ulama - Universitas Sebelas Maret

Marriage Right Protection For Muslimah Infected With HIV/Aids

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THE REPRESENTATION OF MARRIAGE RIGHT

PROTECTION FOR MUSLIMAH INFECTED WITH HIV/AIDS IN SURAKARTA INDONESIA

Argyo Demartoto

[email protected] Siti Zunariyah

[email protected]

Department of Sociology, Universitas Sebelas Maret, Surakarta, Indonesia

ABSTRACT Mudzakarah Nasional Ulama (National Discussion of Islamic Scholars) about HIV/AIDS Transmission Overcoming dated November 30, 1995, states that HIV/AIDS is a common hazard (al-dharar al-‘Am) potentially threatening everyone regardless sex, age, and profession, including muslimahs (Moslem Women). This research aimed to study the marriage right protection for HIV/AIDS-infected muslimahs in Surakarta Indonesia. This qualitative with exploratory approach was conducted on HIV/AIDS-infected muslimahs, their partner, husband and other family member, Religious Affairs Office of Pasar Kliwon Surakarta, Program Manager of Surakarta City’s AIDS Commission, and SPEK HAM NGO as the facilitator of women with HIV/AIDS. Data collection was conducted using observation, in-depth interview, and documentation, while data validation using data source triangulation, and data analysis using interactive analysis model. Moslems are obliged to attempt to prevent HIV/AIDS using various methods. There is no special treatment for HIV/AIDS-infected muslimahs wanting to get married; they should obligatorily undertake medical test in local Public Health Center including Voluntary Counseling and Testing. HIV status is confidential in nature. Marriage contains not only advantages but also some mafsadah (hazards) including bad character of wife, parents in law, and new family; forgetting God, secular pleasure and etc. The openness to the partner is very important to a husband-wife couple, one of which is infected with HIV/AIDS thereby not harming each other. They still can make sexual relation with safe

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sexual behavior by using condom. Pregnancy decision is joint decision, because their right does not change due to HIV infection. Pregnant muslimahs with HIV/AIDS should be educated about their pregnancy discontinuation or continuation due to risk of mother-to-child HIV/AIDS transmission. Delivery with section caesarian should be conducted carefully with self-protection apparatus. Thereafter, muslimahs can be recommended to choose contraceptives to prevent the next pregnancy.

Keywords: muslimahs infected with HIV/AIDS, marriage right, sakinah (peaceful) family INTRODUCTION

HIV/AIDS global situation reveals 35 millions people living with HIV in the world up to 2017, but 19 million of them do not know their HIV-positive status.1 HIV prevalence rate in most Asian countries is still low, less than 1%, but in Thailand and North Indian, while in Asia Pacific there are 350 thousands new people infected with HIV and about 64% of them are males.2 There are 5,425 HIV cases and 1,719 AIDS cases in Central Java up to 20173. There are 2857 HIV/AIDS cases in Surakarta consisting of 974 HIV, 1,883 AIDS cases, and 701 death per December 2018. By sex, there are 214 people infected with HIV/AIDS consisting of 61 (53%) males and 54 (47%) females in HIV cases and 149 (70%) males and 65 (30%) females in AIDS cases during January-December 2018.4

Indonesian Islam Scholar Chamber (MUI) also cares about AIDS because among people living with HIV/AIDS (PLWHA) there are Muslims.5 Ulama (Islam scholar), as the heir of prophecy treatise, attempts to bring God’s mercy into reality in universe, and assume its main duty and

1 UNAIDS. 2014. The Gap Report. Geneva, Switzerland: UNAIDS 2 UNAIDS. 2013. HIV in Asia and the Pasific. UNAIDS Report 2013.

Bangkok, Thailand: UNAIDS 3 Info DATIN Pusat Data dan Informasi Kementerian Kesehatan Repuvlik

Indonesia. 2018. Situasi Umum HIV/AIDS dan Tes HIV. Tes HIV dan HIV Positif Berdasarkan Laporan SIHA Tahun 2013-2017. Jakarta: Info DATIN Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia.

