AIDS, Female Genital Mutilation and Islam

By Marion D.S. Dreyfus
 

In a symposium some months ago, The Radical Lies of Aids, a Frontpage roundtable discussion on the current state of HIV/AIDS, no mention was made of Islamic cultural habits and African tribal customs. Both have a substantial impact on the transmission and impact of this modern-day blight.

While the panel experts parsed the “puzzling absence of causes” for the widespread HIV pandemic in Africa, legitimately dismissing the unsubstantiated, politically correct notion of heterosexual HIV transmission–fostered so fatally for the past 25 years and leading to the needless deaths of so many thousands.

Certainly, once upon a time, self-appointed HIV disease handlers had to pretend that various populations were at risk who were not at risk at all: They could then belabor and wheedle reluctant funding out of the government and the Centers for Disease Control.

The “next risk group,” however, has never been ordinary heterosexuals with no IV drug or multiple-partner sexual habits, which is what the ballyhoo remained for too long, while the real culprits never got proper attention.

As the ensuing years have shown, homosexual-rights interest groups refuse to consider closing bath-houses and notorious sex-parlors in the three disease hotspots –  New York, San Francisco and LA. They have refused to advocate the historically tried and true containment methods of behavior modification or contact tracing, insisting on the far weaker alternatives of “safer-sex” and conscientious prophylactic usage.

The problem is that condoms are hardly foolproof in the best of times, and HIV/AIDS has been one of the toughest tests they have had to weather. Dismissing the hocus-pocus of healthy partners in penile-vaginal transmission, or vagina-penis disease transfer – disease transfer from females to males is much harder to do, for a variety of reasons – the experts seemed uncharacteristically unclear as to what can be reliably pointed to as plausible explanations for the continued spread of HIV.

Yes, they acknowledge the well-documented and well-understood actions of accidental pin-sticks and poor technique, office-based error, non-professional insertions, “barefoot doctors” and the like, all of which are called “iatrogenic” causes. Needle punctures, from dirty or used syringes or application error, are a prime transmission vector – but this cause is responsible primarily for medical personnel becoming infected. Not, usually, actual patients or non-medical people.

In other words, dirty needles and bad medical technique can hardly — especially in the case of Africa –  be considered the primary cause of fatal patient-HIV transmission. After even one visit to Africa, one learns that sexual custom for men in many tribes, in urban as well as rural areas, includes extramarital sex with non-local females, prostitutes, as well as with boys, often, and even with animals, if females are unavailable. The male then returns to the bed of his wife or common- law mate, who contracts the disease from her erring partner.

All viruses and sexually transmitted diseases (STDs) picked up from the sexually active unfaithful find a hospitable environment in the misused wife, and incubate into various forms of sexual disorder or, of late, especially into HIV. Sadly, the now visibly ill women are frequently blamed for initiating the disease: beaten, divorced or otherwise abused. This is a frequent Islamic reaction from husbands, brothers, fathers, even sons, to the perceived ‘dishonoring’ of the family or rape of their (innocent) women. Some wives, suspected baselessly of cheating, are killed.

More relevant in this cultural implication is that more than 100 million, even as many as 140 million – latest estimates –  African girls and women are estimated by WHO and  ReligiousTolerance.com (among others) as victim/recipients of female genital mutilation (FGM, also called infibulation). Infibulation in the medical literature or public arena is so widespread and so taboo that it assumes a special place in the history of hushed-up critical problems in the world.

Because it is considered a private, ‘social’ or often a “religious” issue, one that riles up many male Muslim “authorities” and average healthcare practitioners, infibulation –FGM – is a major third-rail political agenda, one vociferously denied and hotly debated in outrage with anyone intrepid or foolhardy enough to bring up such a detonating issue.

The existence of virtually ubiquitous FGM in African tribal cultures guarantees long-term vaginal tissue damage, as the genital mutilation has been performed – without anesthesia or a single sterile tool – by lay non-physician practitioners, usually female, acting on shanghai’ed and unprepped preteen girls as young as three. After “stitching” with rough thread or twine, the local medicine woman leaves an opening the width of little more than a matchstick head. Enough to expel ureic wastes or menstrual fluids, barely.

At marriage – or rape –  the force of intercourse on this damaged and nearly nonfunctional site instigates further massive tissue damage, and initiates a wound site that is continually subject to infections, bleeding, bacterial fester and disintegration of various kinds, including the proliferation of bacteria and viruses from prior sexual encounters and new diseases foisted on them by their partners.

The use of barrier prophylactics, condoms, which some say is effective as anti-STD-transmission, is firstly, frowned upon in black African (often Muslim) or animist societies as “unmasculine” and suspect; and secondly, haphazardly practiced, if the woman is lucky enough to be with someone willing to use one; thirdly, widely acknowledged to be tragically undersupplied in the third-world regions where HIV casts its longest and darkest shadow.

Add two other salients to this ugly brew: Condoms cost money, even in Africa. And prostitutes cannot charge unsympathetic customers the going rate if they try to use such fanciful flourishes.

In concert with a disregard for safe or practical concepts of sex, or with animal-human sexual encounters that are still a sometime-habit in Africa to contend with, intimacy with a sexually wandering mate often provokes painful and persistent gynecological disfigurement and exacerbation as well as the efflorescence of any lurking HIV. Normal sexual intercourse with healthy females and non-HIV-carrying mates is known to be safe in relation to contagion in every other parallel circumstance, so there is no reason to think that, given similar circumstances – healthy male-female intimacy in Africa – there would be an upsurge in reported cases of HIV/AIDS.

