KUALA LUMPUR: Human immunodeficiency virus (HIV) infection that leads to acquired immune deficiency syndrome (AIDS) was first detected in Malaysia, back in 1986.
Thirty three years on, Malaysia is ranked the seventh highest in adult prevalence of HIV/AIDS in Asia after Thailand, Papua New Guinea, Myanmar, Cambodia, Vietnam and Indonesia, with a 0.45 per cent prevalence rate.
Malaysia’s Health Ministry’s data showed that every day, an average of nine new HIV cases and two AIDS-related deaths were reported to health authorities nationwide.
According to the United Nations, Malaysia is one of the 10 countries which together accounted for over 95 per cent of all new HIV infections in Asia-Pacific.
In a recent interview with the New Straits Times, PT Foundation acting chief operating officer Raymond Tai made a poignant observation about World Health Organisation’s theme for World AIDS Day titled ‘Communities make the difference.’
“HIV is both preventable and treatable. HIV isn’t a death sentence, it's societal stigma and ignorance that drives key populations underground, restricting their access to prevention, testing and treatment,” he said.
Unless and until there is strong will among our communities to normalise conversations about safe sex to break down social stigma and discrimination, he reckoned Malaysia is not likely to be able bring down the rate of new HIV infections.
Tai said societal stigma drives internalised stigma which often result in psychological and emotional struggles for those who do not fit into the 'social norms'.
In Malaysia, ‘social norms’ dictate that only sex between a man and a woman who are married to each other is legitimate. Monogamy is held up as the ideal, and outside of it, only abstinence is promoted.
Therefore, anyone who does not conform to these ideals tend to be regarded as morally undesirable. They include single men and women who engages in pre-marital sex, gay and lesbian couples whose relationships are not recognised, transgender men and women.
Even if teenagers are curious and aware of the basic use of condoms for HIV/AIDS prevention, it takes a lot of courage to buy condoms at convenience stores, discuss safe sex with their partner, and use the protective barrier properly.
"The challenge to openly buy condoms at supermarkets and ask for advice on proper use of 'the rubber' is compounded if the person is a school dropout, a gay man or a transgender woman," Tai said.
He went on to highlight government-funded sexual reproductive health education tend to leave out such groups.
He said awareness on HIV/AIDS preventive methods and how to access these prevention methods are not readily available to marginalised groups who tend to be of low income earners and lacking in educational knowledge.
"It tends to be left to non-governmental organisations (NGOs) like PT Foundation to reach out to these marginalised groups," he said adding with scant resources and restrictions on access to mainstream media, NGOs can only reach out to small segments of people living in urban cities.
Today, there are far more effective means of protection, aside from condoms, such as the Pre-Exposure Prophylaxis (PrEP), a pill taken daily to prevent the spread of HIV infection.
"PrEP has been proven to be even more reliable than condoms in HIV prevention. Yet, this is not accessible through government clinics and only available at selected private clinics at high prices," Tai said.
He also said many people living with HIV still go to considerable lengths to hide their antiretroviral drugs from family members and colleagues in the office, so that their HIV status is not revealed. "They are driven by fear of the way others will treat them, if their HIV status is revealed."
Established more than 30 years ago, PT Foundation now runs comprehensive sexual health programmes focusing on key affected populations.
Its flagship programmes include the Community Health Care Centre Clinic (CHCC), MSMPOZ, a Treatment Adherence and Support Programme for men who have sex with men and those who are living with HIV.
Concurrently, PT Foundation runs the compassionate 2nd Chance Programme, which provides a psycho-social mentoring and support initiative for urban poor children infected or affected by HIV/AIDS.
PT Foundation also initiated online communication campaign Take Charge Today to promote safe sex, HIV and sexually transmitted infections testing and access to community friendly clinics throughout Malaysia.
Tai highlighted the CHCC is being managed as a social enterprise, of which beneficiaries of the programme pay a small fee for sexually-transmitted diseases tests and counselling services.
"Some pay forward more donations which enables CHCC to sponsor HIV tests for those who cannot afford them. Fees are kept low because selected test kits are sponsored by the Health Ministry, while more expensive fourth generation test kits are offered to CHCC at a discounted price," he said.
The CHCC, based on this business model, is recognised by government agency Malaysian Global Innovation Center (MaGIC) as a sustainable social enterprise.
Recently, the World Health Organisation declared AIDS can globally end by 2030, if all nations are able to get at least 90 per cent of those who are at high risk of HIV infection to be tested, and if the results are HIV+ they are provided access to treatment, and they must follow through with their treatment.
Tai explained the medication for HIV is so effective in this day and age that a HIV+ patient who has been on treatment for more than six months can "become virally undetectable."
At this stage, he explained, the HIV+ patient cannot infect another person during sex, even if a condom is not worn.
In view of such medical advances, Malaysia's government had reportedly committed to end AIDS here, by an even earlier date – 2023.
"While we now have the medical advances to end AIDS, the battle in Malaysia is to eliminate stigma and discrimination," Tai said. This involves a shift in how soon Malaysia can move from a conservative and judgemental culture to one that embraces diversity, irrespective of race, religion and sexual orientation.
For this to happen, Tai urged the government to lead the way in being more inclusive. "We need more enabling laws and policies.
"There has to be more political will in channeling more funding and efforts into HIV/AIDS prevention as a matter of public health and community development."
In a separate interview, Karex chief executive officer Goh Miah Kiat said for the past decade, his team has been working closely with the government and non-governmental organisations to raise awareness among our society, the importance of safe sex.
It is not easy to encourage sexually active adults to choose condoms over other contraceptives and as as part of safe sex practice.
Many men using a condom during sexual intercourse with their lover have have described it cumbersome and limits physical contact. Some have even likened wearing a condom is like "taking a shower in a raincoat."
Despite such feedback, the World Health Organisation advocates the condom is still the most effective tool in family planning and disease prevention.
Goh said there are many types of condoms that couples can choose from that can ensure safety that does not compromise on pleasure.
Karex produces five billion condoms annually from its four factories, with much of its output being sold in bulk to international agencies for family planning and safe-sex drives.
Malaysia is the world’s biggest exporter of condoms. According to Malaysian Rubber Export Promotion Council, in the first six months of this year, condom producers here shipped out RM163.5 million worth of the contraceptives to more than 180 countries worldwide.
Goh reiterated early family planning and sex education is extremely critical to Malaysia's economy to reduce and eradicate heartbreaking social ills such as like baby dumping, unintended pregnancies and deadly sexually transmitted infections such as AIDS.
"We're here to break barriers, overcome stigma and to get people comfortable enough to talk about sex in an educational and beneficial way," he said.
"We want to make condom use as socially acceptable as toothpaste and safer sex as second nature as wearing seatbelt," he added.
As part of Karex corporate social responsibilities, Goh said for the sale of each pack of ONE condoms, 50 sen will be channelled to PT Foundation, which provides HIV/AIDS support programmes, when purchased through ONE condoms official stores on onecondoms.com, Shopee or Lazada.