4 Komisi Penanggulangan AIDS Kota Surakarta. 2018. Kasus Desember 2018 Laporan Kasus HIV AIDS di Solo Raya. Surakarta : Komisi Penanggulangan AIDS Kota Surakarta

5 Global Burden of Disease Health Financing Collaborator Network. 2018. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995-2015. The Lancet. 391(10132: 1799-1829)


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role. Ulama serves to give guidance, counseling, and role model to the community according to Islam religion tenets and values to Islam community’s resilience in dealing with global civilization and cultural challenge; and to do amar ma’ruf nahi munkar to build and to protect the life of sakinah (tranquil) family replete with mawaddah warohmah (affection and blessing). Therefore, Indonesian Islam Scholar Chamber stipulates Mudzakarah Nasional Ulama (National Discussion of Islamic Scholars) about HIV/AIDS Transmission Overcoming dated 7 Rajab 1416 or November 30, 1995 AD. Ulamas see HIV/AIDS dissemination as common hazard (al-dharar al-‘Am) potentially threatening everyone regardless sex, age, and profession. Meanwhile, recalling the hazard of HIV/AIDS, ulamas oblige all parties to take preventive measures in many ways either individually or collectively, from religious, cultural, social, or health aspect.6

HIV/AIDS becomes a health challenge and affects social, economic, legal, psychological, and religious life, including marriage within community.7 For that reason, Republic of Indonesia’s Ministry of Health released Circular No. GK/MENKES/001/I/2013 containing an appeal to improve early attempt of detecting and preventing HIV transmission from mother to children including the prospect bride/bridegroom.8 Prospect bride and bridegroom are required obligatorily to take VCT (Voluntary Counseling and Testing) in order to recognize its HIV status as a condition for the publication of marriage permission by the local Public Health Center (Puskesmas). It is intended to prevent and cope with HIV/AIDS, because there is an indication that a prospect bride and a prospect bridegroom or a prospect couple of bride-bridegroom and husband-wife develop HIV/AIDS, for example the case in Surakarta, Indonesia9. This public health phenomenon becomes more complex when it is associated with the fulfillment of marriage protection rights, moreover when one of or both bride-bridegroom who will get married are diagnosed with HIV-positive. This research aims to study the marriage protection rights for Muslimahs infected with HIV/AIDS in Surakarta Indonesia. 6 Majelis Ulama Indonesia.2011. Himpunan Fatwa MUI. Jakarta: Erlangga

7 Peraturan Menteri Kesehatan Republik Indonesia Nomor 21 Tahun 2013 Tentang Penanggulangan HIV/AIDS

8 Surat Edaran Menteri Kesehatan Nomor GK/Menkes/001/I/2013/Tentang Layanan Pencegahan HIV dari Ibu ke Anak

9 Peraturan Daerah Kota Surakarta Nomor 12 Tahun 2014 Tentang Pencegahan dan Penanggulangan Human Immunodeficiency Virus dan Acquired Immune Deficiency Syndrome.


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LITERATURE REVIEW

Regulation, Condition, and Objective of Marriage

Article 1 of Republic of Indonesia’s Law Number 1 of 1974 about marriage states that marriage is a material and spiritual bond between a man and a woman as husband and wife aiming to create happy and everlasting family or household based on the belief in the divinity of God. Article 2 (1) mentions that the marriage will be legitimate when it is conducted according to individual religious laws and believes. The requirements of marriage are, among others: bride and bridegroom’s approval, 21-year age and parents’ permission.10 Marriage is a way that Allah chooses to be human’s way to make sexual intercourse legally between man and woman, and a way to maintain descent. 11,12,13

Quran surrah Al-Baqarah verse 187 states that man and woman are like a suit, meaning the one needing another. It means that it has been Allah’s qadrat and iradat that human beings are created to have mate and to make relation between man and women. Some surrahs explain marriage: surrah Ad-Dukhan verse 54 and surrah At-Takwir verse 7 mentioning that living in pairs and living in mates are instinct of all Allah’s creatures, including human beings. Surrah Az-Zariyat verse 49 states that it is from Allah’s creatures are created in pairs that human beings proliferate from one generation to the next. Meanwhile, Surrah An-Nisa verse 1 mentions that Islam organizes human beings in living in mates through marriage the stipulation of which is formulated in the form of rules called marriage law.14

Islam guides its community to elect prospect bride/bridegroom with certain characteristic criteria. In choosing prospect bride, the prospect

10 Undang-Undang Republik Indonesia Nomor 1 Tahun 1974 Tentang

Perkawinan 11 Katz, June S., and Ronald S. Katz.1978. Legislating social change in a

developing country: The new Indonesian marriage law revisited. The American Journal of Comparative Law 26(2): 309-320.

12 Soewondo, Nani. 1977. The Indonesian Marriage Law and its implementing regulation. Archipel 13(1): 283-294.

13 Saleh, Saneya.1972. Women in Islam: their status in religious and traditional culture. International Journal of Sociology of the Family. 2(1) : 35-42.

