Thursday, December 02, 2004

HIV and AIDS in the Ummah

AIDS in Muslim Africa

AIDS in the Middle East

AIDS in South Asia

AIDS in The Islamic Republic (Iran)
HIV Positive Muslims

AIDS on the Muslimat BlogRoll

Please check out AlMuhajaba and Sunni Sister's posts on AIDS.

AIDS: What You Don't Know Might Hurt You

AIDS is an acronym; its letters stand for Acquired Immune Defeciency Syndrome. AIDS is believed to be caused by a virus called HIV. HIV is an acronym for Human Immunodefeciency Virus. There is some controversy over whether or not HIV actually causes AIDS, but mainstream scientists are pretty much in agreement that Acquired Immune Defeciency Syndrome (AIDS) is the result of being infected with the the Human Immunodeficiency Virus (HIV) . Just as one can not get the flu without the flu virus, one can not get AIDS without the HIV virus. After you contract the flu virus you experience the flu, which includes bodily aches, chills, runny nose etc. After you contract the HIV virus and it has sufficiently damaged your immune system, then you experience AIDS.

Unlike the flu virus, the HIV virus can stay in your body for years before it ever turns into full blown AIDS. That means that you could have stopped practicing illicit (haraam) sex, or doing drugs or that you could have had a blood transfusion with tainted blood, ten or fifteen years ago and contracted the HIV virus, but you may not experience any symptoms. This is why it is important to be tested for the HIV virus even if you have not engaged in haraam activities for many years. It is also important to be tested if your husband engaged in haraam sex, even if it was many years ago, or if your partner engaged in mut'a (temporary marriage) with unchaste women. If you or your partner are now or have been engaged in haraam sex or IV (intravenous i.e. shooting up) drug use or if your husband has married someone either in nikah or mut'a that was unchaste in the paste, then it is wise to be tested for HIV.

HIV is contracted through exchange of bodily fluids with an infected person. Theoretically one can contract the virus through something as simple as "french" kissing, which involves the exchange of saliva as one person sticks their tongue or lips into the mouth of another. The most common way that AIDS is contracted is through sex (it does not matter if it is hetero or homosexual sex, even chaste married people sometimes contract or spread HIV because of past activities). HIV is also frequently contracted through intravenous drug use aka shooting up, and blood transfusions from infected blood. Screening in the United States is very good, so contracting HIV through infected blood in a transfusion is rare here. Screening procedures may not be so good in other countries. It is worthwhile to find out about screening procedures in your own country.

In the United States, HIV tests are routinely offered to pregnant women who are being cared for by doctors or midwives. In most other situations a woman interested in being tested would need to request a test from her doctor. The HIV test consists of drawing blood, collecting urine or scraping a small amount of tissue from the mouth. When your body is infected with a virus, in this case HIV, the body produces proteins that are meant to help fight the virus; these proteins are called antibodies. HIV antibodies are what the test looks for. If the HIV antibodies are present in your bodily fluid, then you are diagnosed as being HIV positive.

The HIV virus can stay in your body for weeks or months before you test positive, but during this time you can still infect others. Some people experience flu-like symptoms when they are first infected, but others experience no symptoms at all. Many people don't get tested until they have full-blown AIDS and are experiencing the symptoms of that disease. There are drugs, treatment and lifestyle changes that can be made that can extend your life for many years. There are people alive today that were diagnosed with HIV 15 or 20 years ago. Finding out early can save your life. No one, especially those belonging to conservative communities, wants to find out that they are HIV positive, but like all things in life denial will do nothing but hurt you. If there is the slightest chance that you could have contracted the virus, just get tested.

The HIV virus works by slowly damaging your immune system. It breaks down your body's natural defenses against disease. After a certain amount of damage has been done your body is unable to fight even the most common and simplest of diseases and something as simple as the flu, which healthy people fight off within a number of days, can actually kill you. It is not AIDS that kills anyone, it is the viruses or bacteria that people come into contact with that their immune system can't fight off that kills them. All HIV and AIDS do is break down your defenses --your immune system--enough that the germs have an easy time of taking over. Your body is like those old cities that used to build tall walls around the city to protect from invaders. The walls are your immune system. HIV and AIDS are a battering ram that breaks down all the walls so that the enemy armies (viruses and bacteria) can come in and slaughter the inhabitants of the city.

