. “Sodomy and adultery are punished [in the Qur’ān] along the same lines as those mentioned in the Bible, with one reservation—the actual sexual intercourse should be witnessed by four persons. This is, of course, almost impossible unless the intercourse has been carried out in the open” (Bar , 51). As far as Jews are concerned, Ḥassān Ḥatḥūt's personal experience in California, which he related in the IOMS symposium, showed a more positive image. Ḥatḥūt spoke about the media hype in America triggered by the news that the famous basketball player Magic Johnson contracted HIV and about his appearance on television advising young people to practice sex “safely” by using condoms. In the wake of this media hype, the Islamic Center of Southern California in cooperation with the Catholic Church and the Jewish community organized a joint seminar in order to investigate the safety of this supposedly “safe sex.” The standpoint adopted by the participants in the seminar is that the Use of condoms can reduce the risk of HIV infection but it cannot be honest advice about how to truly stay safe. Thus, Ḥatḥūt added, we cannot say to the young people that they are safe as long as they use condoms during sexual intercourse (‘Awaḍī and Jundī , 89). These two instances from al‐Bār and Ḥatḥūt clearly problematize the essentialist approach that some Muslim biomedical scientists tend to adopt when it comes to “Jewish” or “Talmudic” bioethics. Under the title “Religion(s) and Homosexuality Today,” The Brill Dictionary of Religion says: “The Hebrew Bible, on which Orthodox Jewish rules rest, condemns homosexual conduct. For Orthodox women and men, admission of their homosexuality can mean exclusion from their community—no longer physical death, as in ancient Israel, but social ‘death’” (Stuckrad , 880).

Aside from the supposed Talmudic and Jewish influences that al‐Bār wrote about, other participating biomedical scientists had other explanations for the marginal position given in the Western AIDS preventive model to (Islamic) ethical values such as chastity before marriage and fidelity thereafter. In his opening speech during the IOMS symposium, ‘Abd al‐Raḥmān al‐‘Awaḍī, the IOMS president, argued that the AIDS epidemic is a product of Western civilization. This civilization invested too much in just two main aspects of the human being, namely the material side and the bestial instincts or animal drives. That is why this Western civilization boasted promiscuity and unrestricted freedom of sexual practices that “eventually turned into sexual anarchy that even the animal would reject.” Al‐‘Awaḍī added that even words like morality and chastity were laughed at (‘Awaḍī and Jundī , 51). A more sophisticated elaboration of al‐‘Awaḍī's ideas can be found in the Sudanese psychologist Malik Badri's bestseller The AIDS Crisis: A Natural Product of Modernity's Sexual Revolution. In this book, Badri fiercely criticized Western modernity. He argued that the current sexual revolution is a progeny of Western modernity and that AIDS is a natural consequence of the rampant promiscuity propagated by this revolution (Badri , x, xvi–xvii). It seems that Badri's thesis appealed to the IOMS in Kuwait. On its website, the IOMS made three chapters of this book available online (). The selected chapters, namely 8, 9, and 10, compare the Islamic approach to AIDS prevention with the Western preventive model.

An Islamic Approach to AIDS Prevention

Besides criticizing various aspects of the HIV/AIDS preventive strategy adopted and promoted by Western countries and also by the WHO, the participating biomedical scientists reflected upon a possible Islamically oriented preventive approach. In order to demonstrate the Islamic character and legitimacy of this proposed approach, the biomedical scientists quoted a number of Qur'anic verses and prophetic traditions, some of which already appeared in the opening passage of their papers. Two Qur'anic verses and one prophetic tradition were frequently quoted. In al‐Bar's paper, they already appeared in the opening paragraph. The two Qur'anic verses read: “And do not approach immoralities (al‐fawaḥis), what is apparent of them and what is concealed” (06:51) and “And do not approach unlawful sexual intercourse (zinā). Indeed, it is ever an immorality (fāḥisha) and is evil as a way” (17:32). The prophetic tradition, below referred to as the fāḥisha‐tradition, reads “Immorality (fāḥisha) has never become so rampant in a community that they openly practice it but outbreaks of plague and diseases, that were never known among their bygone forefathers, will be widespread among them.” According to the biomedical scientists, the linchpin of these three texts is that all immoral practices included in the broad Arabic concept fāḥisha, whose plural is fawāḥish, are categorically forbidden in Islam. Additionally, premarital and extramarital sexual relationships described as zinā (adultery and formication) are among these immoralities (fawāḥish) that have been condemned by the Qur’ān. Finally, the prophetic tradition warned that those who collectively and publicly contravene this moral obligation will not go unpunished, especially in this life, that is, before the day of resurrection. This divine punishment will take the form of new plagues and diseases that were not known among earlier generations (Abū Lisān , 211; ‘Awaḍī and Jundī , 41, 52–53; Bār , 227; Bār , 585).