14 Departemen Agama Republik Indonesia. 2010. Al-Qur’an dan Terjemahan. Bandung: CV Diponegoro

15 Shomad, A. 2017. Hukum Islam: Penormaan Prinsip Syariah dalam Hukum Indonesia. Jakarta : Kencana


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bridegroom should choose a religious woman having noble character. He should choose a woman based not only on her beauty, but also based on her noble character and religiosity. Muslimah to marry should have affection, because affection between husband and wife will support the household life sustainability. In addition, she should be able to produce descent for civilization and wealth purposes. A woman should choose a prospect pious husband with noble character in order to be able to treat her well and when he will divorce her later he will do so well.15

Before two individuals with different sexes enter into marriage stage, they should surely find out first the definition of marriage, because a couple of husband-wife will cooperate difficultly when they do not have the same idea and direction in understanding marriage. Therefore, both of them should absolutely determine their mutual objective first. The key is mutual trust or shared philosophy. It does not mean that prospect husband and wife should always have shared thought or madzhab. But they should have an agreement first in the term of basic spiritual and moral values becoming the starting point and give a clear target of any thing they will do.15

The objectives of marriage are to obtain and to maintain descent, to fulfill human sexual passion or need and to express their affection or love, to comply with religion’s call (demand), to take care themselves from evil and damage, to grow sincere responsibility for accepting right and obligation, and to obtain rightful (halal) wealth, to build household in order to create composed or tranquil community based on love and affection. If the conditions have been fulfilled, the marriage is legitimate and results in the presence of any right and obligation as husband and wife. The prospect bride is rightful (halal) to be married by the man who wants make her his wife. So, the woman is not the one forbidden to be married either temporarily or forever, and the wedding rite (akad nikah) should be attended by witnesses.16,17,18

15 Basyir, Ahmad A. 2014. Hukum Perkawinan Islam. Cetakan XIII.

Yogyakarta: UII Press. 16 Bedner, Adriaan, and Stijn Van Huis. 2010. Plurality of marriage law and

marriage registration for Muslims in Indonesia: a plea for pragmatism. Utrecht L. Rev. 6 : 175.

17 Jones, Gavin W., Chee Heng Leng, and Maznah Mohamad, eds. 2009. Muslim-non-Muslim marriage: Political and cultural contestations in Southeast Asia. Institute of Southeast Asian Studies.

18 Toyota, Mika. 2008. Editorial introduction: international marriage, rights and the state in East and Southeast Asia. Citizenship Studies 12.(1): 1-7.


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Premarital check up

Some supporting documents required to deal with marriage affairs are: Electronic Identity Card, Family Card, recommendation from Neighborhood Association (RT) and Citizen Association (RW), and BPJS (Social Insurance Organizing Agency) card or other health insurance if any. All of documents were duplicated in 2 copies and submitted to the local Puskesmas along with the original document for Premarital check up. Premarital check up is conducted to know condition, risk, and health history the couple has. Before getting married, this attempt of preventing and dealing with can be taken as early as possible, particularly when the couple wants to have descent, as it highly affects the reproductive health of both man and woman.

The advantage of premarital check up for prospect bride-bridegroom is that it gives information on the couple’s health status; identifies infectious disease like hepatitis B and HIV/AIDS; detects disease/genetic disorder, such as sickle cell anemia, thalassemia, hemophilia. In addition, it is intended to prevent the couple from blaming each other later. Premarital check up generally focuses on infection affecting reproductive health including minimizing congenital disease likely to be decreased again. It starts with a series of blood examination such as Hb, hematocrit, leukocyte, thrombocyte, erythrocyte, and blood deposition rate, TORCH and HIV tests. In addition, some health vaccines are recommended for: Human Papiloma Virus, Hepatitis B, Mumps Measles Rubella, Varicela, Pertussis, and Diphteria. Medical check up can be conducted in hospital, Public Health Center or closest health clinic. Meanwhile, premarital check-up fee is dependent on how many tests to be taken.19

Considering the Minister of Health’s Circular GK/Menkes/001 /I/2013, HIV test is obligatorily undertaken by prospect bride-bridegroom.20 Voluntary Counseling and Testing (VCT) is a two-way conversation process between HIV/AIDS counselor and client. VCT consists of three stages: HIV pretesting counseling, HIV testing, and HIV post-testing counseling. The principles used in VCT are: client’s informed consent, confidentiality, no discrimination, and guaranteed quality. The advantages of VCT are reducing HIV-infected risky behavior, helping an individual accept his/her HIV status and leading PLWHA to the needed service. At community level, it can break the HIV transmission chain. 19 Lynn P. Buckner and Connie J. Salts. 1985. A Premarital Assessment

Program.Family Relations 34(4): 513-520 20 Surat Edaran Menteri Kesehatan op.cit.