AIDS has no cure, but there are treatments and lifestyle changes that can be made that will extend your life for many years. It is true that the time of our life or death is fixed, but Allah (swt) also answers du'a and the efforts you take to keep yourself healthy along with the prayers you make are a powerful du'a. It is also true that life is not only about quantity, but about quality. A healthy person is better able to serve Allah (swt) in a myriad of enjoyable ways. Learn more about testing here.

Monday, November 29, 2004

Birth Control and the Muslima Part III

Progestin Based Contraceptives Cont....
Progestin based contraceptives do not contain estrogen. These contraceptives work by thickening the cervical mucous to keep sperm from reaching the egg. They sometimes prevent ovulation as well. There are four types of progestin based contraceptives available: The mini-pill, Depo-provera, Norplant implants and IUDs.

The Mini-Pill aka POPs (Progesterone Only Pills)
Unlike the regular birth control pill, the only hormone that the mini-pill contains is the synthetic hormone progestin, which is made to mimic the natural hormone progesterone. Progestin works by thickening the cervical mucus making it very difficult for sperm to reach the egg. It also keeps the ovaries from releasing an egg. It is 92-99.7% effective when used properly.

Depo-Provera is a shot of the synthetic hormone progestine which is administered into a woman's arm or buttocks every three months. It works by preventing ovulation. There is an increased risk of bone-thinning in women who used Depo-provera so it is not recommended to use it continuously for more than two years. It is 97-99.7% effective. According to Wikipedia, many women stop having regular periods while taking Depo-provera.

Norplant is a long-term progestin based birth control method. The Norplant system can last from two to five years depending on which dosage you choose. The two year system consists of implanting two tubes and the five year system uses six tubes. Norplant is actually a hormone called levonorgestrel (a progestin) that is placed into matchstick sized tubes of silicone rubber. The tubes are inserted into the upper arm during an outpatient surgical procedure. The hormone in the tubes releases into your body slowly over time. Norplant was discontinued in the UK in 1999 and according to the Planned Parenthood website it is no longer available in the United States. There was a class action lawsuit against Norplant which settled in 1999. It is reportedly 99.7% effective.

IntraUterine Devices (IUDs)
There are two types of IUDs one containing hormones and the other without hormones. The only hormone based IUD available to women in the United States is called Mirena. It is a T shaped deviced that is inserted into the uterus through the cervix; a small plastic string hangs out of the cervix and a little into the vaginal canal. Scientists are not completely sure how or why IUDs work. One theory is that they effect how the sperm or egg moves, another theory is that they may cause the egg to move through the fallopian tube too quickly to be fertilized. The hormone (progestin) in the Mirena IUD also thickens cervical mucous which makes it very difficult for sperm to move.

The hormone free IUD contains a small amount of copper. It is believed that in addition to the whatever helps prevent pregnancy in the IUD itself, that the copper changes the conditions in the uterus making it difficult for a fertilized egg to implant. Occasionally the presence of the IUD may abort an attached, fertilized egg making it iffy from a fiqh perspective. If you are uncomfortable with that possibility than I encourage you to do further research on the topic. According to shi'a fiqh once a fertilized egg attaches to the uterus it becomes haraam --excepting of course life threatening circumstances--to discontinue the pregnancy. Of 100 women who use the ParaGard or Mirena, one or fewer will become pregnant during the first year of typical use. Fewer than one will become pregnant with perfect use.

InshaAllah the next post will cover natural abortifacients as well as the details of the surgical abortion procedure and information according to various Islamic schools of thought on the permissibility of abortion. I will also post resources for further research. Bismillah, I hope that my small efforts have been or will be of some help to my sisters.

Thursday, October 07, 2004

Birth Control and the Muslima Part II

In the last entry I described natural birth control and barrier methods. In this post I will (InshaAllah) talk about the various kinds of hormone based birth control, as well as those that require surgical procedures.

Hormone Based Contraceptives

The Pill: A Short History
When most of us think of birth control the first thing that comes to mind is the birth control pill. Though birth control pills have only been around for the last 40 years, hormone based contraceptives have a very long history among womankind. 4000 years ago Egyptians ground up pomegranate seeds and mixed them with wax to form what may well have been the first birth control pill. We now know that pomegrante seeds contain a natural estrogen, so it is likely that this concoction prevented ovulation! There is also recorded evidence that the ancient Greeks used a pomegranate seed based birth control method. It is not a far stretch to assume that Muslims too have been using this hormone based contraceptive for centuries as the famous Muslim scientist Ibn Sina (Avicenna 980-1037) prescribed pomegranate as a postcoital contraceptive.