During the third international conference on “Islamic Medicine” held by the IOMS in 1984 in Kuwait, the two Saudi physicians ‘Abd al‐Wahhāb Walī and Anwar al‐‘Awaḍī submitted one of the earliest papers on Islam and AIDS. According to these two authors, the term fāḥisha mentioned in the aforementioned faḥisha‐tradition means not only adultery and fornication but also homosexuality. When these prohibited sexual relations became common practices among people in the West, Walī and al‐‘Awaḍī argued, outbreaks of new sexually transmitted diseases, especially AIDS, became widespread. The two physicians held that the specific word “plague” in the text of the prophetic tradition implies miraculous indication of the truthfulness of the prophet of Islam. Although there is no mention of traditional plague outbreaks in these Western communities, there are two main similarities between plague and AIDS, namely the epidemiological spread and the high rates of death. That is why people in the USA call this mysterious disease, that is, AIDS, the “gay plague.” Keeping in mind that the etiology of AIDS remains unknown, Walī and al‐‘Awaḍī added, further research may demonstrate a possible link between plague and this mysterious disease. The two authors quoted another prophetic tradition and argued that it also implies miraculous indication of the prophet's truthfulness. The tradition reads: “Unlawful sexual intercourse (zinā) has never become rampant in a community but death will prevail among them.” According to Walī and al‐‘Awaḍī, it has become recently clear now that the number of AIDS‐related deaths is high (Walī and al‐‘Awaḍī , 325). This inclination toward the “miraculous” interpretation of the scriptural texts did not disappear among the biomedical scientists who wrote in the 1990s. For instance, like‐minded interpretations for similar prophetic traditions can be found in al‐Bār's extended document submitted to the ninth session of the IIFA held in 1994 (Bār , 603–04).

The main point of agreement among the biomedical scientists is that the AIDS outbreak cannot be disentagled from what they considered the degraded state of sexual ethics and morals in the West and in various parts of the world. According to them, the real catastrophe is not that sexual immorality (faḥisha) is being practiced but that it has been normalized, practiced in public, and also defended under the name of inviolable personal and human rights, whereas moral virtues such as chastity and fidelity are laughed at (Abū Lisān , 211; ‘Awaḍī and Jundī , 51, 139; Bār , 614; Majallat , 529). As evidence for the veracity of their moralist thesis, the biomedical scientists said that the magnitude of the AIDS pandemic in the Muslim world remains small if compared with other regions in the world. Al‐Khayyāṭ and Wahdān spoke about two main factors in this situation, the first of which has to do with the late entry of the HIV/AIDS infection into the Muslim world. The second factor has to do with the moral and religious values which are still undeniably powerful among Muslims. For ‘Abd al‐Raḥmān al‐‘Awaḍī, the IOMS president, the second factor was more important because the rate of HIV/AIDS spread is also considerably low among Muslims living as religious minorities in the West (‘Awaḍī and Jundī , 52, 130; Khayyāṭ and Wahdān , 70–71). In addition to Islamic morals, the Islamic ritual of male circumcision was also mentioned in this context. During the IOMS symposium, Muḥammad ‘Alī al‐Bār said that he read in some African medical journals that circumcision has protective effects against HIV. Wahdān commented on this point and said that this preventive effect has also been confirmed by academic studies. On the other hand, questions were also raised about the possible negative influence of female circumcision, which is also common in some Muslim countries. The Egyptian physician Aḥmad Imām asked Dr. Wahdān if any academic studies have investigated whether female circumcision might increase the risk of HIV transmission. Wahdān replied affirmatively and said that this applies for the so‐called “pharaonic” circumcision, which usually involves the excision of a large part of the external female genitalia. This type of circumcision, Wahdād added, causes scars or bleeding during sexual intercourse, which in turn increase the risk of HIV transmission. Al‐Ṣayyād was not satisfied with Wahdān's answer and said that “pharaonic” circumcision is not an Islamic ritual. Female circumcision in Islam involves only the removal of the protruding part which causes sexual arousal when it is rubbed by the clothes. Thus, al‐Ṣayyād argued, this Islamic ritual can never have negative effects on the female genitalia (80, 86, 101, 110).

