It is the most widely used contraceptive in the country, and yet no one is supposed to talk about it. With the emergence of 6,000 new HIV cases each year, Malaysians can't afford to be silent about condoms anymore, writes CHAI MEI LING.

THE adage HIV/AIDS does not choose its victims has never rung so true up until now.

More housewives than sex workers tested positive for HIV in 2006.

In that same year, 36 per cent of those infected were youths between 13 and 29 years old.

Shocking revelations, but not when the figures are dissected and the reasons behind them revealed.
Malaysians in general are well aware of HIV preventive methods - eight out of 10 correctly named condom use - but knowledge doesn't translate into practice.

Some studies rate condom use at 20 per cent while others 80.

Dr Soraya Aziz, a consultant to the United Nations Development Programme's project on HIV/AIDS & Islam, says she's taking the 80 per cent figure with a pinch of salt.

"From talking to people, we get the impression that Malaysian men are quite resistant to using the condom."

And public input for her study reveals that many don't even know how to put a condom on.

"A lot of people say to me, 'Yeah, we know what a condom is, but actually how do you use it?' This is especially true of the younger people."

Prevention of HIV/AIDS through sexual intercourse is as easy as ABC - both literally and figuratively - abstinence, being faithful to one's partner, and condom use.

Condoms do not guarantee a 100 per cent safety net, says condom exporter Clinton Ang, but it is the safest method to prevent sexually transmitted infections and the most cost effective.

The male condom comes in just one size, doesn't break easily if used with water-based lubricants, and is so strong that it is recommended by the British Special Forces to be included into the survival kit because it can hold up to 18 litres of water.

Ang says non-governmental organisations working on HIV prevention use 50 to 70 per cent of their funds on condom procurement alone at any one prevention programme.

In containing the infection spread, it makes sense that people argue abstinence and being faithful are effective methods, says Dr Soraya.

"But if you tell people only about abstinence and don't give them an option - if they want to have sex, they won't know how to practise safe sex. So abstinence is not good enough on its own.

"That's why we have to talk about the A, B and C."

The reality, in Malaysia at least, is people do not talk about condom at all.

Condom myths, such as that they break easily and reduce sexual pleasure, have made their rounds more than once.

But the biggest misconception locally, even if it's never said out loud, is condoms are associated with people who are promiscuous and immoral.

Many forget that the first condoms were invented to prevent pregnancies. It started off with family planning.

A case lost in translation, perhaps, but no amount of information can right this negative perception if the issues surrounding sex remain a taboo subject.

Cultural sensitivities make talking about condoms doubly hard because one has to pass through the first layer of sensitivity on sex in general, before overcoming the second barrier on condoms in order to get the message on safe sex across.

Dr Soraya says Malaysians need to speak about health related issues as they are because sex is part of life, and especially when lives of young people are at risk due to ignorance of HIV and other STIs.

Although religions prohibit pre- and extra-marital sex, it shouldn't stop religious scholars from talking about condom use within marital relations because there's a growing number of wives being infected by their husbands, she adds.

"For marginalised groups like sex workers and transsexuals, we have to find other channels. But we have a door open here, why not use that open door to talk about condoms?"

From the UNDP project, Dr Soraya found that many religious professionals don't promote condom use, but they accept medical practitioners stepping in to do so.

"We cannot expect the religious authorities to speak the same language as the NGOs and medical professionals."

The female condom is a great option in helping overcome the gender power imbalances with regards to condom use, says Dr Soraya.

It is currently not available in Malaysia, but will soon be made so as a United Kingdom-based female condom manufacturer has just set up a plant in Balakong and will introduce it to the local market.

It is pricey (RM13 in other countries) but the female condom takes away the need to have the man's co-operation in using a barrier method for protection.

"It will put the power back into women's hands."

It's a short-term measure in the fight for gender equality.

Leading by example

LAST week, the Iranian government installed five condom and syringe vending machines in Teheran as part of its fight against the spread of AIDS and hepatitis among drug users.

The harm reduction campaign might raise eyebrows but scores big in the HIV/AIDS prevention milestone.

Many countries have employed various ways in bringing down the number of infection, but Senegal is probably the best example how a Muslim-majority country was able to tackle the HIV/AIDS epidemic, says Dr Soraya Aziz.

