Abstinence, Marriage and Religions for the Prevention and Control of HIV Infection and Other Sexually Transmitted Diseases

About 84% of world's population is linked to five major religions: Christianity, Islam, Judaism, Buddhism and Hinduism. One thing common in these religions is marriage, which is a life-long cultural and spiritual union between man and women. Religions give great emphasis to marriage and discourage immorality and adultery. In Holy Bible, it is narrated, "Let marriage be held in honor among all, and let marriage bed be undefiled, for God will judge sexually immoral and adulterous" (Hebrews 13:4). Holy Quran describes, "And among His (God Almighty) signs is that He created for you spouses from among yourselves, that you may find peacefulness in them, and He has put between you affection and mercy, verily, in that are signs for a people who reflect" (30; 21). In Judaism, marriage is an important event and avoiding from it is considered as unnatural. In Buddhism and Hinduism also marriage is a sacred ceremony and lifelong commitment between wife and husband. Center for Diseases Control and Prevention recommends to abstain from oral, vaginal, and anal sex; or to be in a long-term, mutually monogamous relationship with an uninfected partner. Marriage is an excellent mod of mutual relationship between spouses, provides ample opportunity for sex entertainment and together with religious attitude helps to abstain from sex outside marriage. Present article is aimed to promote marriage and religions for prevention of sexually transmitted diseases, particularly Human Immune-deficiency Virus infection, which is becoming epidemic worldwide and there is no effective vaccine or treatment for that so far. Citation: Randhawa MA, Alrowaili MG (2017) Abstinence, Marriage and Religions for the Prevention and Control of HIV Infection and Other Sexually Transmitted Diseases. J AIDS Clin Res 8: 715. doi: 10.4172/2155-6113.1000715


Introduction
The word religion originates from the Latin "Religio" meaning conscientiousness, sense of right, respect for what is sacred, obedience and worship for God. Another possible interpretation of religion can be traced to Marcus Tullius Cicero (An eminent Roman scholar) who relates religion to "re" (again) and "lego" (read), i.e., "go over again" or "consider carefully". Some scholars such as Tom Harpur and Joseph Campbell prefer to derive religion from "re" (again) and "ligare" (bind, connect), i.e., obligation or bond between man and God [1][2][3].
In a broader sense religion may be defined as a cultural system of behaviors and practices, based on believes about supernatural being and sacred texts; that provide norms of life or "an order of existence" or "societal organization" and help humanity to live peacefully in a community. Religious practices may include prayers, rituals, ceremonies, sermons, sacrifices, festivals, feasts, matrimonial services, funerary services, public services, or other aspects of human culture [4,5].There are about 10,000 religions in the world and almost 84% of the world's population is linked to one of five major religions: Christianity, Islam, Judaism, Hinduism and Buddhism. Nearly 11% are atheists and remaining 5% belong to other religions [6].
Besides many others, one thing common in these religions is marriage, which is a life-long spiritual and cultural union between spouses (Men and women). The marriage is an institution in which interpersonal relations, including sexual relations, are recognized. Moreover, it establishes rights and obligations between spouses, their children and their in-laws [7]. The marriage serves some important objectives of human life: The propagation of human race and the provision of a life-long companion to share 'thick and thin' of life and for love and enjoyment. Almost all religions give great emphasis to marriage and discourage immorality and adultery.
The marriage when religiously practiced is an excellent mode of 'relative sex abstinence', i.e., sex abstinence outside marriage. Sex abstinence is being recommended for the control of sexually transmitted diseases (STDs) and HIV, but the absolute sex abstinence is generally very difficult to practice. Some programs regarding education of sex abstinence to prevent STDs were not much effective [8]. The marriage provides a life-long companion and an ample opportunity for sexual entertainment. Moreover, marriage supported by religious attitude and behavior helps in the avoidance of sex outside marriage. Some epidemiological studies also support the view that the religion and matrimonial relationship are important factors in the prevention and control of STDs. According to these studies, the societies and countries where religion and marriage are practiced the incidence of STDs and HIV infection is lower [9].
The present article is aimed to promote marriage and religions as important tools for the prevention and control of STDs, particularly HIV infection, which is spreading like a fire and becoming epidemic in many parts of the world, taking millions of human lives and causing financial losses of trillions of dollars every year. Moreover, there is no valid treatment or vaccine available for HIV infection. For the convenience of the readers the manuscript is structured into: A) Marriage and various religions; B) Abstinence and STDs/HIV; C) Marriage as a mode of 'relative sex abstinence'; D) Epidemiology and impact of religion on HIV/STDs; and E) Conclusion.

