Does Muslim religion have an impact on HIV transmission?

How is it that the nations of the Middle East and North Africa appear to have relatively low rates of HIV (see https://blogs.bmj.com/sti/2011/09/19/bringing-to-light-the-hiv-epidemiology-of-%E2%80%9Chidden%E2%80%9D-msm-populations-in-the-middle-east/)? A recent paper in the American Sociological Review – Adamczyk & Hayes  – seeks to demonstrate that the predominance of the Muslim religion in a country may have a macro-level, cultural impact on the sexual behaviour (pre- and extra-marital sex) of its residents.  What do they mean by qualifying religious impact as, to some extent, macro-level and cultural?   They are claiming that the impact of religion is not reducible either to individual affiliation, or to formal restrictions.  In their words, it is, in their words sui generis – unique of its kind.  Behind this is a Durkheimian understanding of the religious group as something more than the sum of its parts (http://asr.sagepub.com.libproxy.ucl.ac.uk/content/77/5/723.abstract).

To test their hypothesis the authors use data from the Demographic and Health Survey (DHS).  Their most interesting findings relate to pre-marital sex.  Muslims are far less likely to report pre-marital sex than Christians/Jews (0.61: 0.77).  This effect is not explained wholly by age of first marriage.  As the proportion of Muslims in a nation increases likelihood of all residents (including non-Muslims) reporting pre-marital sex decreases substantially.  So, for a non-working rural woman, likelihood of premarital sex  is 0.71 where 1% residents are Muslim, 0.61 where 23% are Muslim, 0.28 where 90% are Muslim.  Muslims, however, are not more likely to report pre-marital sex as the proportion of Muslims decreases.  Interestingly the relationship between likelihood of pre-marital sex and percentage Muslim does not seem to be mediated by formal restrictions (exemplified here by restrictions on women’s mobility).

The tentative conclusion of the study is, therefore, that the striking relationship of pre-marital sex and percentage Muslim may not be a matter of individual affiliation (or Muslims would be more likely to report pre-marital sex where percentage Muslim decreases).  It may also not be a matter of formal restriction, for in that case the relationship of pre-maritcal sex to percentage Muslim would be mediated by women’s mobility).  Hence the relationship is likely to be explained by something other than individual affiliation, nor formal restriction – i.e. probably macro-level cultural effect.

To non-sociologists this argument from premises to conclusion might seem tenuous.  However hypothesis of a relationship between religion and behaviour is interesting, and the authors claim that this is the first serious attempt to test such a hypothesis on the basis of international data. The interest of the paper for STI journal readers may go beyond the intriguing question of why certain populations should be less susceptible to HIV epidemics than others. From the angle of sexual health policy, the claims of Adamczyk & Hayes matter because they suggest the existence of other potentially refractory cultural factors (i.e. religion in the sense of Adamczyk & Hayes ) – a “black box”, if you like – that, depending on the policy, could turn out to have negative as well as positive effects. On the face of it, this seems at least plausible, and, if it is the case, would certainly be important for health policy. To the extent it militates against “one-size-fits-all” approaches to health policy, the argument of Adamczyk & Hayes may be additional ammunition in the “armentarium” of the “programme science” based approach  that is a topic of ongoing comment in this journal (see for example Aral & Blanchard: http://sti.bmj.com/content/88/3/157.abstract?sid=a6dd8144-b34c-4bcd-a4b2-0f997ae60fd0). STI journal readers will be interested to know that STI journal continues to run a series on Programme Science, edited by Dr Sevgi Aral.

 

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