Dealing With The Grim Reality Of HIV And AIDS

By now, Malaysians should have realised the grave situation hovering over the HIV epidemic in the country.

As indicated by the Ministry of Health (MOH), the cumulative numbers of HIV-positive people have very much advanced since the first reported case in 1986.


According to the ministry, there were 80,938 HIV-infected persons as at the end of 2007 while in the first half of this year there were 1,766 new cases, raising the number of HIV-infected persons in the country to 82,704.

The statistics for people living with HIV in Malaysia are set to soar to about 300,000 by the year 2015 if there are no concrete attempts to impede the spread of HIV/Aids.

Datuk Dr Hasan Abdul Rahman, the ministry's Director of Disease Control of Department of Public Health, revealed these figures in his speech at the launch of the MOH and UNICEF Report 2008 on "Woman and Girls Confronting HIV and Aids in Malaysia" held here recently.

According to Dr Hasan, the highest number of HIV-infected persons brought to MOH's attention was in 2002, involving 6,978 cases.

It was highest then, at 28.5 percent of every 100,000 people but this has steadily gone down to 16.7:100,000 in 2007.

Despite the government allocating RM500 million to implement the National Strategic Plan on Aids and the Harm Reduction Programme for 2006-2010, Dr Hasan said managing the HIV and Aids issue needs high level of commitment from various parties.

"Prevention and monitoring actions must be taken to check the spread of HIV before it gets out of control.

"Public awareness campaigns on the risks of the spread of HIV must be enhanced and those who are at risk must go through a screening test to determine their HIV status as well as participate in controlling the spread of the disease," he stressed.

SOME STARTLING FACTS

The 101-page MOH and UNICEF Report 2008 revealed some startling facts about the HIV epidemic in the country.

Men were the majority (92 percent) of cumulative HIV cases while women and girls accounted for less than 10 percent.

Currently, the cumulative reported cases of HIV transmission have been predominantly through injecting drug users (72.7 percent), followed by heterosexual intercourse (15.3 percent) and homosexual or bisexual contact (1.7 percent).

By ethnicity as of December 2007, Malay men aged 20-39 made up the majority of HIV cases. HIV acquired through Injecting Drug Users (IDU) use seems predominant among the Malays and Indians.

As for the Chinese, they appear to contract HIV through heterosexual transmission.

The Report also noted that the epidemic has spread to the Orang Asli community (0.04 percent) and the indigenous population in East Malaysia (Sabah Bumiputera - 0.5 percent, Sarawak Bumiputera 0.4 percent).

Youths aged 13-29 years represent 35.9 percent of all HIV cases reported in Malaysia thus far, the majority being male and IDUs.

FEMINISATION OF HIV

According to the MOH and UNICEF Report 2008, women remain one of the fastest growing populations being infected with HIV in Malaysia.

It said although the proportion of women and girls reported to have been infected with HIV remains less than 10 percent as of December 2007, the past five years have seen dramatic increases in the number of new cases documented among women.

From the first reported HIV case in 1986, the face of the Malaysian epidemic has been predominantly male, largely related to risk behaviours associated with drug use, particularly among those utilising injecting equipment.

Nevertheless, the profile of those newly infected and affected in the Malaysian HIV epidemic is slowly changing, whereby the incidence profile has slowly shifted from male to increasingly becoming female in nature.

According to the report, the number of women and girls newly infected with HIV increased by 39 percent from 629 cases in 2002 to 875 in 2006 which in itself represents a jump of 344 percent from 197 new cases seen in 1997.

By December 2007, a total of 6,834 women were reported to have been infected with HIV compared to 74,104 men.

In terms of Aids cases and Aids-related deaths among women and girls, the numbers are 1,438 and 847, respectively.


Out of the 6,834 Malaysian women that acquired HIV since 1988, 59 percent of the cases were reported between 2002 and 2006.

The same period also saw 65 percent of all reported female AIDS cases and 59 percent of Aids-related deaths among women and girls.

In Malaysia, although the general picture of the epidemic is largely concentrated around specific population groups such as drug users, women experience HIV and Aids in many different circumstances and environments other than as injectors.

Due to biological factors, women are 2-4 times more at risk than men in getting infected with HIV through unprotected sexual intercourse, besides vulnerabilities brought about by socio-economic circumstances.

