Emerging HIV epidemics in muslim countries: Assessment of different cultural responses to harm reduction and implications for HIV control

Abstract

Harm reduction, including needle exchange and opioid substitution therapy, has been demonstrated to reduce high-risk behavior and HIV infection among injection drug users. An increasing number of countries in the Middle East, North Africa, and Asia, including those with Muslim majorities, have experienced or are at risk for HIV epidemics initiated by burgeoning injection drug use. Although use of intoxicants is expressly forbidden within Islam, the local culture impacts the interpretation of Islamic law and influences the response to drug misuse, whether punitive or therapeutic. Harm reduction programming has received varying acceptance within this global region, which may be reflected by national trends in HIV prevalence. The purpose of this paper is to examine cultural and religious response to injecting drug use and associated HIV prevalence trends in Malaysia and Iran, with possible application of lessons learned to an emerging situation in Afghanistan.

HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis

“…Among other interventions implemented in Iran are drop-in centers, integration of substance use treatment and HIV prevention into the rural primary health care system, and community education centers [62],[101]–[105]. These efforts appear to have been successful in reducing sharing of injecting equipment [106]–[108], though the coverage of harm reduction continues to be lower than adequate [104].…”

An assessment of health-care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency

“…Fostering favorable attitudes toward traditionally stigmatized groups is not an easy task, especially when certain stigmatized behaviors conflict with religious beliefs. The influence of religious leaders may be the key to improving attitudes of health-care providers (Kamarulzaman & Saifuddeen, 2010; Todd, Nassiramanesh, Stanekzai, & Kamarulzaman, 2007). In 2012, a mosque located in Kuala Lumpur began offering methadone treatment for opioid dependent PWIDs in response to alarming rates of HIV infection among this population (Gooch, 2012).…”

A Moderated Mediation Model of HIV-Related Stigma, Depression, and Social Support on Health-Related Quality of Life among Incarcerated Malaysian Men with HIV and Opioid Dependence

“…With over 100,000 cumulative HIV cases [3], Malaysia’s rapidly expanding HIV epidemic is the fifth largest in the Asia-Pacific region and concentrated within the most-at-risk populations, especially among people who inject drugs (PWID). The epidemics of HIV and injection drug use are intertwined in Malaysia [4, 5], with an estimated HIV prevalence of 12.5%–19.2% among PWID [6, 7], who are disproportionally concentrated within the criminal justice system (CJS) due to harsh criminalization for drug use. Results from mandatory HIV testing of the approximately 40,000 prisoners in Malaysia documents HIV prevalence to be 10–15 times greater (4.6% vs. 0.40%) than in the general population [8, 9].…”