By Dr Rafidah Hanim Mokhtar, Dr Samsul Draman and Dr Anis Safura Ramli

We regret that Dr Nur Ilyani Mohamed Nawawi’s simple message on her Facebook was harshly misconstrued into the argument that she is being undiscerning and judgmental. As a Muslim medical doctor, despite her religious beliefs, she already made it clear that she “does not discriminate against her patients based on their sexual orientation and gender identity”.

Misconstrued statements against anyone who dares to state the principles in the Quran and Sunnah with regards to the LGBT community in these modern days are common. Often, these individuals or groups are labelled as bigots and religious extremists, and accused of spreading hatred even if this is done with the intention of giving advice to the public. It’s even more so in the case of a Muslim doctor who is expected to adopt a secular stand in patient management, as if Islam and being a Muslim are a hindrance to good patient management.

This is a totally baseless assumption. The fact of the matter is, “a Muslim doctor holistically integrates the knowledge of naqli (revealed knowledge from the Quran and Sunnah) and aqli (reasoning and empirical evidence) and works around the concept of Maqasid Shariah in striving for the best for their patients, regardless of whether they are of different faiths, having criminal records, or have performed acts considered sinful in Islam”. Maqasid Shariah stresses the importance of preserving life (hifz ad-deen), and preserving progeny (hifz al-nasl), which the LGBT issue is very much related to.

Furthermore, a Muslim doctor abides by “The Oath of the Muslim Physician”, which first and foremost states that:

“In the name of Allah, Most Gracious, Most Merciful. Praise be to Allah, the Sustainer of His Creation, the All-Knowing. Glory be to Him, the Eternal, the All-Pervading. O Allah, Thou art the only Healer, I serve none but Thee, and, as the instrument of Thy Will, I commit myself to Thee.”

Often, our duties and obligations to ensure that the health of the population is taken care of is mixed with the issue of the rights of LGBTs not to be discriminated against, abused or harmed.

Both issues go hand in hand and should not be seen as two sides of the coin. As Muslim doctors, we never discriminate. We treat all our patients with dignity and respect, including those who are LGBT. Respecting them as patients does not mean that we endorse their high-risk sexual behaviour.

Therefore, it is also our duty to inform our patients and the general public that it is their high-risk sexual behaviour which contributes towards the HIV/AIDS epidemic. Additionally, discussing the epidemiological data of HIV/AIDS from a medical perspective and addressing the rising trend of new cases of HIV among the target groups should not elicit accusations of persecution and discrimination where there is none.

As medical professionals, we should be fair and not jump to the conclusion that discrimination is the main contributing cause to the rising trend in HIV cases. We should not disregard the biological nature of the mode of transmission, or the epidemiological data showing that there are high incidences of HIV/AIDS cases among gay, bisexual and transgender people in developed countries which have progressed in their legal and social acceptance of LGBT, e.g. Australia and the US, just to name a few. In the US, for example, public support for gay marriage climbed from 27% in 1996 to 61% in 2016. In line with this development, the US Center for Disease Control showed in 2014 that 70% of new cases of HIV was among the gay, bisexual and transgender community.

The concept of “treatment is prevention” in HIV merits some serious discussion. It is suggested that this be adopted, rather than the concept of “prevention by abstinence” in target groups (homosexuals and bisexuals, intravenous drug users, sex workers and transgenders).

The San Francisco city zero-infection project, which combats the spread of HIV infection, has been put forward by some as a good example. The city uses pre-exposure prophylaxis medication, or PrEP, for people who do not have HIV but who are at substantial risk of getting it to prevent the infection. This is done by taking a pill every day. Two other methods are early detection and reducing stigma. San Francisco receives a lot of funding for this, and there are already concerns over a hike in drug prices, as well as drug resistance.

Is this concept of taking prophylactic pills on a daily basis for those who wish to be involved in high-risk activities cost-effective and suitable for Malaysia? Or would we rather adhere to the concept of prevention by abstinence, as espoused by many religions as a more effective measure to curb the epidemic and keep our society well-informed of the risk?

We have written elsewhere that the religious approach should not be an anathema to the betterment of health among gay, bisexual and transgender people and should not be viewed as a form of discrimination. Unaids Data 2017 shows that in the entire Middle East and North Africa (where most Muslim countries are located), there was reportedly 0.1% prevalence of adult HIV compared with the US as a single country where the prevalence was much higher (0.9% in 2013). Closer to us in Thailand, prevalence was at 1.1%. From a research perspective, the role of religion has been proven to be beneficial.

In a review paper entitled “The Influence of Religion on HIV Risk”, it was reported that 31 out of 51 studies conducted showed that affiliation with religion reduced sexual risk. Another study specifically on transgenders showed that belief in religion helped facilitate risk-reduction in inculcating responsibility to not transmit the virus to others.

In conclusion, highlighting the risk of HIV to the groups most at risk and merging this with religious advice for patients who seek this intervention by choice should not be seen as a form of discrimination.

Universiti Sains Islam Malaysia (Usim) and International Islamic University Malaysia have collaborated with religious agencies in strengthening this effort as a form of prevention where the thin line of advice (an-naseehah) and stigmatisation is spelt out clearly. Under its knowledge transfer programme, Usim has conducted courses for healthcare workers on the front line by inviting transgenders to share how communication should be with the community, so as to encourage them to see the health authorities.

Medical fraternities should not play the blame game. It is our role as medical educators to guide our younger colleagues and work together hand in hand for the health betterment of our nation through the best proven methods.

The views expressed are our views as Muslim medical doctors. They may or may not represent the views of our affiliated institutions.

Dr Rafidah Hanim Mokhtar is head of the Research Academy of LGBT, The World Fatwa Management and Research Institute, Universiti Sains Islam Malaysia.

Dr Samsul Draman is a consultant family medicine specialist with International Islamic University Malaysia.

Dr Anis Safura Ramli is consultant family medicine specialist with Universiti Teknologi Mara.

The views expressed are those of the authors and do not necessarily reflect those of FMT.