INVISIBLE FACES OF HIV AND AIDS

Datuk Seri Tunku Puteri Intan Safinaz Tuanku Abdul Halim, the chairperson of Sultanah Bahiyah Foundation who attended the launch of the MOH and UNICEF 2008 Report, expressed her profound concern on the feminisation of HIV in Malaysia.

"In 1990, only one in every 86 new HIV infections was among women and girls. As at the end of 2007, the numbers are one in six new infections.

"Shockingly, surveys show that in 2006, more housewives tested HIV-positive than sex workers.

"Beyond each of those statistics, each of those women, you would find tens of thousands of children who are living in homes shadowed with HIV. These children are the invisible faces of HIV and Aids, and their plight is often forgotten.

"Their rights are sadly neglected in the tangled web of morality that we have woven around the issue," she said.

According to the Kedah Princess, for a family affected by HIV and Aids, the disease itself is not the issue that has the biggest impact.

With effective treatment, she said, the disease could be kept under control for many years and that would ensure families remain united and ensuring that mothers could continue to love and nurture their children.

IMPACT FROM STIGMA

However, the princess said, the biggest impact comes from the social stigma.

"Mothers I have met whose families are affected by HIV and Aids are most frightened by the people around them. They are frightened about the reaction from their friends, from their extended family, from their work colleagues and from their communities.

"I have heard a case where a shopkeeper in Kedah refused to allow a woman with HIV to enter his shop.

"Fear of HIV and Aids has been allowed to shape our thoughts, cloud our judgement, and to hurt people beyond what the disease could do to them.

"Stigma could shroud a person with shame and cast the shadow of disgrace upon his or her family," she said.

Tunku Puteri Intan Safinaz said, the stigma could cause a person to be detested by friends and neighbours, disliked by those who would normally love and care for them in troubled times.

"It does not end there, stigma can cause an HIV-positive husband to be so fearful that he refuses to allow his wife to be tested. Stigma could cause a woman to be so ashamed that she does not seek treatment, meaning an early death and young children left without a mother," she explained.

Still elaborating on stigma, the princess said it could also cause HIV-positive children to be shunned by their teachers and school friends.

She said, stigma could force children orphaned by Aids to live on the streets because no one will care for them.

"These issues are real, and they happen every day," said Tunku Puteri Intan Safinaz.

COLLECTIVE RESPONSIBILITY

In the princess' views, reducing the impact of HIV requires that the needs and issues of women be addressed globally, nationally, and at the community level.

"We need to work together to reverse the underlying socio-economic factors that contribute to women's HIV risk, gender inequality, poverty, lack of economic and educational opportunity, lack of legal and human rights protections, overcoming all these challenges is critical for success," she said.

To that effect, the princess said strong male voices are needed not only to speak against violence towards women but also to urge others to refrain from sexual behaviour that puts women and girls at risk and committed to educating their daughters.

UNICEF's Representative to Malaysia, Youssouf Oomar agreed with the princess on collective responsibility.

He said: "We could advocate for behaviour change, challenge the discrimination of people living with HIV, and create an environment where women, youth and children affected by HIV receive all the protection, care and support they need."

UNICEF would continue to support Malaysia's response to address women's vulnerability and in that respect, he said, the knowledge of women and girls on the HIV infection must be heightened while their access to sexual reproductive health education and testing need to be expanded.

"We must also increase their ability to protect themselves from HIV as well as fight gender discrimination and violence," said Oomar.

IMPORTANCE OF YOUNG PEOPLE

According to Oomar, women must also be empowered to make positive decisions in the face of the HIV epidemic, not only for themselves but also for their children.

"It is estimated that close to 2,000 children in Malaysia are HIV-positive (out of total cumulative cases from 1998-2006). Many have been orphaned, with one or both parents dying of Aids. There are more who live in homes shadowed by HIV, profoundly affected by the stigma attached to the condition.

"Even if a child is not HIV-positive, the effects of discrimination, apathy and denial are incredibly damaging, leading to situations where a child cannot enjoy his or her schooling experience, where friendships fall apart because of misconceptions, where there is no support even from relatives and others on the community," he said.

In his speech, the UNICEF Malaysia Representative described the young people as important in the struggle to control the HIV epidemic in the country. With HIV infections rising steeply among women in the last 10 years, children are the ones who would bear the consequences of this epidemic.

"Yet children and youths are the ones who have the power to change attitudes and behaviours, and alter the course of HIV for generations to come," Oomar added.