MARCH-APRIL , 2023 | THE HEALTH

Figure 1

SOURCE : US NATIONAL INSTITUTE OF HEALTH

The following are the policy recommendations proposed by EMIR Research to the relevant stakeholders : 1 . Bolstering HIV early intervention programmes The MoH should bolster the current outreach programmes so that it ’ s more inclusive and expansive – that is , the target shouldn ’ t be only primarily focussed on those with a sexually active lifestyle and high-risk communities like sex workers , homosexuals ( gays and lesbians ), drug addicts , etc . but also the wider population inclusive of our migrant labour and also encompassing the less developed regions too ( e . g ., Kelantan – the number of PLHIV due to homosexually-oriented transmission in the state has increased by 33.2 per cent over the past five years ).

The outreach programmes should have prevention as their aim alongside early intervention . These include public awareness campaigns which should be run simultaneously with screenings for HIV .

At the same time , the MoH should identify “ hotspot ” areas with a high number of HIV-positive people to provide integrated services for detection / screening , diagnosis and advice / referral . 2 . Adding special provisions to the Prevention and Control of Infectious Diseases Act ( 1988 ) The Prevention and Control of Infectious Diseases Act ( 1988 ) should be complemented and supplemented by special provisions pertaining to the achieving of the National Strategic Plan for Ending AIDS ( 2016-2030 ) together with the 95-95-95 strategic targets or objectives alongside the “ Three Zeros ”.

Towards that end , special regulations or subsidiary legislations should be prepared and implemented to ensure that PLHIV who are yet to be detected or made aware of their condition report to screening and treatment , including tourists and visitors and our local foreign migrant labour population .

This could entail , e . g ., making it compulsory for employers to periodically require their foreign workers to be subject to screening / testing and submit the results to MoH , the Ministry of Human Resources ( MoHR ) and the Home Ministry . 3 . Providing psychological and nutritional services for PLHIV

Psychological and nutritional healthcare services are part of the broader HIV treatment regime . It goes without saying that the mental health of an individual is significantly challenged and impacted by having HIV .

This is in line with , for example , a study which found that almost one in every three people who suffer from a long-term physical medical condition also struggle with mental health conditions ( see “ Physical health and mental health ”, Mental Health Foundation , Feb 18 , 2022 ). Not only that , having a wholesome , nutritious diet boosts general health and aids in the maintenance of the immune system , which could play a vital role in complementing and supplementing the effects of ART .

In addition to having second-line ART and routine check-ups , PLHIV patients should periodically be scheduled for a compulsory consultation session with a psychologist and nutritionist . Thus , PLHIV can be placed on a healthier lifestyle as driven by a balanced and highly-nutritious diet alongside mental well-being . 4 . Providing State-supported health insurance policies for PLHIV PLHIV aren ’ t insured with health insurance coverage in Malaysia as HIV doesn ’ t fall under the category of critical illness . This is due to the lack of awareness by insurance companies of the improvements in the long-term outlook for PLHIV ( see , “ Malaysian survey on HIV and insurance companies shows gaps in knowledge on the disease and why coverage is needed ”, Malay Mail , Dec 6 , 2019 ).

Even where it ’ s available , the cost of these policies is high ranged , whereby most middle-income and low-income PLHIV wouldn ’ t be able to afford them . As such , the MySalam national health protection scheme should be expanded to include the first two stages of HIV infection . Currently , this scheme only covers a ) full-blown AIDS ( CD4 count less than 200 cells ) and b ) HIV infection due to blood transfusion .

In conclusion , whilst HIV is an incurable infection , the spread of this illness can be stopped by intervening actions taken by the relevant stakeholders . – The Health

Jason Loh and Jachintha Joyce are part of the research team at EMIR Research , an independent think tank focused on strategic policy recommendations based on rigorous research .

Stage 1 : Acute HIV infection ( seroconversion illness ) This is the initial stage of HIV infection , typically appearing two to four weeks after HIV infection . The risk of HIV transmission ( i . e ., from the carrier to another individual ) significantly rises during the acute HIV infection stage due to the extremely high level of HIV in the blood . Stage 2 : Chronic HIV infection ( asymptomatic / clinical latency ) The second stage is where the virus will continue to mutate at this stage albeit at very low levels and the CD4 count will continue to drop if proper treatment isn ’ t provided . Stage 3 : AIDS Here , the CD4 count will hit to less than 200 cells . The body can ’ t fight off opportunistic infections and infection-related cancers that occur more frequently or are more severe in people with weakened immune systems . Without ART , people with AIDS typically survive about three years .

As reported in the Global AIDS Monitoring Report 2022 by MoH , infected patients are only aware of their condition in the later stages . In 2021 , 68 per cent of infected patients with HIV were only diagnosed in the later stages due to a lack of awareness and concomitantly screenings / tests .

BEYOND issues with late-stage diagnosis , people living with HIV ( PLHIV ) -related concerns in Malaysia also include :

• Stigmatisation and discrimination – household , workplace and society

Lack of political will to stem disinformation and fear-mongering have resulted in PLHIV being discriminated and ostracised by family , the workplace and wider society . The welfare of the PLHIV community is also overlooked and neglected by politicians as policymakers .

Recently , the Selangor Mufti Department prohibited the administration of pre-exposure prophylaxis ( PrEP ) medication for homosexual couples in the State ( see “ S ’ gor Mufti Dept : Giving anti- HIV drug to LGBT is colluding in sin ”, Malaysiakini , Jan 19 , 2023 ). PrEP – a preventive medication for HIV transmission – is clinically proven to be able to prevent the spread of HIV by 99 per cent during sex . Notwithstanding , the absence of PrEP medication could increase the number of PLHIV and increase HIV transmission in the State .

• Inadequate coverage of health care services As mentioned , only slightly more than half of the ( reported ) PHLIV community were receiving ART ( in 2021 ).

The rest isn ’ t due to insufficient awareness , psychological barriers of the fear of stigmatisation ( e . g ., family members ), financial constraints ( especially when it comes to second-line treatment ), etc .

Thailand , one of the few countries with the highest LGBTQ community , incorporated HIV services , including ART , into its universal health care scheme in 2006 . As a result of more than three-quarters of the 94 per cent of the PLHIV who are aware of their status have achieved viral suppression , new infections in Thailand have decreased by two-thirds since 2010 ( see “ Law , criminalisation and HIV in the world : have countries that criminalise achieved more or less successful pandemic response ?”, Matthew M Kavanagh et al ., BMJ Global Health , Vol . 6 , Issue 8 , 2021 ).

Additionally , since 2014 , Thailand has started providing ART to all PLHIV regardless of their CD4 count . Malaysia should follow suit as well – as part of the initiative to provide a holistic and comprehensive HIV treatment that ’ s inclusive and more equitable – and thereby achieving the 95-95-95 strategic targets or objectives and “ eliminating ” the scourge of AIDS in the country and , thus , realising the ambition of the “ Three Zeros ”.