HIV/AIDS CHALLENGES IN MALAYSIA

HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. It is spread by contact with certain bodily fluids of a person with HIV, most commonly during unprotected sex (sex without a condom or HIV medicine to prevent or treat HIV), or through sharing injection drug equipment. If left untreated, HIV can lead to the disease AIDS (acquired immunodeficiency syndrome).

The first reported cases of HIV/AIDS in Malaysia were in 1986. Since that time, there are now over 100,000 reported cases of HIV infections in the country, and over 16,000 people have died from AIDS as of December 2013. It is concentrated within injecting drug users (IDU), sex workers (SW), transgender (TG) and men who have sex with men (MSM) communities. At the end of 2012, Malaysia was estimated to have 81,900 people living with HIV (PLHIV) since the first case was detected 27 years ago. In 2013 as many as 3,393 new HIV infections were reported, which means that every day almost 10 Malaysians become HIV infected.

In Malaysia, we see a higher rate of HIV transmission through sexual transmission versus injecting drug use. The official number of infections transmitted through heterosexual intercourse has increased.  The number of HIV positive women has been increasing as well. AIDS has caused the deaths of more than 13,000 Malaysians.

HIV stigma continues to be a major barrier to prevention, testing, and treatment, and HIV continues to affect certain groups of people more than others. They include men who have sex with men (especially young, black and Latino/Hispanic men), people who inject drugs, and transgender women.

HIV prevention and treatment efforts, among others, involve Islamic-related agencies in Malaysia. The Department of Islamic Development Malaysia (JAKIM) conducts HIV-related workshops with Muslim leaders and lesbian, gay, bisexual, and transgender (LGBT) communities. A methadone maintenance treatment (MMT) project was implemented in a mosque in Kuala Lumpur, incorporating religious and social supports alongside provision of health services. Additional services including premarital HIV testing are discussed. Islamic values point to the need for compassion, nonjudgment, and taking action to improve lives, while reluctance to support harm-reduction strategies among sexual minorities highlights the important role of community advocates and social workers within nongovernmental organizations.
Malaysia has taken great strides in tackling HIV, but difficult issues remain for the mainly Muslim country, including the use of condoms outside of marriage.

The needle exchange programme has been well received and successful in mitigating the spread of HIV among IDU. The good thing is that we have good partnership between Ministry of Health, National Drug Agency, Ministry of Women, Family and Community and Community Development and Malaysia Department of Islamic Development (JAKIM).
In 2001, JAKIM gradually (state by state) introduced premarital HIV screening for prospective Muslim couples. While the department made screening obligatory, Muslim couples are screened on a voluntary basis through clinics run by the Ministry of Health. It has had the synergistic effect of decreasing HIV transmission and emphasises that the purpose is to know your HIV status and to subsequently counsel and educate people.

In 2008, the health ministry started working with the Ministry of Defence to ensure that school leavers embarking on their national service programme took an HIV education module. Ministry of Health has been working with JAKIM and have produced a training module to educate religious leaders about HIV, including the modes of transmission and how to reduce stigma. Working with the religious department is crucially important to reduce the spread of HIV in a country where religion is important in every issue. Muslim leaders initially focused their attention on reducing stigma and discrimination against people living with HIV/AIDS, then counselling them by way of Islamic principles.  Efforts were carried out to educate the public and religious leaders not to discriminate against transgender.

Malaysia has made great inroads in controlling its HIV/AIDS epidemic. In a nation where issues surrounding HIV are exceedingly sensitive, engaging with religious leaders is certainly no small feat. Such collaboration is a positive step in the right direction, and one that requires a continued concerted effort by all those involved.

As a human being, when we hear about HIV and AIDS we will have stigma towards the person. Same goes to me when I was schooling and a teenager. As I become medical student 16 years ago, the understanding of HIV and AIDS better and it helped me in dealing with the patient. The knowledge and understanding about the medical condition also help me in managing the patient. In return, the stigma towards HIV/AIDS declined and makes me treat them with holistic approach under multidisciplinary team. Throughout my journey as a medical officer started from house officer in Hospital Kuala Lumpur, medical officer under various clinics under Ministry of Defence and now working in Hospital Pengajar Universiti Putra Malaysia in 11 years helps me to be more empathetic towards the patient and their family, see things differently, made me more thankful of what I had and not being judgmental about things. Perhaps Malaysians will understand better about HIV/AIDS in the future and help in reducing the incidence rate with multidisciplinary involvement.

DR NORSUHANA BINTI MOHAMAD SAPIAN
Medical Officer
Family Medicine Clinic, Hospital Pengajar Universiti Putra Malaysia