Are Imams in Egypt Prepared to Help Stop the Spread of HIV/AIDS?

"Muslim religious leaders in Egypt - known as imams - appear to know more than the average Egyptian man about HIV/AIDS and its modes of transmission; but there are major gaps in imams' knowledge about the disease, and their attitudes are not favorable toward people living with HIV."

This article from two faculty members of Assiut University in Egypt presents some of the findings of their United Nations Population Fund (UNFPA)-funded research on the preparedness of imams to take a role in prevention and control of HIV/AIDS in Egypt. The article briefly discusses: HIV prevalence in Egypt; risk-related sexual behaviours in the cultural context of Egypt; stigma; the Cairo Declaration, a document produced in 2004 by high-ranking Muslim clergy; and, in more detail, the results of their research.

Background for the research includes the following: Though a low-prevalence country, Egypt's conservative culture may cause under-reporting of sexual behaviours that are high risk, such as having multiple sexual partners and men having sex with men. "Stigmas surrounding people living with HIV obstruct the development of a national surveillance system and prevent people from being tested and seeking care if the result is positive." In response to the global HIV/AIDS crisis, Muslim clergy produced the Cairo Declaration, offering these guidelines for imams who have day-to-day contact with people:

• Imams need to be empowered, updated by sound scientific knowledge on HIV/AIDS, to ensure that their understanding of sexual abstinence and mutual fidelity as the cornerstones of HIV prevention is correct but not sufficient to control the potential epidemic.
  
• Imams need to accept the reality that some people do not conform to religious guidance, teachings, and standards that prohibit sexual relationships outside marriage.
• Imams need to be able to communicate sound information on methods of protection including the use of condoms.
  

In 2009, to assess the knowledge and attitudes of religious leaders about reproductive health issues, including HIV/AIDS, more than 300 imams from 4 governorates in Upper Egypt participated in the Assiut study and completed a self-administered, anonymous questionnaire, the results of which were compared to a 2008 Demographic and Health Survey (DHS) of men ages 15 - 59 about HIV/AIDS. General knowledge of imams about the disease and its modes of transmission appeared to be higher than that of the general male population reported in the DHS. "74 percent of the imams knew that abstaining from sexual intercourse reduces the risk of getting HIV, compared with 23 percent of Egyptian men surveyed in the DHS. But still there were major gaps in the imams' knowledge - only 45 percent said that using a condom every time a couple have sex can reduce the risk of HIV. They also had misconceptions about transmission of HIV from sharing food or from a mosquito bite, although their knowledge seemed to be higher than the general population."

The survey measured imams' attitudes towards people living with HIV/AIDS (PLHIV), and, though it found that their attitudes were generally not favourable, the imams scored higher than the male population:

• Would not want the HIV status of a family member to remain secret: 73% among imams, compared to 34% male population
  
• Are willing to care for a family member with HIV at home: 45% compared to 20%
  
• believe that an HIV+teacher should be allowed to continue teaching: 37% compared to 9%.

The article concludes that: "In Egypt, changing people's behavior and perceptions must involve imams who are respected role models and can openly encourage positive behaviors. Imams in Egypt appear more knowledgeable than the general male population, but they still need to improve their knowledge. While 72 percent of the imams in the UNFPA study said that they talk with people about HIV/AIDS in their Friday sermons or other occasions, only 8 percent reported having received training on HIV/AIDS. Training imams in Egypt is a huge challenge; more than 50,000 imams need information on a culturally sensitive topic that deals with difficult issues such as sexual orientation, sexual health, and condom use. But the sooner the imams are trained, the more lives and resources will be saved."