Vaginal intercourse, difficult and painful for African females who have been brutally deprived of their anatomically rightful genitalia by FGM (whose purpose is to stem female sexual satisfaction, lust or potential unfaithfulness to future spouses) often leads to male preference for anal intercourse at home. Fragile rectal tissue in all people yields only reluctantly to force, of course. The subsequent lesions and tissue breakage in the female anal tract (no less, of course, than in the male, the source of the lion’s share of homosexual transmission) is anything but unfriendly to the blossoming of the virus.

Childbirth presents more complicating factors, and often leads to HIV-afflicted infants.

The intransparency of male sexual misbehavior – their failure to admit their sexual misdeeds with the unsanctioned – in almost all of sub-Saharan Africa adds to the difficulties scientists and investigators have in discovering the means of transmission of many diseases, especially in viral-origin diseases in the news today, but is an open secret to locals, and those who – equally passionately – refuse to subject their “private” behaviors of dismissive sexual abuse of their women to the open air of detailed examination and rigorous scientific discussion.

Current news accounts include problems with Muslim males even permitting male doctors to examine Muslim women. Even in medical emergency. Even in extremis. Since female doctors are few and far between, this translates into women not getting enough attention, soon enough, to prevent advanced disease, dysfunction or death.

Despite strong medical considerations, many tribal and Islamic councils have consistently voted to continue the barbaric practice of clitoral ‘circumcision’ so as to ensure their females’ continued “purity” and an unsullied “family honor.” And if, as the literature attests, victims of FGM might have a lower incidence of HIV, the reasons are easy to adduce: Such women have less sex, far fewer sexual contacts; they clearly don’t seek out sex as much as their unmutilated sisters, and consequently their risk and their exposure, and thus their incidence of disease, is less. On the other hand, because they have a running start on infection and  tissue damage, almost any sexual contact can exacerbate into major disease or infection.

If such casual abuse of women and ignorance of the transmission modes and loci is demonstrated by the Islamic or local animist males in many African cultures, the numerous tribesmen, with some measure of both embarrassment and pride, admit their sexual proclivities in countries as diverse as Sudan, Egypt, Uganda, Zambia, Mali and Zimbabwe, Kenya and Tanzania, these countries, while suffering the difficult societal constraints upon women imposed by the minority religion of Islam or animism, the problem is even more notable in countries where the dominant religion is Islam, or is becoming more Islamo-dominant, such as Nigeria, and tacit prohibition on discussion of FGM (cliteridectomy in more advanced circles) is even more pronounced. Mothers in countries coming under increasing Islamic influence must be constantly vigilant to prevent their daughters from falling into the hands of FGM proponents.

Conversely, women in countries where modern Christianity or other non-Islamic faiths are entrenched or experiencing inroads are likely experiencing a growing, if below-the-radar, resistance to a practice that has come to be regarded as mandatory in order to ensure a good marriage partner, although the Qur’an does not, strictly speaking, order it: Muslims have apparently adopted this modality by themselves, in fervid and random excess against the possibility of female orgasmic pleasure hinted at in the Qur’an, where women are “nine parts of desire” (to men’s single part out of 10).

FGM has been practiced for as little as 1400, and perhaps as long as 2000 years, among the nomadic and African tribes and, since the advent of Islam in the seventh century, by Muslims. In terms of how much mutilation women endure, once the extreme-practice version has been practiced in any region, as seen in many religious arenas, it is difficult to go back to the more moderate, less extremist version. Some practice only to “minimize” the size of the “outsize” clitoris (Egypt), where others remove all labia plus clitoris under the general rubric of ‘less [sexual tissue] is… more secure [against sexual enjoyment and unfaithfulness].’

Current research indicates those females fortunate enough to have mothers educated beyond just the third year of school often escape submitting to the predations of this ugly and joy-deadening procedure. Such women, accordingly, will be far freer of HIV/AIDS than will their less fortunate captive sisters under the terrible aegis of a pre-medical faith that has yet to be updated to contemporary standards of hygiene and routine healthcare practice. Of late, several women (a Somali case was in the news some years ago) have notably sought refuge, even the legality of political asylum, as escapees of the procedure in the United States.

That any modern-day symposium, much less the cautionary “Radical Lies of AIDS,” would be missing such important and critical elements of the African and, particularly, Islamic experience is unfortunate and in need of corrective.

There is something we can do to make a change in terms of the terrible crime and tragedy of FGM. While female circumcision, such as that described here, is illegal in advanced countries, some animist religionists and Islamic practitioners occasionally try to foist it on their female children in the United States and the West, notably Great Britain, by coercing or bribing sympathetic medical practitioners. Such tragic efforts must be strongly resisted, and practitioners brought to the attention of municipal medical authorities. Healthcare practitioners must refuse to perform the operations. School personnel must be alert to signs of school absence, ill health, pain and anemia in young African females.

As modern healthcare methods are becoming more understood, more educated females are learning of the consequences of such primitive customs, and the practice has, at long last, been fading as newer generations become acquainted with the physiological costs, dangers and damages.

Marion D.S. Dreyfus is a British-born journalist with particular interest in world healthcare, pharmacology and medicine, the politics of the Middle East, and the environment. She has traveled widely in Africa and lived in Central and South America, Europe, and the Far East.