As its neighbouring countries in sub Saharan Africa struggle with booming HIV/AIDS rates, Senegal has managed to keep its number of infection down to less than one per cent of the population.

The decisive factor was that Muslim religious leaders were brought onto the agenda of HIV/AIDS prevention very early on, says Dr Soraya.

The country's leaders consulted very early on with the religious leaders, who talked openly about safe sex and reproductive health issues nationwide.

"It's possible, even in a Muslim-majority country, to do such a thing."

In Bangladesh, religious authorities and imams undergo training programmes, which touch on HIV/AIDS, gender equality and reproductive health, before they assume their role.

Because of the cultural sensitivities surrounding sex and reproductive health issues, it also makes sense to overcome the gender barrier by having women communicate with their peers, says Dr Soraya.

Mosques in China have not only male imams, but also female counterparts who reach out to the women in the congregation.

"If we need to talk about such difficult topics, perhaps female religious leaders would be more appropriate in conveying the message to the female part of the congregation."

Malaysia, too, has good practices, says Dr Soraya.

For example, the Federal Territory Islamic Affairs Department (JAWI) and PT Foundation have been holding religious classes for the transsexual community for the last four years.

"That may not translate to talking about practising safe sex and condom use, but when you have interfaces between the religious authorities and marginalised groups, you begin to have a better understanding of the needs of regular people in dealing with the issues of HIV/AIDS."

What they say:

Dr Mohd Asri Zainul Abidin,
Perlis Mufti

Islam's stance on condom use outside of marriage, even for the reason of prevention of the spread of HIV/AIDS, is non-negotiable, says the Perlis Mufti.

It is permitted within marriage for spacing of children and as a means to protect a spouse from being infected with sexually transmitted diseases by the other half, but condoms can never be misused for immoral sexual activities, says Dr Mohd Asri Zainul Abidin.

The doors of religion must remain closed on the subject of condom use in the context of unmarried couples.

"We don't want to open the doors, because that's an encouragement for people to do it (have sex outside of marriage).

"That is why all religions do not delve on this topic. All religions preach abstinence.

"If you want to have sex, get married first."

Muhamad Kasim Mohd Osman
Religious teacher in PT Foundation elected by the Federal Territory Islamic Affairs Department (Jawi)

Use a condom if you or your spouse is infected with a sexually transmitted infection to prevent it from spreading in the family institution itself, says religious teacher Muhamad Kasim Mohd Othman.

"A husband who's infected, by all means, should protect his wife. Don't put her and the unborn's lives on the line."

The Federal Territory Islamic Affairs Department-elected teacher is well aware of the prevalence of HIV/AIDS cases in the capital.

He provides religious guidance for transsexuals, one of the high-risked communities PT Foundation works with on HIV prevention, support and care programmes.

Condom can also be used for family planning, but it should not be permanent feature, he says.

"In Islam, the function of a family is clearly spelled out. Procreation is very important."

For unmarried people, abstinence works best in the prevention against HIV/AIDS.

Religion equips one with the self-discipline and inner strength needed to resist temptations like sexual desires, says Muhamad Kasim.

Even if one has not the adequate religious upbringing, high moral and discipline will help in such challenging situations.

Asked to comment on Tehran's initiative in installing condom vending machines as part of their harm reduction programme to bring down the number of HIV/AIDS cases amongst the drug users, Muhamad Kasim says this will not necessarily work out if applied in Malaysia.

"Other countries might be able to view this matter in a more open manner, but Malaysia is still very entrenched in our cultures, moral and religions. In our multi-racial setting, we hold strong to our culture."

The way forward is for the relevant parties to reach a common ground, he says.

The religious sector, medical professionals, and the society must discuss on issues on condom use because it's a sensitive matter which concerns the whole community.

"People get confused and conflicts arise when there's no synchronisation. Religions say no, society frowns upon it, but for medical reasons, you have to use it. We need answers."

Datuk A. Vaithilingam
President of Malaysian Consultative Council of Buddhism, Christianity, Hinduism, Sikhism and Taoism; Malaysia Hindu Sangam President; and Vice President of Malaysian AIDS Council

When former Prime Minister Indira Gandhi introduced a two-children-per-family campaign to control the high birth rate in India many years ago, condom was one of the widely used contraceptives.

