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Where we are on HIV

The article below appeared in the November 7  issue of Health with Perdana, a regular column in The Star by Perdana University faculty members. This week’s article is contributed by Dr. Sangeeta Kaur Singh, Senior Lecturer, Epidemiology and Public Health Medicine, Perdana University-Royal College of Surgeons in Ireland, School of Medicine and Mr. Randeep Singh Sidhu.

Malaysia has made good progress against the HIV/AIDS epidemic, but challenges to better management still remain.

WHEN the first case of HIV/AIDS (human immunodeficiency virus/ acquired immunodeficiency syndrome) made its way to Malaysian shores in 1986, it was met with jeers and sneers, and was considered a sensitive topic to be discussed.

With Malaysia being a conservative society, HIV patients are most often frowned upon, which sadly causes patients to be reluctant in seeking treatment.

Only about one in three patients (32%) opt for treatment, due to societal norms and beliefs, and the general lack of awareness of the available treatment.

While the stigma still exists today, it has been substantially reduced over the decades.

In 2001, the Islamic Development Department (Jakim) introduced premarital HIV screening for Muslim couples.

Although it is voluntary, most couples are urged to get screened at any Health Ministry clinic.

This is so that they are aware of their HIV status, and not in any way discouraging or preventing the marriage.

This was an essential step in the right direction.

Decreasing the stigma

Getting religious leaders to join in raising awareness and contributing to conversations propelled the country further towards betterment.

The Health Ministry actively worked with Jakim to produce training modules to educate religious leaders about HIV.

This module includes the various modes of transmission of

HIV and how religious leaders can play their part in reducing the stigma around the disease.

Such efforts are needed to address the knowledge gap, which is still persistent.

Continuity in strategic partnership with religious leaders is essential in promoting Islamic principles in counselling and inserting positive HIV messaging.

Such efforts also act as reflection exercises that help religious leaders become aware of their stigmatising actions and assist in transforming their habitual use of discriminatory language.

In 2004, the Health and Education Ministries collaborated to produce modules to educate secondary school-goers about HIV/AIDS and other sexually-transmitted diseases (STDS).

Today, these modules have been integrated into the curriculum of science-based subjects in school.

National campaigns are also being actively carried out in schools to educate students about HIV/AIDS prevention.

Important information such as the dangers of sharing needles and having unprotected sex is being discussed more in schools, especially at the secondary level.

The topic is not as taboo as it was say, 20 years ago, and students’ overall awareness is higher as time goes by.

Still taboo

The Malaysian HIV epidemic is primarily driven by sexual transmission and needle-sharing practices.

While the country has taken excellent steps towards combating HIV, there are still evident challenges.

Based on research conducted, it was found that some healthcare specialists’ knowledge, attitude and perception, especially those who have not been sensitised on mana-ging people living with HIV and AIDS, causes inevitable communication breakdowns with such patients.

Such barriers have resulted in around a third of people living with HIV being aware of their status, but not the available treatment.

Even though Malaysia has customised training materials in HIV counselling, it is still a challenge when it involves various topics that are deemed sensitive.

HIV counselling is a process of communication between a healthcare provider and patient in discussing Hiv-related issues,

Healthcare providers are still struggling to properly communicate such information to patients with accuracy.

Overall, there is a gap in knowledge in providing solutions to Hiv-related problems.

The more significant challenge is the societal and cultural views surrounding areas related to HIV.

Practising safe sex for prevention of STDS, including HIV, goes against some religious beliefs where both premarital sex and the usage of condoms are prohibited.

This is where societal and cultural norms, and science, disagree, which causes all sorts of disputes.

In the end, silence is resorted to due to sensitivities, instead of persevering with the difficult conversation to seek a satisfactory conclusion for both sides.

Homosexuality continues to be unacceptable, as well as illegal, in Malaysia.

Hence, it is difficult to broach the topic of homosexual relationships that could contribute to HIV infections.

Many would rather not disclose their sexual orientation for fear of being punished by the law.

Therefore, coming up with solutions for homosexual relationships, whether between men or women, is not easy, although they belong to a high-risk group.

The same applies to transgender people and men who have sex with men, who are also highly exposed to HIV, yet are discriminated against due to societal beliefs.

Public health priority

After 40 years of effort, the frequency of HIV remains high among men who have sex with men, transgender persons, people who inject drugs, sex workers and their clients, and incarcerated persons.

Scientific evidence has shown that testing and treating is one way forward that can immediately halt HIV transmission.

This is as HIV treatments can result in a sufficiently suppressed viral load that the patient does not transmit the virus sexually.

This is indicated by the concept of “Undetectable = Untransmittable (U=U)”.

AIDS was portrayed as a security threat 40 years ago.

Today, with the availability of more effective treatments and prevention, the threat of HIV/AIDS has somewhat been downgraded to another public health priority.

The slogan “no one is safe until everyone is safe”, which became common during the Covid-19 pandemic, was also used 40 years ago about HIV.

In a paper titled Reflections on 40 Years of AIDS, published in June in the journal Emerging Infectious Diseases, infectious diseases consultant Dr Kevin M. De Cock and his colleagues certainly hit the nail on its head by stating, “HIV/AIDS may not be central to global health discourse as it was earlier, but it will remain a yardstick by which to judge commitment and efforts, including and especially to, health security.”

In conclusion, it is undeniable that Malaysia has made impressive progress on HIV/AIDS since the 1990s.

However, this STD is still taboo to most people, which could hinder other positive outcomes in reducing further infections.

It is strenuous to get everyone on the same page in a country where citizens are not entirely comfortable speaking about sex and STDS.

Collaboration between various stakeholders is required, and this can only be achieved once everyone can set aside their differences for a fruitful discussion.

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