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HIV / AIDS

Human Immunodeficiency Virus (HIV) is a virus impairing body immunity system, by infecting and destroying CD4 cell. The larger the number of CD4 cell destroyed, the weaker is the body immunity, and the more vulnerable is the body to various diseases. HIV infection not managed immediately will develop into serious condition called Acquired Immune Deficiency Syndrome (AIDS). AIDS is the last stage of HIV virus infection. At this level, body immunity to resist infection has vanished completely. There has been no drug to cure HIV/AIDS until today, but there has been a drug to decelerate the disease development and can improve the patients’ life expectancy, antiretroviral (ARV). 21,22,23

HIV transmission occurs when an infected individual’s blood, sperm, or vaginal liquid enter into others’ body. HIV infection can occur through either vaginal or anal sexual intercourse. Despite scarcity, HIV can also be transmitted through oral sex. However, the transmission through oral sex can occur when there is an opened wound in the patient’s mouth, e.g. bloody gum or oral ulceration (sprue). Sharing syringe use with HIV patients is one of ways that can make an individual infected with HIV. For example, using syringe jointly during tattooing or injected drug use. HIV transmission may occur when an individual receive blood donor from HIV patients. In addition, HIV can transmit from pregnant women to the infant she contains. HIV can also be transmitted during delivery process or through breastfeed during breastfeeding process. HIV cannot be transmitted through eating equipment, clothing, towel, handkerchief, toilet used jointly, cheek kissing, hand shaking, living at the same house along with HIV/AIDS patients, mosquito biting, and other social relation. 24,25,26

22 Weiss Robin A. 1993. How does HIV cause AIDS. Science. 260 (5112): 1273-9.

23 Douek Daniel C, Roederer Mario, Koup Richard A. 2009. Emerging Concepts in the Immunopathogenesis of AIDS. Annual Review of Medicine. 60: 471-84.

24 Sepkowitz Kent A. 2001. AIDS – the first 20 years. The New England

Journal of Medicine. 344 (23): 1764–72. 25 Krämer Alexander, Kretzschmar Mirjam, and Krickeberg Klaus (eds). 2010.

Modern infectious disease epidemiology concepts, methods, mathematical models, and public health (Online-Ausg. ed.). New York: Springer. p. 88.

26 Kirch Wilhelm (ed). 2008. Encyclopedia of Public Health. New York: Springer. pp. 676–77.


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Republic of Indonesia’s Minister of Health has launched and implemented HIV/AIDS prevention with social campaign of ABCDE: A (Abstinence), the absence of risky sexual intercourse when the partner is known to develop sexually transmitted disease; B (Be Faithful), being loyal to the partner (not changing sexual partner); C (Condom), wearing condom in risky intercourse; D (Drugs), avoiding drug misuse; E (Equipment), the availability of sterile general equipment.27

METHOD

This explorative research was taken place in Surakarta Indonesia, because some prospect brides-bridegrooms were found infected with HIV around the wedding time. Data and information used in this study included meaningful subjective perception coming from 2 key informants: Program Manager of Surakarta AIDS Commission (A1) and administrative division of Religion Affairs Office of Pasar Kliwon Sub District of Surakarta (A2); 8 main informants: not married HIV/AIDS-infected muslimahs and their partners (B1 and C1, B2 and C2), and married HIV/AIDS-infected muslimah and their husbands (B3 and C3, B4 and C4). In addition, data was also obtained from 5 supporting informants: C1’s mother (D1), a religion leader/Islamic scholar (D2), clinician in VCT clinic of Surakarta Dr. Moewardi Hospital (D3), VCT counselor in Puskesmas Manahan Surakarta (D4) and facilitator of women with HIV/AIDS from SPEK HAM NGO (D5). Data collection was carried out using observation, in-depth interview, and documentation, while data source triangulation was used to validate the data. Data analysis was carried out using an interactive model of analysis encompassing data collection, data reduction, and conclusion drawing. 28,29

27 Peraturan Menteri Kesehatan Republik Indonesia op.cit 28 Schwaiger, Manfred and Otto Opitz (eds). 2003. Exploratory Data Analysis

in Empirical Research: Proceedings of the 25th Annual Conference of the Gesellschaft für Klassifikation e.V., University of Munich, March 14–16, 2001. Verlag Berlin Heidelberg: Springer.

29 Creswell, John W. 2013. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 4th ed. London, United Kingdom: Sage Publications Inc.