Unfortunately, much of ancient medical knowledge has been lost or ignored. The modern birth control pill was approved for use throughout the western world in the 1960's. In the U.S. it was approved by the Food and Drug Administration (a federal regulatory body responsible for ensuring the safety of food and drugs for public consumption) in 1960.

Early birth control pills contained much larger doses of hormones than were necessary for regulating periods and preventing pregnancy. The extra hormones caused side effects like thromboembolism (occasionally fatal obstructions of blood vessels leading to the brain, heart, or lungs), which were the subject of much debate. In the 1970's the birth control pill was reformulated with lower dosages of hormones, but controversy of its ethicacy and safety continue today.

Hormone Based Contraceptives II

Your Fertility Cycle
In order to fully comprehend how hormone based contraceptives work, it is best to have a basic knowledge of how female fertility works. Subhanallah, it is a truly beautiful and miraculous process.

When a baby girl is born she has all of the eggs that she will ever need in order to produce children. The eggs are stored in her ovaries, each egg is nestled in a sac called a follicle. At the onset of puberty the body begins to produce hormones that signal the eggs to begin maturation. At the beginning of the cycle the hypothalamus ( a gland in the brain) will secrete a chemical that signals the pituitary gland to produce hormones called Follicle Stimulating Hormone (FSH) and Leutinizing Hormone (LH). This stimulates the follicles (that are holding the eggs) to produce estrogen. As the follicles ripen they produce increasing amounts of estrogen which causes the lining of the uterus to thicken and the cervical mucous to change. The thickening of the uterine lining helps to provide nourishment to the anticipated fertilized egg. The change in cervical mucous makes it easier for sperm to travel from the vagina, through the cervix and eventually to the waiting egg.

Once the estrogen levels reach a certain amount, the pituitary begins to release more leutinizing hormone which triggers ovulation (when the now mature follicle opens and releases the egg). Just before ovulation the follicle (called the corpus luteum after the egg is released) also begins to produce progesterone. Progesterone production will continue and peak five to seven days post ovulation. If the egg is not fertilized the corpus luteum will shrink and stop producing estrogen and progesterone. This will cause the lining of the uterus to shrink and nearby arteries to constrict. The arteries in the uterus then re-open and bleed causing the top of the lining to detach and shed, this is what we call menstruation. This cycle will repeat monthly, pausing only during pregnancy or stopping completely at menopause, when the ovaries stop making estrogens.

If the egg is fertilized, the body continues to produce large amounts of estrogen along with other hormones that help secure the pregnancy and nourish the growing fetus. In fact, in one day a pregnant woman produces as much estrogen as a non-pregnant woman does in three years!

Combined Contraceptives
Hormone based contraceptives currently on the market fall into two catagories: combined and progestin based. They work by interfering with your body's production of estrogen and progesterone.

Combined contraceptives have synthetic forms of the hormones estrogen and progesterone. They basically work by introducing so much estrogen that the body that the body thinks that it is pregnant and stops ovulating. The synthetic progesterone thins the lining of the uterus so that if an egg manages to release anyway, and a particularly determined little sperm manages to reach it, the fertilized egg can not attach to the uterus.

There are three different kinds of combined contraceptives available to American women: The pill, the patch and the ring.

The Pill is taken daily and must be prescribed by a doctor. It is covered by most types of health insurance. There are a variety of possible side effects to long term use of the birth control pill. Please consult your doctor for more information. Of every 100 women who take the pill, eight will become pregnant during the first year of typical use. Fewer than one will become pregnant with perfect use.

The Patch is made by a company called Ortho-Evra. It is a thin, plastic patch that can be attached to the stomach, upper arm, buttocks, or upper torso. It must be reapplied once a week for three out of four weeks. It releases the same kind of synthetic hormones that are in the pill, the hormones are absorbed through the skin and into the bloodstream. The patch is only available via prescription and has similar side effects as the pill. No studies on the efficacy of the patch have been published, yet it has still be approved for use by the FDA.

The Ring also called NuvaRing, is a small flexible ring that is inserted into the vagina for three weeks out of the month and is removed on the fourth week. The ring releases hormones that work the same way as those in the patch and the pill. Like the patch, the ring is a relatively new form of birth control and no studies on its efficacy have been published. The ring is only available via perscription.