On the ground of this moralizing understanding of AIDS etiology, the biomedical scientists argued that curbing the AIDS pandemic would not be possible without restoring the (Islamic) religio‐ethical values, especially those regulating sexual relations. In the first sentence of his paper, Abū Lisān recognized the naturalness of sexual desire because it is something created by God, who also legitimized its satisfaction through lawful channels (Abū Lisān , 211). Also, one of the recommendations of the EMRO symposium held that sex is a biological part of the human constitution. It has its own natural needs and demands which must be regulated and controlled according to the accepted social norms (Munaẓẓamat , 37). Aḥmad al‐Jundī, the IOMS secretary general assistant, said that instead of the slogan “safe sex” promoted by the non‐Muslim world, the IOMS and the EMRO adopt the slogan “lawful (ḥalāl) sex” as an effective AIDS preventive strategy (Majallat , 529). The main concern of these biomedical scientists was thus to show how sexual desire should be channeled and how sexual relations should be regulated. The aforementioned two Qur’ānic verses (06:51 and 17:32) condemning sexual immoralities (fawāḥish) in general and sex outside marriage in particular (zinā) were instrumental. The phrase “do not approach (lā taqrabū)” was interpreted not only as prohibition for unlawful sex but also for any other act that leads to this unlawful sex. The IOMS president al‐‘Awaḍī and al‐Bār argued that the scourge of AIDS and other sexually transmitted diseases will not be successfully uprooted unless every means that helps the promulgation of promiscuity is also prohibited. That is why, al‐Bār explained, the Qur’ānic verses (24:30–31) made it obligatory for both males and females to “lower their gaze and guard their modesty.” The same holds true for the Qur'anic verse (24:19) in which God harshly condemned those who “love that sexual immorality (fāḥisha) proliferate among those who believe.” In al‐Bar's view, this verse is applicable to a broad category of people in contemporary Muslim societies who “love that sexual immorality proliferate among those who believe” but disguise their evils under false names such as progressiveness, open‐mindedness, entertainment, and tourism. As for tourism in specific, al‐Bār referred to what Gulf newspapers published about Russian female “tourists” who visited the Gulf region in order to disseminate AIDS there. He also spoke about groups of young people from the Gulf countries who traveled to Thailand, The Philippines, and India for the sake of “tourism.” Eventually, they were infected with various sexual diseases including AIDS. Al‐Bār also made reference to some articles existing in the codified laws adopted by most of the Muslim (Arab and non‐Arab) countries, which make sex outside marriage (zinā) and homosexuality legal. As part of the Islamically oriented AIDS preventive strategy, he stressed that all these laws must be repealed. Al‐Bār found it unbelievable that countries calling themselves “Islamic” would permit prostitution and consider it a recognized profession. By doing this, he argued, these countries contravene natural disposition (al‐fiṭra), reason (‘aql), and Islamic law (Shar‘), and also expose their peoples to extremely dangerous sexual diseases (‘Awaḍī and Jundī , 52–53; Bār , 604–06, 616).

Parallel to prohibiting every (homo)sexual practice before or outside marriage, the biomedical scientists explained that Islam encouraged satisfying the sexual desire through the institution of marriage. Young Muslims, al‐Khayyāt and Wahdān pleaded, should be stimulated to get married at an early age and all social and financial barriers to achieve this goal must be removed. According to al‐Khayyāṭ, encouraging early marriage should be a state‐sponsored policy and Muslim religious scholars should also promote this idea among Muslim youngsters. However, al‐Khayyāṭ and Wahdān added, the married couple should use contraceptives in order to avoid pregnancy at early age because of its negative effects on the young woman's health. The Muslim religious scholar, Abū al‐Nīl, found the advice of postponing pregnancy controversial and wondered, “How come that pregnancy would harm woman's health after reaching the age of puberty (bulūgh)?” In response, al‐Khayyāṭ explained that reaching the age of puberty does not mean that the organs of the woman's body have been fully developed so that they can stand the physical difficulties of pregnancy. That is why those who get pregnant at an early age are prone to complications that sometimes put the woman's health at risk. Thus, from a medical perspective, pregnancy at a very early or very advanced age is not recommended. Two other physicians from Saudi Arabia, namely al‐Bār and the gynecologist ‘Abd Allāh Bāsalāma, tried to nuance al‐Khayyāṭ's conclusion. Al‐Bār said that he came across a good article in a Saudi medical journal, which conducted research on 2,000 cases of delivery in Saudi Arabia. The article concluded that the optimal age for pregnancy and labor ranges between 16 and 25 years. The same article mentioned a number of women who gave birth while they were still younger than 16 years and some of them were even 12 years old. These cases were documented in the two regions of Abhā and ‘Asīr and just few complications were recorded. ‘Abd Allāh Bāsalāma said that the optimal age for pregnancy and labor ranges generally between 18 and 24 years. However, Bāsalāma added, medical textbooks usually mention the well‐known but also exceptional incident of a Peruvian woman who gave birth at the age of five. Al‐Bār and Bāsalāma concluded that pregnancy before the age of 16 should not always be portrayed as something extremely dangerous, especially because physicians nowadays have more advanced technologies to take care of the woman and her child (‘Awaḍī and Jundī , 95, 100, 104–05, 108; Bār , 605; Khayyāṭ and Wahdān , 71–72).