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RESULT A1 stated that:

“Surakarta government is attempting to suppress HIV/AIDS and TBC transmission rate in Surakarta. It is intended to achieve zero new HIV and to attempt to realize zero AIDS-induced death, and no discrimination against AIDS. It is accomplished, among others, by obliging the prospect bride-bridegroom to undertake HIV/AIDS and TB tests for free. The test also applies to the young family who is undertaking a program to have baby. As the preliminary step, through People Welfare Division of Surakarta Local Secretary, the Surakarta City Government gave an education themed: Facilitation in Health Sector related to TB and HIV/AIDS diseases for Prospect Bride-Bridegroom and young family in Balai Tawangarum of Kompleks Balai Kota (Tawangarum Room of Town Hall Complex), on Tuesday (8/5/2018). Such activity presented three keynote speakers from Health Office, Surakarta AIDS Commission, and health observer from Solo dr. Oen Hospital”.

A1 added that:

“Using VCT, a not-married individual’s HIV status can be recognized, so that her child/descent is expected to be healthy as well, because the objective of creating a family is to have good and healthy descents. If the result of HIV test of one of prospect couples is positive, the marriage will be continued or instead discontinued. Generally, the prospect bride-bridegroom stated that they will continue it. So it does not become a matter when one of them is HIV-positive, because there will be facilitation from clinician and Surakarta AIDS Commission. Many children become their parents’ HIV/AIDS victim so far; therefore, taking HIV test as early as possible will save the children. HIV/AIDS can be transmitted from HIV-infected pregnant women to the infant contained or through blood transfusion”.

The Protection of Marriage Right for HIV/AIDS-Infected Muslimah

A2 and D2 revealed that


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“In Islam law, marriage is sacred as it contains both vertical and horizontal values. Marriage is an attempt to create civilized human life far away from uncivilized practice. A marriage legality is mentioned in Quran Surrah Ar-Rum verse 21 that marriage contains not only advantages but also disadvantages or hazard (mafsadah) that should be taken into account. Therefore, marriage should be prepared well and they should be sure with their choice of getting married, as they will deal with marriage hazard or risk later”.

Muslimahs who want to get married should be able to accept their husband, parents in law, and new family’s bad characteristics of likely ignoring Allah, loving secular or profane life, and even tending to ignore an attempt of earning living rightfully, so that they can take any illicit ways to earn living and bravely take the risk of sin over their incapability of implementing household right and obligation.

D2 said that:

“Those who want to get married should prepare themselves and be able to safeguard themselves from marriage risk. Similarly, those who want to marry PLWHA should know the risks.

A2 stated that:

“HIV/AIDS-infected Muslimahs who want to get married will not get specific treatment, but they should obligatorily take HIV test despite their confidential HIV status. VCT is conducted with the corresponding one’s informed consent along with counseling (giving complete information) before and after test. Moreover, the result of test should be confidential. There is only an obligation to report HIV/AIDS case within community. The report should include sex and age only, without other identities. HIV status is confidential to others but the corresponding one and clinician or VCT counselor, and PLWHA can decide another people (including family) they want them knowing their disease status”.

A2 added that:

“HIV/AIDS-infected muslimahs (prospect brides) who want to get married should undertake medical check up in local hospital


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or public health center, including immunization, and HIV test. It is intended to find out whether or not there is HIV in their body”.

B1 and C1 revealed that they are fellow Injected Drug Users (IDUs) who have established intimate relationship since they still studied in a private university in Surakarta. Two weeks around their wedding day, after they attended VCT in Puskesmas Sangkrah Surakarta as one of requirement to get marriage recommendation letter, C1 should accept a bitter reality that his prospect wife (B1) is HIV-positive. The news started with a deepest apology from B1 making him confused. He was so surprised, stressed, and depressed for hearing the news. However, C1 tried to digest B1’s statement at that time. Before approaching C1 bravely, B1 ensured that she was HIV-negative, but the result of VCT around the wedding said the opposite. C1 cannot make decision directly, whether or not their wedding will be continued. He preferred to calm down his mind and to inform his beloved mother (D1) about this problem. Meanwhile B1 expected that C1 will not cancel their marriage, recalling that her parents were sick. Surprisingly, his mother (D1) instead stated that she has no problem with C1’s decision to marry B1 (a HIV-infected Muslimah), even she convinced him that there must be drug for any disease.

Amid uncertain situation, C1 stepped into the marriage stage with Bismillah capital only. He thought that if they are destined to be a couple (mate), the marriage ceremony (akad nikah) will occur, but if God does not permit it, it will not occur. Eventually, the marriage ceremony was implemented. In the first five months, the marriage seemed to be very happy. HIV did not inhibit them to live in a household. B1 routinely consume ARV, the drug to suppress the number of HIV virus and to improve her body immunity. They always use condom in their sexual intercourse, so that B1 was not pregnant and C1 was not infected with HIV. However, B1 felt less fortunate because she cannot enjoy the beautiful household life just like other couple’s.