Progestin Based Contraceptives
Progestin based contraceptives do not contain estrogen. These contraceptives work by thickening the cervical mucous to keep sperm from reaching the egg. They sometimes prevent ovulation as well. There are four types of progestin based contraceptives available: The mini-pill, Depo-provera, Norplant implants and IUDs.

More on these methods later InshaAllah.

Monday, October 04, 2004

Birth Control and the Muslima Part I

After having done extensive research to determine what method of birth control would be best for my family and myself, I wanted to share my findings. I hope that having a reliable and readily available resource with this information can prove helpful to any Muslim couple trying to understand birth control in Islam.

Is birth control halal?
The short answer, according to the four Sunni madhaahib and the Ithna Asheri Shi'a, is yes. This is based on a number of hadith from both Sunni and Shi'a sources which the Prophet (saawaws) and Imams (as) approved of al 'azl. The question then becomes, under what conditions is birth control halal (permissible) and what kinds of birth control are permissible.

According to the Shi'a madhab (also called Ithna Asheri or Ja'fari) a woman can use any form of halal birth control so long as it does not interfere with the husband's ability be intimate with her. Obviously only abstinance meets that criterion. The only method of halal birth control that the husband can not use without the wife's permission is the withdrawl method and there appears to be a difference of opinion amongst the ulema on this issue. For the exact ruling, you will have to consult your marja. According to the Hanafi madhab the husband can not make a decision about birth control without the wife's consent. According to the Shafi' madhab a wife can not use birth control without the permission of her husband, because children are seen a his right. Unfortunately, I have been unable to find the answers to these questions according to the Maliki and Hanbali madhaahib or the fatawa of the salafi/wahhabi scholars . InshaAllah, if and when I do, I will update this portion of the blog.

All Natural

There are many different methods of natural birth control. For the most part, these methods rely on an understanding of the female reproductive system. All women, regardless of the kind of birth control they ultimately decide to use, should be well acquainted with the general workings of the female reproductive system, as well as how their own unique body works. I can't recommend highly enough Tony Weschler’s, Taking Charge of Your Fertility. These methods may be ideal for muslimat who follow a school of thought that forbids any artificial birth control.

The Rhythm Method
The rhythm method relies on avoiding relations during ovulation. This particular method has become notorious for its failure rate because it traditionally relied on the idea that all women ovulated at the same point in their menstrual cycle. Women were instructed to determine ovulation by charting the days from the last menstrual period.

Fertility Awareness Method
The fertility awareness method (FAM) as described in Tony Weschler's, Taking Charge of Your Fertility is probably the most reliable form of natural family planning available. Basically, Ms. Weschler instructs you to use three major signs in order to determine fertility: cervical fluid, basal body temperature and cervical position. She also instructs you in a variety of secondary fertility signs like breast tenderness, midcycle spotting, or a heightened sense of smell which are less common, but can be helpful predictors of fertility in some women. I used this method for the first several years of my marriage with complete success. The benefit was that within one month of deciding to concieve we were able to do so, because I knew exactly when I was fertile. According to Tony Weschler's work, this method has a 10-12% failure rate.

Lactational Amenorrhea Method
Continuous breastfeeding supresses ovulation. Breastfeeding on demand throughout the day and night stimulates a hormone called prolactin, which in turn suppresses gonadtropin. Gonadtropin is necessary for ovulation. Obviously if a woman does not ovulate, she can not conceive. Of 100 women who use LAM two will become pregnant in the first six months with typical use. Fewer than one (gotta love statistics) will become pregnant with perfect use.

Al 'Azl (Withdrawl)
This method is mentioned in a number of hadith and is considered permissible, with the wife's permission, in all schools of thought. There are differences of opinion within the shi'a ulema and amongst the sunni madhahib regarding whether or not the wife's permission is needed. Please consult your local source of Islamic guidance in order to find out more. Al 'azl involves having the man withdraw from the woman before releasing (sorry for all the euphimisms, trying to avoid the pervert crowd). Of 100 women who use withdrawl, about 27 will become pregnant during the first year of typical use. Four will become pregnant with perfect use. This method is permissible according to the Shi'a and all four Sunni madhaahib.