Concerning IDUs, an HIV high‐risk group, al‐‘Awaḍī and al‐Bār said that Islam has univocally forbidden every intoxicating substance. On the basis of a prophetic tradition they quoted, al‐Khayyāṭ and Wahdān also held that drugs and wine are forbidden in Islam on equal footing. They also made reference to the Islamic legal maxim which states that prohibition (taḥrīm) is usually linked to impurity and harm. The outbreak of the AIDS pandemic has revealed a new harm for drug addiction that people were not aware of before, namely the possibility of HIV transmission. Had drugs had no other harm except this one, al‐Khayyāṭ and Wahdān argued, it would have been sufficient to declare it as prohibited. The final evidence used by al‐Khayyāṭ and Wahdān was the consensus of Muslim religious scholars that every type of drug which affects the consciousness of the brain is prohibited (‘Awaḍī and Jundī , 52–53, 72; Bār , 604–06, 616). Besides this morality‐based preventive policy, practical preventive measures were also mentioned by the biomedical scientists. For instance, they stressed that antibody tests for blood donors must be done consistently in order to minimize the risk of HIV transmission through blood transfusion. Abū Lisān added that blood banks should stop importing blood from abroad and recheck if they have any blood contaminated with the AIDS virus. As for married couples, if one of them contracted HIV/AIDS, then they should use condoms. However, al‐Bār added, they should realize that the use of condoms does not completely guarantee prevention. In Abū Lisān's view, the married couple should simply stop having sex with each other (Abū Lisān , 215–16, 219; Bār , 606–07).

Drafting Religious Rulings (aḥkām)

The linchpin of Islamic jurisprudence as a professional discipline is the craft of drafting religious rulings (aḥkām sharī‘iyya), which was usually seen as the exclusive task of the specialists in this discipline, namely Muslim jurists (fuqahā’) (Sānū , 21). Thus, the attempts made by the biomedical scientists to construe their own perspectives on the aḥkām related to people living with HIV/AIDS represent a striking development in the mechanism of collective ijtihād and in the field of contemporary Islamic jurisprudence in general. On the other hand, it is clear that the participating biomedical scientists showed a high degree of cautiousness and sometimes even reticence in most of the aḥkām they reflected upon. Instead of using the terminology of permissible (ḥalāl) and prohibited (ḥarām), they usually used more nuanced phrases like “these scriptural texts can be used to defend the argument that…,” “there is no need to…,” “this can constitute a legal ground for …,” “this issue is open for discussion and further consideration,” and “this issue still needs a comprehensive and in‐depth investigation from an Islamic legal perspective.”