Marriage and various religions
In this section selective and authentic versus of holy books of five most common religions are mentioned which emphasize the importance of marriage; encourage healthy, respectful and peaceful marital relations between the spouses; and discourage immorality and adultery, which are the root causes of the spread of STDs. An effort has been made to find out the original scripts of different religious books, which have minimum controversies between religions. Authors apologize for any shortcomings in these texts or their references and would be very grateful for the correction or improvement. These versus are the commandments from the Lord, God, Creator, Allah Almighty or His messengers, and need to be religiously practiced for our own benefit and for the benefit of the entire mankind. • Then the Lord God said, "It is not good that the man (Adam) should be alone; I will make him a helper fit for him" (Genesis: 2, 18), ESV.
• "Let marriage be held in honor among all, and let marriage bed be undefiled, for God will judge sexually immoral and adulterous" (Hebrews 13:4), ESV.
• "Therefore a man shall leave his father and his mother and hold fast to his wife and they shall become one flesh" (Genesis 2:24), ESV.
• "Likewise, husbands, live with your wives in an understanding way, showing honor to the woman as the weaker vessel, since they are heirs with you of the grace of life, so that your prayers may not be hindered" (1 Peter 3:7), ESV.
• "Accordingly, she will be called an adulteress if she lives with another man while her husband is alive. But if her husband dies and she marries another man she is not an adulteress" (Romans 7:3), ESV.

Judaism and marriage:
The basic concepts of marriage in Judaism and Christianity are not much different. Most of the scriptures quoted above from the Holy Bible, English Standard Version are from the Old testaments of Bible, which is perhaps same as Hebrew Bible or the Genesis, the first Book of Moses (Peace be upon him) [11].
In the traditional Judaism, marriage is taken as a commandment from the God and a contract between a man and a woman to create a relationship under the will of God. Marriage means that the husband and wife are merging into a single soul (Genesis 2:24). That is why an unmarried man is considered 'incomplete', as his soul is only one part of a larger whole that remains to be filled [12,13]. The main objective of marriage is considered as love and companionship. However, it fulfills the God's commandment to have children (Gen. 1:28).
According to the Talmud, Rav Yehuda taught that 40 days before a male child is conceived, a voice from heaven announces whose daughter he is going to marry, literally a match made in the heaven! In Yaddish language, this perfect match is called 'bashert' a word meaning fate or destiny. The word 'bashert' can be used to refer to any kind of fortuitous good match, such as finding the perfect job or the perfect house, but it is usually used for one's soul mate. A husband is responsible for providing his wife with food, clothing and sexual relations (Exodus, 21:10, the Second Book of Moses (Peace be upon him) [14].
Genesis 24 narrates how the marriage of Abraham's (Peace be upon him) son Isaac (Peace be upon him) and Rebekah took place. Abraham (Peace be upon him) being the father of all divine religions, the mention of the incidence of his son's marriage would explain the original customs of marriage in Christianity, Judaism and Islam. Almost similar customs prevail in Buddhism, Hinduism and many other religions.
'Abraham (Peace be upon him) sent his servant to Haran, his homeland, to look for a wife for his son, Isaac (Peace be upon him). When the servant reached Haran, he came across a well where women came to pick water. There he prayed God to help him to find the right woman. Meanwhile, Rebekah reached the well and met all the signs he was asked for to look into. He handed over the nose ring and bracelets to her, used in Hebrew culture as a symbol of marriage proposal. He was then taken to Rebekah's family and her father agreed for the proposal. Thus, Isaac (Peace be upon him) and Rebekah were engaged to be married. Rebekah was taken to Hebron and in the gathering of Abraham's (Peace be upon him) family she was married to Isaac (Peace be upon him)' [10,11]. Islam and marriage: Holy Quran describes marriage as a divine favor from God Almighty for mankind. There are a good number of versus related to the marital relationship between spouses and a few are given below: 1. "And among His Signs is this, that He created for you wives (spouses) from among yourselves, that you may find repose (peacefulness) in them, and He has put between you affection and mercy. Verily, in that are indeed signs for a people who reflect". (The Noble Quran, 30: 21) [17].
2. "And marry those among you who are single (i.e., a man who has no wife and the woman who has no husband) and (also marry) the Salihun (pious, fit and capable) of your (male) slaves and maid-servants (female slaves). If they be poor, Allah will enrich them out of His Bounty. And Allah is All-Sufficient for His creatures' needs, All-Knowing (about the state of the people)" (The Noble Quran, 24: 32) [17].
3. "It is made lawful for you to have sexual relations with your wives on the night of As-Saum (the fasts). They are Libas (i.e. body cover, or screen, or garments (garments provides cover, protection, beauty and smartness) or Sakan (i.e., you enjoy the pleasure of living with her -as in Verse 7:189)) for you and you are the same for them" (The Noble Quran, 2: 187) [17].
4. "It is He Who has created you from a single person (Adam) and (then) He has created from him his wife (Hawwa (Eve)), in order that he might enjoy the pleasure of living with her" (The Noble Quran, 7: 189) [17].