D3 said that since ARV has been circulated in Indonesia, many PLWHA consume it to increase their CD4 level. Generally, 60% of PLWHA want to get married, 74% of HIV/AIDS patients want to get married with those HIV-negative, while the rest of them want to get married with the one not developing HIV/AIDS at all. In relation to the fulfillment of an individual’s marriage right, a HIV-infected muslimah deciding to get married should be recommended to consume ARV long before she gets married, but it does not mean that she can get married smoothly with her beloved one. Furthermore, D3 said that getting married


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is good and recommended by religion, but for the sake of goodness for both parties, prospect husband and wife are required obligatorily to undertake medical check up including VCT before marriage. If the result is positive, it takes 3-6 months for follow-up treatment before marriage. So, do the test and postpone the marriage first. The prospect bride-bridegroom should postpone their marriage to prevent the transmission of HIV to their partner. Having gotten married, the couple of husband-wife is obliged to use condom, but when a wife wants to be pregnant she may put off the condom and may not use it during sexual intercourse as long as the wife is still on fertile period. Meanwhile, the HIV-positive pregnant woman is recommended to consume ARV in her first day pregnancy, as it can avoid the baby from being infected with HIV.

Many High Risk Men (HRM) are found widely within community, the men who make sexual intercourse and are risky of being infected with HIV due to sexual intercourse without condom with changing women in and out of marriage, for example, with female sexual workers (FSW) or transsexuals. There are two types of FSW: direct FSW (those existing in prostitution localization or on the street) and indirect FSW (those serving as massager, beauty salon worker, student, college student, and etc). There may be bisexual husband, in addition to making sexual intercourse with his wife, he also make it with men called MSM (Men who have Sex with men). The prospect bride can be infected with HIV before marriage, e.g. due to injected drug use, being FSW, and blood transfusion.

If the prospect wife is infected with HIV/AIDS, will the marriage plan be cancelled? Does it inhibit an individual’s right to create family? Marriage remains to be a happy moment, so it is to 2 prospect bride-bridegroom coming from Semanggi, Pasar Kliwon Surakarta (B1 and C1 and B2 and C2) diagnosed with HIV-positive after attending VCT. B1 and B2 were diagnosed with HIV-positive before the marriage ceremony on April 2018. However, A2 said that they kept getting married. They belong to the Most At Risk Populations (MARPS) to be infected with HIV. B1 is an IDU, while B2 is a former FSW. They are 22 (B1) and 35 years old (B2). They have been graduated from Senior High School. They were detected to be HIV-positive after taking medical check up around their wedding.

A1 said that:

“They who want to keep getting married are required obligatorily to use condom during sexual intercourse in order not to transmit HIV to their partner, and comply with ARV consumption. Using


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condom does not mean that they many not have descent, as condom can be put off with a very tight certain condition. The wish to have descent should be postponed first until 6 months after marriage. When ARV therapy has been undertaken for 6 six, condom can be put off during sexual intercourse as long as the wife is still on fertile period, but thereafter, it should be used again”.

The Protection of Right for HIV/AIDS-Infected Wife in Muslim Family

D2 said that:

“Every family craves for a Sakinah, mawaddah and warohmah family. Many people yearn for household adorned with beauty, happiness, and blessing. However, some families are replete with anxiety, restlessness, and sorrow, and even often ended with divorce. Biological relation is a need that cannot be abandoned by every normal one, so that it is very important to find out right and healthy ways. Surrah Al Baqarah verse 223 mentions that everyone must have defect (shame), nobody is perfect, even somebody can bring disaster to others, but in the end there will be an infinite lesson from it”.

D1 argued that:

“The objective of research is to preserve descent and to fulfill sexual passion that will result in hazardous disease when it is not expressed well; meanwhile all of these can be achieved in a marriage. When a couple of husband-wife have those shames, both of them may fasakh nikah (divorce), either before or after sexual intercourse”.

Everyone defines happiness in marriage varyingly.

B3 argued that:

“Happiness in marriage will be achieved when all wishes can be brought into reality”

B4 said that:


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“Happiness is viewed from tranquility, safety, and being free of restlessness resulting from various life problems”.

Meanwhile B1 and B2 stated that:

“Happiness is relative in nature, dependent on every individual or human being. The openness to partner is very important to prevent husband and wife from harming each other, so is to a couple of husband-wife, one of which develops HIV/AIDS”.

This statement is confirmed by their own partner.