A number of the religious rulings discussed by the biomedical scientists focused on the cases of married couples when the husband was the HIV/AIDS carrier. Does Islam in such cases give the wife the right to dissolve marriage? In response, Abū Lisān held that it is the woman's right not only to demand the dissolution of marriage but also to claim financial compensation. Abū Lisān argued that the Qur'anic verse “Divorce is twice and then (a woman) must be retained in good fellowship or released in kindness” (2:229) and the prophetic tradition “There shall be no harm inflicted or reciprocated” may be used to strengthen this pro‐dissolution viewpoint. Because of the AIDS‐infected husband, the woman will always run the risk of contracting one of the most heinous, infectious, and incurable diseases. Thus, releasing her in kindness, that is, divorce, is justifiable. On the basis of the prophetic tradition, the dissolution of marriage will protect the woman and also her child from possible serious harms. Al‐Bār's opinion was less vocal than that of Abū Lisān. He said that first of all the wife should be checked to see if she has already been infected. If infection already happened, then there is no point in dissolving the marriage. If the wife was not infected yet, then there is also no need to dissolve marriage if they both consensually agreed to give up sexual intercourse. In this case, the HIV‐infected husband does not have the right to demand having sexual intercourse with his wife, even if he will use a condom because it does not completely guarantee HIV prevention. Al‐Khayyāṭ and Wahdān argued that two main problems would arise if the husband was an AIDS carrier. The first problem is that the husband's sexual potency will be affected by the HIV/AIDS infection because of the need to use a condom, if the wife gave her consent, on every occasion and all through sexual intercourse. If the wife did not give her consent, then there could be a legal basis for divorce. The second problem is that the consistent use of a condom during sexual intercourse makes the possibility of having children, usually seen in Islam as one of the main objectives of marriage, almost nonexistent. This problem could also constitute a legal ground for divorce (Abū Lisān , 220; Bār , 234; Khayyāṭ and Wahdān , 70–71).

The biomedical scientists also reflected upon the question: Is it permissible to abort the pregnancy of an HIV/AIDS‐infected woman? In response to this question, the biomedical scientists had to address a scientific aspect of the question on the basis of which the religious ruling can be decided, namely the possible rate of mother‐child infection during pregnancy. Abū Lisān held that the risk of HIV transmission during pregnancy is scientifically proven. Thus, the permissibility of aborting an HIV‐positive woman's pregnancy during the first weeks and thus before the stage of ensoulment, is in principle open for discussion and further consideration. On the other hand, al‐Bār said that AIDS experts in the WHO and elsewhere in the world declared that the rate of HIV transmission from the mother to her child during pregnancy ranges between 25% and 30%. This means, al‐Bār explained, that 70% of the HIV‐positive mother's children will not be infected and thus, abortion even before the stage of ensoulment, cannot be justified on medical grounds. However, al‐Bār added, many Muslim jurists and academies of jurisprudence permitted abortion if the woman suffers from an advanced stage of AIDS and pregnancy will exacerbate the disease. After ensoulment, abortion cannot be tolerated on any ground because it will be tantamount to homicide. Again, al‐Khayyāṭ and Wahdān provided different percentages. They held that the rate of mother‐child infection during pregnancy does not go higher than 10%. Additionally, scientists are still unable to examine the fetus in order to know whether it contracted HIV during the first four months following conception (i.e., before ensoulment). If scientists managed later to diagnose HIV during the early stage of pregnancy, that is, before ensoulment, then this can be a legal ground for aborting the pregnancy because AIDS is still an incurable disease. According to al‐Khayyāṭ and Wahdān, by investigating this issue through the lens of the mother's interest, abortion can be tolerated and even recommended. In order to argue for this opinion, they recalled the scientific information that pregnancy is one of the factors that reduce the incubation period of the AIDS virus and accelerate the development of the disease. This is because woman's health in general becomes more vulnerable during pregnancy. In this way, al‐Khayyāṭ and Wahdān concluded, there can be a strong legal ground for aborting this pregnancy so that the mother's health can be preserved and her life can be saved (Abū Lisān , 220–21; Bār , 238; Khayyāṭ and Wahdān , 66–67).