Buddhism and marriage:
In Buddhism also the marriage is a sacred event and the family is regarded as a basic unit of social integration. The close, loving relations between 'husband and wife' and 'parents and children' are considered essential for cohesive social order and happiness in the life. In order to emphasize and explain the proper marital relations, Buddha is reported to classify marriages into four kinds [23]: "A wretch lives together with a wretch; a wretch lives together with a goddess; A god lives together with a wretch; a god lives together with a goddess".
"And how does a wretch live together with a wretch? Here, the husband is one who destroys life…, engages in sexual misconduct, speaks falsely and indulges in wines, liquor, and intoxicants, the basis for negligence; he is immoral, of bad character; and his wife is exactly the same in all respects".
"And how does a wretch live together with a goddess? Here, the husband is one who destroys life..., he is immoral and of bad character.
But his wife is one who abstains from the destruction of life (Wines, liquor and intoxicants); she is virtuous and of good character".
"And how does a god live together with a wretch? Here, the husband is one who abstains from the destruction of life..., who is virtuous, of good character. But his wife is one who destroys life...who is immoral and of bad character".
"And how does a god live together with a goddess? Here, the husband is one who abstains from the destruction of life (Wines, liquor and intoxicants); he is virtuous, of good character; and his wife is exactly the same in all respects".
It is further narrated that the virtuous wife and husband will remain in one another's sight so long as they live in this life and will be together in the future life as well [24].

Hinduism and marriage:
In Hindi language marriage is called as 'Vivaah', which means a sacred union of people (one wife and one husband), based on cosmic laws. In Hindu traditions marriage is considered as 'Samskaras' , a lifelong commitment and a 'sacred oneness' , which joins two individuals for life, so that they can perform their duties ('Dharma'), look after their possessions (' Artha') and enjoy their physical desires, including sex ('Kama') [25,26].
Like marriage, few other concepts are common in Hinduism, Christianity and Islam, to include is the origin of all mankind from one father, 'Manu', equivalent of the Biblical (and Islamic) 'Adam' and the 'Lord Brahma', the 'Hindu God of Creation', who created 'Manu', equivalent of the Biblical (and Islamic) 'Creator' [27,28]. Prajapatya vivaah: This is arranged when the groom and bride are both very young. Bride's father gives her daughter to the groom's father during hand-receiving ceremony ('Panigrahan'). The actual wedding is usually accomplished when boy and girl are old enough.

Daiva vivaah:
When the girl's parents are unable to find a suitable groom for several years after puberty or the parents are unable to afford marriage expenses and further delay is not considered suitable. She is garlanded with simple ornaments and married to any willing man or a priest in the venue of the religious ceremony. The expenses are usually provided by some rich person as charity.
Arsha vivaah: In this type of marriage, the family of the groom pays bride-price ('Kanya-shulkam') to the parents of the bride, which is usually a cow with a calf and a pair of bulls. Such marriages usually happen in poor communities and rural areas.
Asura vivaah: In this case, generally the groom is of lower social class than the bride and gives as much wealth as he can afford to the bride's parents and relatives, perhaps, tends to compensate with his wealth.

Gandharva vivaah:
In this marriage a man and a woman marry for love and without the willingness of their parents. The Gandharva Vivaah is similar to 'love marriage' .

Rakshasa vivaah:
The girl is willing to marry the boy but her parents are against their wedding. The girl is then abducted and married.

Paishacha vivaah:
In this case the girl is not in her senses or is intoxicated with drugs and is married unwillingly. The Paishacha Vivaah is considered as a sin.
Like other religions, the primary objective of Hindu marriage is to provide life-long harmonious relationship between man and woman, protection of the women from evils of society and to prevent adultery; as is clear from the following scripture of the 'Manusmriti': 5/151 [30]. Girls are supposed to be in the custody of their father when they are children, women must be under the custody of their husbands when married and under the custody of their sons as widows. In no circumstances are women allowed to assert themselves independently.

