May-June . 2024 | The HEALTH

However , in the latest decade , the mode of transmission between men who have sex with men ( MSM ) tops the statistics among key populations with a shocking increase of 19 per cent in 2012 to 62 per cent in 2021 . Additionally , 74 per cent of new transmissions consist of the younger generation aged 20 to 39 .

MORAL , A SOCIETY GUIDELINE OR A BARRIER ?

In this imperfect world , the ideal moral concept constructed by our society has witnessed the agonies of key populations who were silenced , stigmatised and treated unfairly , making it harder to detect HIV transmission . This also resulted in delayed treatment , access to proper care and support needed by those battling with HIV / AIDS to recover .

The truth is , that Malaysia reported 70 per cent of cases of late diagnosis among new HIV cases in the year 2022 . This reflects the urgency to empower not just the key population but anyone with high-risk behaviour to seek testing for their wellbeing .

Our experience living in this world shapes our identity , and how we identify ourselves shapes us into who we are - yesterday , today and tomorrow . After decades of journeying together as global villagers , it has come to our realisation that the HIV epidemic is no longer merely an issue of health or moral downfall .

BY REBECCA ANG LI YUAN

CRIMINALISATION OF KEY POPULATIONS

HIV transmission can be prevented using the methods of science , yet stigma is an obstacle . A study published by the Institute of Public Health shows more than three-quarters of Malaysian respondents project discriminatory attitudes towards People living with HIV ( PLHIV ).

Studies have proven that most discriminatory attitudes stem from inadequate knowledge about HIV , which causes irrational fear and concern about infection , further hindering healthy discussion on such a difficult issue , and negatively impacting the well-being of PLHIV and their willingness to seek medical treatment .

Malaysia has six main statutes pertaining to drug offences aimed at enforcing harsh detention and compulsory rehabilitation programmes for drug users . Aggressive law enforcement drives drug users to hide deeper and further away while still sharing used needles .

Although the harm reduction approach has demonstrated its effectiveness , the conflict between the evidence-based approach and punitive drug policies ( i . e . Section 37 of the Dangerous Drugs Act 1952 ) brings endless dilemmas to policymakers .

Another industry which is well known yet remains hidden among us is unlawful sex work . The Ministry of Health ( MoH ) estimated that 45,000 or more individuals earn a living this way in Malaysia , fuelled mainly by poverty , survivorship or being forced into the industry and other social issues .

Studies have shown that this community is highly vulnerable to sexual violence and abuse of personal will , yet has limited access to support such as legal protection and healthcare services due to shame and fear of potential arrest by authorities , thus hindering national responses in combating HIV and AIDS .

Next , reaching out to MSM locally is full of challenges despite them being at the top of statistics due to the criminalisation of samesex practices in our nation .

Labelled as a violation of public indecency under Malaysia ’ s civil law , it is unfortunate , yet common , to see opportunities such as employment and healthcare services being denied to the transgender community . Many pieces of evidence show that criminalisation and punitive approaches to transgender individuals , especially those forced into sex work due to livelihood , are indirectly preventing the desire to seek social support , hindering efforts in HIV prevention and delaying treatment .

Last but not exhaustively , there are laws such as Age of Majority Act 1971 , which require minors to be accompanied by a parent or legal guardian when seeking medical services , restricting minors from voluntary testing , counselling and receiving treatment for Sexually Transmitted Infections ( STIs ) and HIV .

IT TAKES A VILLAGE TO RECOVER

According to the World Health Organisation ( WHO ), Social Determinants of Health ( SDOH ) are conditions in which people are born , grow , live , work and age . Be mindful that HIV transmission disproportionately affects poorer communities , people of colour , women and children , the incarcerated and the nonheterosexual community .

A retrospective study of 28.3 million Brazilians over nine years has proven that illiterate people had a 46 per cent higher risk of becoming an AIDS case and a 176 per cent higher risk of an AIDS-related death when compared to counterparts who complete their higher education . Positive youth development programmes for upper primary and secondary students can focus on impactful health promotion , life skills , education support and addressing issues within safe spaces such as teen pregnancy , substance abuse and stigma surrounding HIV .

Interventions need to take into consideration the impact of poverty and joblessness as influencing factors on the population ’ s risky behaviours contributing to the risk of HIV transmission . There is a need to call for more collaborations between the government , microfinance institutions and existing advocacy groups to distribute equitable health services , legal advices on inheritance rights , while providing information on HIV / AIDS prevention according to the needs of the at-risk community .

Malaysia has reached 81-68-87 in HIV treatment cascade , fast-tracking towards “ End AIDS by 2030 ”. However , key populations continue to report high prevalence in HIV transmission and unmet prevention needs .

Policymakers should acknowledge personcentred approaches during the planning programme implementation , focusing on respecting every person ’ s dignity , resulting in empowerment to improve one ’ s wellbeing .

A systematic review highlights that poor neighbourhoods , in the absence of reproductive health services and interventions , foster at-risk behaviours within the community . The systemic injustice we see today between the rich and impoverished is inevitably the by-product of interaction between policies , laws , and practices passed down for decades .

We see the need for state assembly representatives to include social empowerment programmes in their planning to improve the people ’ s well-being , supported by a council of residents and local community-based organisations to enhance the level of cohesiveness and goodwill in targeted neighbourhoods . Additionally , upscale the existing pre-exposure prophylaxis ( PrEP ) programme through local clinics and leverage new media to accelerate efforts for HIV prevention .

A local study in 2020 alarmingly revealed that the rate of urban youth knowing about HIV / AIDS is only 14.7 per cent among their peers , while only 10.9 per cent of rural youth respondents have such knowledge . Peer educators have proved their effectiveness by sharing their own experiences , intending to advocate , educate and caution non-HIV persons .

Malaysia , like many other nations , finds itself struggling , not so much in the medical and financial battle ; it is a struggle for human rights . Perhaps “ Let Communities Lead ” means recognising the connection between human rights and public health outcomes .

Perhaps recognising the weight that each of our lives carries , including the marginalised , would be a continuous inspiration for all to live a healthy and fulfilling life . – The HEALTH

Rebecca Ang Li Yuan is Leader , Policy , Advocacy and Research at Malaysian CARE