Barrier Methods

Male Condoms
Male condoms are phallic shaped sheaths that provide a barrier between the husband and his wife's cervix. Most condoms are made from latex rubber. Unfortunately, a growing number of Americans have latex allergies. For those who are allergic to latex there are also condoms made of lamb instestines, these are often called lambskins, and polyurethane(plastic) condoms. According to the FDA, latex is preferable because it's best at preventing pregnancy and protecting against STDs. For those with environmental or animal rights concerns it would seem that latex would be the best choice, because latex rubber comes from a tree. Of 100 women who use condoms, about 15 will become pregnant during the first year of typical use. Two will become pregnant with perfect use. This method is considered permissible by the Shi'a, Hanafi and Shaf'i.

Female Condom
The Female condom is a polyurethane pouch that lines the vaginal canal. The female condom is relatively expensive compared to the male condom and it has a higher failure rate than male condoms. It also has other drawbacks that you can read about in the above link. Of 100 women who use a spermicide 29 will become pregnant during the first year of typical use. Fifteen will become pregnant with perfect use. This method is considered permissible by the Shi'a. I have not been able to find information on other schools of thought.

A diaphragm is a bowl shaped piece of thin rubber that fits over a woman's cervix. The diaphragm holds spermicide in place. You must go to the doctor to be fitted for a diaphragm so if you are short on cash, it may be a pricey matter. The good thing is that once you get one you won't need to continually replace it like condoms, which can only be used once. The diaphragm must stay in place for at least six hours after intimacy, but not longer than 24 hours. Of 100 women who use a spermicide 21 will become pregnant during the first year of typical use. Five will become pregnant with perfect use. This method is considered permissible by the Shi'a. I have not been able to find information on other schools of thought.

Cervical Cap

The cap is a soft rubber cup that fits over the cervix. It is smaller than the diaphragm, but still requires a visit to the doctor to ensure that it fits properly. It is also reusable. Of 100 women who use the cervical cap and have not given birth 16 will become pregnant during the first year of typical use. Nine will become pregnant with perfect use. Of 100 women who have given birth and use the cervical cap 32 will become pregnant the first year of typical use. Twenty-six will become pregnant with perfect use. This method is considered permissible by the Shi'a. I have not been able to find information on other schools of thought.

The Sponge
The sponge is a soft disk-shaped device made from polyurethane foam. Like cervical caps anddiaphragms this device fits over a woman's cervix in order to prevent sperm from entering the uterus; however , unlike those two devices the sponge also absorbs sperm and gradually releases a spermecide over a 24 -hour period. The sponge must be wettened with water before it is inserted in order for the spermicide to be activated. It should be left in for 6 hours after intimacy and removed by 24 hours at the latest. You do not need a prescription for the sponge, they are single -use and disposable.

When the Today Sponge was introduced in 1983 it gained rapid popularity with American women. In 1994 the FDA removed the sponge from the market because it found that the water used in the Today Sponge plant was contaminated. Instead of fixing the problem, the company simply stopped producing the sponge in the United States. The Today Sponge is now produced by a different company and is on the market in Canada, but it is still awaiting FDA approval for distribution in the United States. American women who are interested in obtaining the sponge may be able to purchase them over the internet. This method of birth control is permissible according to shi'a scholars.

Coming Next (inshaAllah): Part II
Hormone based methods and the IUD

All the caution in the world will mean nothing if it is written for a couple to conceive. Allah (swt), however, does answer du'a and has given us intellect so that we could determine ways of living that suit us best.

Saturday, October 02, 2004

Ahlan Wa Sahlan! Welcome! Benvenidos!

Several months ago a friend of mine--pleased, no doubt, with the catharsis and sense of community she found while blogging-- recommended that I start my own blog. I hesitantly agreed to give it a try.

I began my adventures in the blog world, or as I prefer to call it "blogistan", with a very political blog. I soon discovered, though, that motherhood was such a large and important part of who I am that I preferred that to be the predominant theme of my blog. I still did not find that satisfactory. What I am hoping to create in this space is a comfortable little community of readers with whom I can share my struggles to improve myself as a Muslim, a mother and an American in these divisive political times. This is a place to share the themes that unite us as human beings as well as those things that are unique to our own choices in the world.

I have learned so much from the people whose blogs I read regularly and I hope that through sharing my own experiences here, that I can provide the same kind of enlightenment and enjoyment that I have recieved.

Maa Salaama
Go With Peace