Hinduism has never opposed to the use of condom as a family planning method, and definitely not in the case of prevention against diseases.

The main fear, however, is that it can be misused, says Malaysia Hindu Sangam president Datuk A. Vaithilingam.

"The urge to have free sex is always there. The urge to do anything is always there. But there must be some discipline within ourselves.

"We believe that sex should only be practised with the person you are entitled to, that is your husband or wife."

The President of the Malaysian Consultative Council of Buddhism, Christianity, Hinduism, Sikhism and Taoism also says the practice of pre- or extra-marital sex is a reality.

However, religions do not promote condom use to unmarried couples because it's a sign of condoning sex outside of marriage.

This is why, he says, condom-dispensing machines are not proper channels of distribution.

"It's very controversial. If you have these in colleges, it'll be an open ticket to free sex. Instead of discouraging, it might be an encouraging factor."

Should condoms be distributed, it should be done by relevant bodies dealing with HIV/AIDS prevention like the AIDS Council, says Datuk Vaithilingam.

"Religious authorities normally leave it to the medical practitioners to make decisions on condom use, but whatever the doctor prescribes, it doesn't mean you go on having free sex."

Pastor Pax Tan
Senior director of the Malaysian Christian Association for Relief

Malaysians are generally religious people, and religion has much to do with morality and working within boundaries and rules to keep the social fabric intact.

However, in the face of increasing adversities posed by the HIV/AIDS epidemic to the nation, religious authorities may have to reconsider their measures in addressing this issue, says Pastor Pax Tan.

"In this age, when sex has been proven as something increasingly done outside of marriage and among the youths, and we don't seem to be able to stop that, then we have to think how to prevent diseases and unwanted pregnancies.

"These are issues that even the religious people have to face."

Tan, who has been working on the ground dealing with prisoners, drug users, the disabled, orang asli and the HIV-positive for the last 24 years, says immoral sexual activities can best be prevented by correct teaching and moral practice.

Religion acts as a deterrent for the religious.

"But what if people still engage in sex outside of marriage? Given the prevailing moods of the day and the sense of freedom that people have to express themselves, it's very, very difficult for some to refrain from that.

"Then the next thing to do, of course, is to prevent disease and pregnancies that are not planned for."

Does that put condom as a resort, albeit the last one?

"Yes, if the person persists to do what he wants to do."

If there's persistence in having sex outside of the marriage, says Tan, there should be harm reduction, especially in the light of HIV/AIDS and STDs.

"Extraordinary times demand extraordinary measures. HIV/AIDS has now painted a brand new landscape and we have to respond in a special way. Prevention of this virus is definitely high priority."

HIV/AIDS, says Tan, is more of a gender and economic issue.

A lot of women are not in the position to deny their spouse or protect themselves, which is why at one point in time, World Health Organisation statistics showed that up to 90 per cent of women, who have the virus, got it from the husbands.

This is especially true in very poor countries, where women have no say, says Tan.

"In Malaysia, many still can't say no to sex if their husbands insist. A condom can prevent the wife from being infected. But the question is whether the husband will actually want to use a condom."

In his outreach and support programmes, Tan has encountered numerous widows and children who have been infected with HIV.

Religion plays a double-pronged role - prevention and help - in combating this issue, says Tan.

Acting as a deterrent, religion helps people to refrain from indulging in acts that will endanger themselves and others.

But religion is also about compassion.

"When someone is infected, it's our role to help that someone. We can say that what the person has done is wrong, but we cannot condemn. Religion must help to redeem."

But for that to happen, Tan says one must be armed with facts and education.

"Being religious is good, but if one doesn't know about the virus and how it's spread, he won't be able to respond in a compassionate way.

"Condemning, ostracising, discriminating and not caring for them, doesn't improve the situation any bit."

HIV/AIDS is not a punishment from God, says Tan.

"Say, a poor lady gets the virus because she cannot protect herself. A rich woman sleeps around but because she knows about AIDS and how to protect herself, she doesn't get HIV.

"Does that mean God didn't punish her but God punished a woman who slogs in the kitchen every day and does all the housework, and who had sex with the husband who got infected outside?"