Abstinence and STDs/HIV
In the 'Prevention Guidance' by the Center for Diseases Control and Prevention (CDC) it is mentioned that a reliable way to avoid transmission of STDs and HIV is to abstain from oral, vaginal and anal sex (Absolute abstinence) or to be in a long-term, mutually monogamous relationship with an uninfected partner (Relative abstinence)". Screening for common STDs is recommended for persons intending to have mutually monogamous relationship [31].
Cochrane Database Systemic Review (2007), based on 30 electronic databases (e.g. CENTRAL, PubMed, EMBASE, AIDSLINE, PsycINFO, etc.) and meant for the assessment of the effects of abstinence-only programs for HIV prevention in high-income countries, indicates that abstinence-only interventions are ineffective in decreasing HIV risk among participants, comprising US youth [32]. Similarly, Cochrane Database Systemic Review (2008), meant for the assessment of the effects of abstinence-plus programs for HIV prevention in high-income countries also reported that abstinence-plus programs also had no effect on the incidence of sexually transmitted infection [33].

Marriage as a mode of 'relative sex abstinence'
Marriage is the God's chosen plan for prevention and control of STDs, STIs and HIV for all mankind. It provides an excellent opportunity for mutually monogamous relationship with an uninfected partner for the whole life. The marriage provides a life-long companion and an ample opportunity for sexual entertainment. Moreover, with strong commitment, honesty and religious support, it allows to practice abstinence from any type of sex outside marriage.  studies conducted in 38 sub-Saharan African countries revealed negative relationship between prevalence of HIV and being Muslim, which could be due to the practice of Islamic sexual codes, including marriage, abstinence from extramarital affairs and circumcision [9].
The WHO world figures about the prevalence of HIV in adults (15-49 years) for the year 2015, also indicate lower figures (Less than 0.1 to 0.2%) in the Eastern Mediterranean region (Middle East and North Africa) where a fair majority of Muslims adopt marriage religiously and abstain from extra-marital sex, as compared to Europe, Americas and Africa (0.45, 0.5 and 4.4%, respectively) where there is little consideration of marriage and ample opportunities of sex outside marriage ( Figure  1) [35]. However, unfortunately, the situation is changing in Eastern Mediterranean region and, consequently, the number of cases suffering from HIV and STD is also increasing. Lower figure (0.1%) in Western Pacific region (China, Japan and Australia, etc.) are, perhaps due to lesser immigrations and travel between these countries and the regions of higher incidence of HIV, as well as vigilance in the detection of HIV in the visitors and immigrants, although the life style is not much different from the areas of high prevalence.

Impact of religion towards HIV patients:
Religions forbid discrimination, prejudice and maltreatment; and demand tolerance. They encourage to support all suffering persons and to help them receive the best possible care and treatment. In many cases, religion has restored respect, dignity and understanding for persons with HIV/ AIDS. Many religious groups provide care for such persons [36].
Overall impact of marriage in control of HIV/STDs: Around 84% of the world population is linked to one of the 5 major religions: Christianity, Islam, Judaism, Buddhism and Hinduism. The practice of the instructions given in the sacred books of these religions pertaining g to the marriage and abstinence of sex outside marriage, mentioned above, would contribute a lot in the prevention and control of HIV and STDs because the transmission and spread of HIV and STDs is mainly due to break in these instructions. The remaining 16 percent of population would also benefit from the practice of these instructions in the prevention and control of HIV/STDs because a formal link to one of these religions is not compulsory for that purpose. However, if they will believe and practice these religions will have many other benefits in this life and in the life hereafter. The additional benefits in this world which would contribute in the prevention of HIV/STDs include the ability to abstain from extra-marital sex, extra vaginal sex, homosexuality, drug and alcohol abuse and sex with animals; inculcated by the teachings of these religions.

Conclusion
The basic teachings about marriage and extra marital sex, that can help to control HIV infection and other STDs, are almost the same in all major religions of the world: Christianity, Judaism, Islam, Buddhism and Hinduism. The individuals and communities who follow these instructions religiously they benefit, and those who do not practice their chances to get HIV and other STDs are enhanced. Like a patient when comply the prescription of his doctor benefits and if doesn't would suffer. Therefore, there is an immense need to propagate the original words of the Lord, God and Allah Almighty pertaining to marriage and marital relationship for the best interest of the entire mankind.