D3 stated that:

“HIV/AIDS-infected muslimahs should not stop making sexual interaction, but they only need to make it safely. Vaginal and oral sexes can result in blister or wound on skin or vital organ membrane. The safe sex means avoiding HIV-infected blood, sperm, or vaginal liquid from entering into the partner’s body through such blister or wound. It means that they should use condom any time they make sexual intercourse. In oral sex, despite small risk, it should be considered that mouth and gum wound or inflammation can be the entrance for HIV”.

Meanwhile D4 said that:

“When making sexual intercourse with their partner, PLWHA should use condom. Condom is usually equipped with lubricant. However, when PLWHA want to and lubricant to prevent wound from occurring inside vagina, they can choose the one appropriate to the condom material, to prevent the condom from breaking. For latex-made condom (found widely in Indonesia), PLWHA should use water-based specific lubricant. Never use lubricant containing baby oil or body moisturizer, as it can damage the condom”.

D5 stated that:

“Using condom correctly belongs to a safe sex. The correctly used condom is effective to avoid sperm, vaginal liquid, or blood from entering into body during sexual intercourse. So, it is intended not only to avoid pregnancy. Virus cannot pass through or penetrate the good-condition condom. Pay attention to the expired date included in the condom packaging. When wrapping


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it, be cautious to prevent condom from being torn. Use the condom when erection occurs. After ejaculation, put off the condom when the penis is still tense to avoid sperm from spilling. Tie the used condom and dispose it in waste basket, and use new condom in any sexual intercourse. Making safe sex has some advantages: protecting ourselves from sexual transmitted infection such as gonorrhea (GO) or syphilis that will affect our health and protecting our sexual partner from HIV. If the partner is infected with HIV as well, the safe sex can avoid repeated infection from occurring with different HIV type”.

B3 and B4 always discussed their pregnancy with their husbands. B3 and B4 worry about their babies’ risk of being infected with HIV that will affect their health.

D3 said that:

“HIV-infected muslimahs should unnecessarily feel failed or imperfect. Despite some points to be considered maturely during pregnancy planning, the baby’s risk of being infected with HIV is below 30 percent. This risk can be mitigated by complying with ARV consumption. HIV-infected muslimahs should find more information and consider whether or not they will get descent.

The pregnancy decision is the one made by HIV-infected muslimahs along with their partners. They should not be forced to make a decision or to take any action, because HIV infection does not affect or change their right. All babies born from HIV-infected mother have HIV antibody. As such, it does not mean that all babies have been infected with HIV. The baby’s HIV status can be seen in their 18-month age.

A1 and D5 argued that:

“HIV-infected and pregnant Muslimahs should be educated about their pregnancy, including the continuation and the discontinuation of pregnancy due to the presence of HIV/AIDS vertical transmission risk from mother-to-baby of 25-45%. Preliminary examination should be undertaken by the pregnant women. The treatment for HIV-infected pregnant women is not different from that for non-pregnant women, because ARV has a very little ability to harm the fetus”.

D3 stated that:


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“Delivery help should be done cautiously and should apply universal alertness and complete self-protecting apparatus. Baby mucosa suction cannot be done using mouth suction pump, but it should be done using suction pump catheter connected to suction pump machine. All fetuses should be treated just like non-infected individual during delivery because vertical transmission is only 25-45%. Preventive measure should be taken to avoid HIV infection transmission from mother to baby. Mother should be recommended to avoid her baby from being affected with her body secretion. After delivery, the HIV-infected Muslimahs are recommended to choose contraceptive they prefer to prevent the next pregnancy from occurring. Contraceptive should be used as lately as 4 weeks after delivery. The contraceptive method recommended is condom as it gives protection from HIV infection and Sexually Transmitted Disease”.

DISCUSSION

Generally, Muslims consider that HIV/AIDS is God’s punishment for His slaves as the reward for the deed breaking the religious tenets, like disloyalty to wife or partner, syringe use, and etc. 30,3132 However, the reality shows that HIV/AIDS affect not only Muslim making sex intercourse breaking the religious rule. Even a housewife can be infected with HIV because she makes sexual intercourse with her husband infected with HIV first and the innocence baby can be infected with HIV/AIDS as well. Due to unsterile syringe, a good person can be infected with this virus. That is why an assumption that HIV/AIDS is God’s curse is not fully correct. Muslimahs and members of family infected with HIV/AIDS are in fact not only those doing some deeds in contradiction with religion, but also those do not know it and those who are innocence. It is more appropriately called calumny (ordeal). If an individual is infected with

30 Bennett, Linda R. 2007. Zina and the enigma of sex education for Indonesian

Muslim youth. Sex Education 7(4): 371-386. 31 Takyi, Baffour K. 2003.Religion and women's health in Ghana: Insights into

HIV/AIDS preventive and protective behavior. Social science & medicine 56(6): 1221-1234.