Ḥajj or pilgrimage to Mecca is a fundamental obligation to be performed at least once by adult Muslims worldwide whose health and finances permit. One of the main rituals of ḥajj is that these millions of pilgrims have to have their head shaved or their hair cut short. The problem here is that shared use of shaving instruments could lead to the transfer of blood from the HIV/AIDS‐infected pilgrims to the healthy ones. How should this risk of HIV transmission be avoided during the season of ḥajj? As a preventive procedure, Abū Lisān did not see any harm in demanding an HIV testing from every pilgrim coming from the AIDS‐affected regions. According to him, the possibility that there will be AIDS‐carriers among the pilgrims is high. Realizing the fact that AIDS is an incurable and fatal disease, some of the AIDS‐infected pilgrims may have the will to pay the last visit to the House of God asking for His forgiveness. On the other hand, Abū Lisān was reluctant concerning the possibility of banning HIV/AIDS‐infected people from performing ḥajj and said that this issue still needs a comprehensive and in‐depth investigation from an Islamic legal perspective. However, he held that such a ban can be justified on the basis of two main arguments. Abu Lisān recalled the Islamic instructions, based on a prophetic tradition, concerning a plague‐struck region; those who live inside this region are not allowed to flee from the plague and those who live outside are not allowed to approach this region. “Thus, Islam will surely prohibit us from giving the plague‐carriers [i.e., AIDS‐infected persons] permission to enter our countries as long as we have the power and the means to prevent them,” Abū Lisān argued. In order to demonstrate that such a ban is a human rights–friendly procedure, Abū Lisān made reference to the USA. According to him, the USA, which usually boasts freedom, democracy, and human rights, prevents the carriers of the AIDS virus from entering its territory even for participating in a less than one‐week conference. If the USA has the right to protect its citizens from the AIDS virus, Abū Lisān concluded, then the Kingdom of Saudi Arabia does have the right to protect Muslim pilgrims as well. Unlike Abū Lisān, al‐Bār did not see the solution in imposing an official HIV/AIDS screening protocol or demanding a certificate of freedom from the AIDS virus from each pilgrim. Performing the rituals of pilgrimage, al‐Bār explained, can usually be done through short‐term visits. However, al‐Bār argued, and Abū Lisān agreed with him, practical preventive procedures should be adopted because some of the pilgrims come from heavily AIDS‐affected regions. According to them, a strict supervision on the ritual of shaving (ḥalq) during the season of pilgrimage should be applied so that only private razors or shaving tools will be used. The Saudi authorities, al‐Bār proposed, can also give every pilgrim, upon arrival, a cheap disposal razor that he/she can use for the ritual of ḥalq. Also, preventive precautions, al‐Bār added, should be taken whenever these pilgrims are admitted to hospitals (Abū Lisān , 221–23; Bār , 230, 239–41).

As a possible preventive measure for the spread of AIDS, the participating biomedical scientists agreed in principle that deliberate HIV/AIDS transmission should be seen as a criminal act and that the culprits should be penalized. In order to defend this position, they quoted a Qur'anic verse, a prophetic tradition and an Islamic legal maxim. The Qur'anic verse reads: “And there is (a saving of) life for you in al‐Qiṣāṣ (the Law of Equality in punishment or retaliation” (02:179). The prophetic tradition says, “There shall be no harm inflicted or reciprocated.” Finally, the Islamic legal maxim reads “All harm must be removed.” On the basis of these three texts, they concluded that everyone should be deterred from harming others and AIDS is one of the most serious harms because it is still an incurable fatal disease. However, al‐Bār, al‐Khayyāṭ, and Wahdān did not give any concrete proposals for a specific punishment that can be inspired or derived from Islamic jurisprudence. Abū Lisān held that an analogy can made between drug dealers and those proved to be guilty of premeditated HIV transmission. If these drug dealers are punished by imprisonment of up to several years or even by the death penalty in some countries, then those who deliberately infect others with the AIDS virus also deserve a deterrent punishment commensurate with the gravity of their misdeed. Abū Lisān also made reference to a decree issued by the Emir of Kuwait stating that such people will be imprisoned for a period of up to seven years and will be fined an amount up to 7,000 Kuwaiti dinars (about 24,000 U.S. dollars) (Abū Lisān , 219; Bār , 236; Khayyāṭ and Wahdān , 67).

The final question addressed by the biomedical scientists was whether AIDS should be equated with the Islamic legal concept of maraḍ al‐mawt (literally disease of death), which is close to the bioethical concept of terminal disease. Once maraḍ al‐mawt is established, a cluster of Islamic legal rulings (aḥkām) immediately ensue. These aḥkām regulate the legal effect of acts that the sick person undertook after entering the sickness from which he/she eventually died. For instance, any transaction including testament or charitable endowment (waqf) conducted by someone on his/her deathbed that negatively affects the rights of the legal heirs will be void from an Islamic legal perspective (Shaham , 26, 135–38). Only al‐Khayyāṭ and Wahdān dedicated a distinct chapter of their paper to this issue. They clarified that an HIV‐positive person can live up to ten years or more although death, according to available medical knowledge, remains inevitable. In this vein, the carriers of the AIDS virus face a situation similar to those who have cancer; both can still live for several years despite their disease. Accordingly, al‐Khayyāṭ and Wahdān argued, an HIV‐infected person should not be judged as someone who suffers maraḍ al‐mawt. This can be the case only during the very last stage of the AIDS disease, usually characterized by deteriorating effects on the nervous system that results in the so‐called “AIDS dementia complex.”