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HIV – The Malaysian Dilemma

dr farrah

Recently SIS posted on their page regarding the stigma towards HIV in Malaysia and quoted the Malaysian AIDS Council (MAC) in one of their publications.

I quote a paragraph in the article (http://www.themalaymailonline.com/what-you-think/article/hiv-concerns-all-a-shared-responsibility-malaysian-aids-council):

“We must recognise that it is not a person’s sexual orientation, gender identity or the fact that he/she is a drug user or sex worker that puts one at risk of acquiring or transmitting HIV, but the failure to adhere to appropriate measures to prevent HIV for lack of knowledge and access to prevention tools in addition to a myriad of other factors. In Malaysia, restrictive socio-cultural and legal environment and pervasive stigma and discrimination prevent individuals most at-risk from coming forward to access HIV prevention and treatment services.”

SIS also posted, and I quote:

“Time and time again, SIS has been lambasted simply for referencing accurate data from legitimate sources. #Isma on the other hand, continues to perpetuate the HIV stigma, by confusing risky sexual behaviour with sexual orientation. Risky sexual behaviour is not exclusive to only homosexuals.

Thus, we suggest that rather than spreading inaccurate information on the contraction of HIV, let’s now move on to focus on the actual groups affected by HIV, implement policies accordingly and end the stigma against HIV positive individuals.”

The above entry was a response to an article by Dr Rafidah Hanim entitled; Homosexuality: In defence of JAKIM.

We know that HIV is not a new issue in Malaysia and this topic was highlighted in the media because of the recent move taken by JAKIM to distribute flyers entitled “10 myths about homosexuality”. I regard this as a brave act although the malaymail online quoted some criticism on the way the flyers were presented as well as their contents.

Well, for once congratulations JAKIM for taking a brave move and as a doctor I will support your efforts by all means. The medical wing of ISMA – i-Medik will surely be willing to put our efforts into producing a better quality and well researched flyers if we are consulted by JAKIM or any other bodies interested in spreading the facts – straight and unbiased.

Again, HIV is not a new issue in Malaysia but relying on the “so called” experts in this field alone does not show any improvements in the statistics. The prevalence of HIV in the last 7 years maintained a steady 0.5% whilst the number of people living with HIV/AIDS has doubled since 2007. We now have about 100,000 people living with HIV/AIDS in Malaysia (CIA World Fact book, 2011). If current efforts are proving benefit, we would have seen a different scenario.

The statistics also stated that Malays are the largest group being affected with HIV/AIDS and that is why JAKIM’s role in the recent event cannot be downgraded.
As a medical doctor, obviously I share the responsibility of improving the statistics. I disagree with the first paragraph I quoted from MAC when they brush off sexual orientation, gender identity, being sex workers or drug users as irrelevant but we should rather focus on the lack of knowledge and access to prevention tools. Religious and cultural values were also blamed into deterring certain group of people from treatment services.

As a practicing doctor, I will say that social stigma is not deterring these patients to seek help. From my medical career I see a lot of cases where patients were not shy or reluctant to admit that they are involved in high risk behaviours. They do admit of sexual promiscuity, intravenous drug use or homosexuality openly, I need not explain to great length before they pour out their life story.

I was also involved in HIV/AIDS pre marital councelling for patients. Yes, some come in with tears and remorse but certainly not shyness. I don’t see them as a product of social stigma. There are too many cases, from adults to paediatrics HIV but in respect of their confidentiality, I will not describe these cases here. These encounters allow me to make better judgement on the HIV perspective in Malaysia.

A public campaign like JAKIM’s does not equate to social discrimination or stigma but rather a kick start for Muslims to shed some light regarding this matter.

Secondly, I don’t agree when they brush off high risk behaviors too easily. Yes, knowledge needs to be increased and prevention methods as well, but the best prevention is to avoid these high risk behaviors in the first place. In medicine, good history taking involves identifying risk factors for patients to develop a particular illness, be it diabetes, stroke or HIV/AIDS. What’s wrong with identifying these risk factors? If you think that we shall not touch or talk about risk taking behaviors then you are the ones who are being phobic and overly sensitive about this issue.

To me, let patient talk to their doctors and be open about it. If we shouldn’t discuss about patients sexual orientation, then why bother about patients’ dietary history or exercise regime? Why the stigma only on sexual orientation?

In the second paragraph, ISMA is accused of spreading the HIV stigma by focusing on homosexuals only, since the statistics also shows that the prevalence of HIV in heterosexuals is higher. Well, this is an obvious fact because most of Malaysians are heterosexuals and homosexuals make about 10% of the population. This is not rocket science.

Let’s think about how heterosexuals get infected. Heterosexuals get HIV not from being heterosexuals alone but from either having partners who are bisexual, practice sexual promiscuity, is an intravenous drug user or through a blood transfusion. They then spread this infection to their partners. So, being heterosexual alone is not a risk factor, but being homo is a direct risk factor. So what’s wrong in dealing with the root of the disease?

Of course, homosexuality is ONE of the factors and there are many more that needs to be addressed. We’ll get there soon.

To conclude, let’s all do our part in this issues rather than criticizing other peoples’ effort. JAKIM and ISMA will focus on the Islamic values in addressing this issue because we believe that that’s where the solution lies. We will continue to provide accurate data and share medical experiences to help our fellow Muslims. If others believe in what we do, they are more than welcome to join us. For now, enough talking and more work please. We can’t grow giant beanstalks overnight.

Dr Nur Farrah Nadia Najib
Chairperson
Biro Keluarga dan Masyarakat
Ikatan Muslimin Malaysia (ISMA) Johor

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