32 Jacubowski, Nadja. 2008.Marriage is not a safe place: Heterosexual marriage and HIV‐related vulnerability in Indonesia. Culture, health & sexuality 10(1): 87-97


383

HIV/AIDS or develops opportunistic infection due to some deeds breaking the religion’s guidance, it is the consequence of his/her deed. However, when the one infected comes from the actually innocence, it is Allah’s ordeal to test his/her quality of creed.33,34,35

Viewed from any religion’s point of view, the best attitude to anyone infected with HIV/AIDS is to keep cultivating and maintaining patience and sincerity in undertaking it. It is indeed not easy to accept sincerely the virus gradually but surely undermining PLWHA’s health. But, accepting it angrily or declining it, moreover taking negative action, will change nothing. It instead will worsen the PLWHA’s condition and make them sad. Otherwise, accepting the condition sincerely and patiently will instead generate motivation to keep undertaking medication and attempting to get healing. On the other hand, the acceptance to the existing condition will build positive mind and energy needed by every PLWHA to improve the quality of life in order to be more beneficial to fellow human beings and to life universe.

Meany measures can be taken to build patience and sincerity in accepting HIV/AIDS that has entered into blood, one of which is to revert to God’s destiny and to have good prejudice to God. How severe the feeling of being infected HIV, even when it has reached AIDS stage with many infections, Islam forbids any attempt of ending life, either wildly (suicide) or medically (euthanasia).

HIV/AIDS is a deadly disease and even it is considered as Allah’s curse or punishment, but when it is managed correctly with consultation with experienced clinicians, the disease can be prevented from transmitting to others. At certain stage, untreated HIV/AIDS will result in opportunistic infection (the disease resulting from decreased body immunity) such as Tuberculosis (TB) and Hepatitis. Fundamental principles related to health in Islam law are as follows: Islam religion aims to maintain religion, spirit, healthy mind and property of human being. Body segment and spirit of human beings belong to Allah given be utilized rather than misused or 33 Gray, Peter B. 2004.HIV and Islam: is HIV prevalence lower among

Muslims?. Social science & medicine 58(9): 1751-1756. 34 Moosa, Najma. 2009.Polygynous Muslim Marriages in South Africa: their

potential impact on the incidence of HIV/AIDS. Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad 12(3).

35 Hoel, Nina, Sadiyya Shaikh, and Ashraf Kagee. 2011 Muslim women's reflections on the acceptability of vaginal microbicidal products to prevent HIV infection. Ethnicity & health 16(2): 89-106.


384

traded. Respect and human right He has given includes all human beings, regardless race and religion. We may not disparage human degree, either the alive or the die one. If there is a conflict of interest between the alive and the die, the interest of the alive one should be prioritized. The law of marrying HIV/AIDS patients is mubah, but some very prudent attempts should be taken to help HIV/AIDS patient prevent and cope with it.

Those married should obligatorily protect their partner or husband-wife from HIV transmission. In certain condition, condom can be used in sexual intercourse. Every HIV/AIDS patient, including HIV/AIDS-infected muslimah should inform her health condition to those interested. The prospect bride who will get married should have her health status examined. Ulama, government, non-government, and community should improve information communication to the public concerning the hazard, the cause, and the way of coping with HIV/AIDS in collaboration with all stakeholders.36

CONCLUSION

HIV/AIDS-infected muslimahs who want to get married will not get special treatment; she should take medical check up in local Puskesmas and undertake immunization for the prospect bride, including VCT. HIV test is conducted with the corresponding one’s informed consent along with counseling (giving complete information) before and after test. HIV HIV status is confidential to others but the corresponding one and clinician or VCT counselor, and PLWHA can decide another people (including family) they want them knowing their disease status. Marriage contains not only advantages but also some mafsadah (hazards) to be taken account. The openness to partner is very important to prevent husband and wife from harming each other, so is to a couple of husband-wife, one of which develops HIV/AIDS. PLWHA should unnecessarily stop making sexual relation; more importantly it should be done safely by using condom. Pregnancy decision is joint decision along with partner. Being infected with HIV does not change PLWHA’s right. Pregnant muslimahs with HIV/AIDS should be educated about their pregnancy, treatment, delivery help, and post-delivery.

36 Majelis Ulama Indonesia.2011. Himpunan Fatwa MUI. Jakarta: Erlangga

op.cit


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