HIV/AIDS battle: Glimpse of hope amid mammoth task

Extracted from the Malay Mail,

health3KUALA LUMPUR, Dec 1 — Through the years, HIV/AIDS has killed and deprived families of their loved ones.

But what was once a deadly disease without any way of being conquered, it has now been tamed, thanks to the multitude of efforts to combat it. 

While there is still no cure in sight, medication like anti-retrovirals (ARVs) have prolonged the lives of those with the disease.

Another element to stop the disease in its deadly track is prevention. 

This includes methods such as the harm reduction programme and safe-sex. 

Battling HIV/AIDS is a mammoth task, no thanks to the stigma and discrimination attached to it. 

Sex and drugs. There is no way of looking past that, leading some saying that those living with the disease must have “asked for it”. 

Malaysia is not unique when it comes to being a part of the disease’s landscape.

Sex workers, injecting drug users (IDUs), transgenders and men who have sex with men (MSM) are not the easiest to reach because they, more often than not, choose to be under the radar for fear of being exposed.

The government spent more than RM180 million (almost 66 per cent) last year in care and ARV treatments while close to RM28 million (15 per cent) for prevention.

When prevention methods are put into place, positive results can be seen. 

Targeting IDUs through harm reduction has seen the number of new infections drop by more than 50 per cent between 2009 and 2013. 

This is in comparison to the 90s where 70 to 80 per cent of new cases were through sharing of syringes.

A study funded by the World Bank and carried out by Universiti Malaya’s Centre of Excellence for Research in AIDS (CERiA) last year showed harm reduction saved the government RM47.1 million in direct healthcare costs — money it would have had to spend on treatment and monitoring. 

A projection for 2006 to 2050 showed about RM910 million can be saved if the methadone maintenance therapy and needle syringe exchange programmes continued.

There is an average return of RM1.13 for every RM1 invested to the programmes while more than 23,000 infections would be prevented over the next decade. 

This leaves the other prickly element of sexual transmission, where the proportion of HIV infection has increased to be dealt with. 

More can be done

CERiA director Prof Dr Adeeba Kamarulzaman said more could be done to ensure further success of harm reduction and providing ARVs in the country. 

Besides widening the coverage of the programmes, she said more support, including equipping them with the necessary job and life skills that can enable them to reintegrate into society.

“We need more one-stop centres such as the Cure and Care Centres by the National Anti-Drugs Agency where treatment is integrated in a friendly environment. It is more than doses of methadone or adhering to the ARVs,” said Dr Adeeba, who is also Malaysian AIDS Council (MAC) exco member. 

“There is a quiet acceptance but we still get flak from the abstinence-based people. But harm reduction has been proven to be bring down infection rates.

“Those tested for HIV on site need to get advice on treatment. It’s the same with Hepatitis C. There are many problems that have not been sorted out yet but this can always be improved.”

Dr Adeeba said Malaysia was a classic case of a concentrated epidemic where the infection rates among sex workers and MSM are high, adding specific programmes needed to be drawn such as having 100 per cent condom use for them. 

In addition, she said there should be age-appropriate sex education. 

Statistics between January and June showed 25.1 per cent of new infections are under the non-heterosexual category such as bisexuals, MSM and transgenders while the risk of transmission from IDUs is 18.97 per cent. 

Heterosexual tranmissions tops the list at 50.1 per cent.

“Malaysians must face the facts and address the ongoing HIV transmission in the MSM, sex worker and transgender communities. We need to look at this from a public health perspective instead of moralising the issue,” she said.

“We cannot let our guard down.”

The projection for the number of new HIV cases for the year has been put at 3,352 and there has been 103,348 HIV infections, 20,833 AIDS cases and 16,742 deaths.

There are 86,606 people living with HIV/AIDS.

Planned international conference

Strides were made by various stakeholders such as the government and MAC (part of whose advocacy efforts is sustained through Yayasan Sime Darby) has led it to playing host to the International Harm Reduction Conference next year. 

Harm Reduction International executive director Dr Rick Lines said one of the reasons was because of the country’s leadership shown in having the preventive method. 

He said studies showed money can be saved and the programmes gave a positive effect in preventing diseases like HIV and Hepatitis C. 

“The returns from harm reduction are definitely more. The harm reduction approach is a positive approach,” he said. 

“The intervention is basic but what makes it complicated is that the disease is loaded with with difficulties. There is criminalisation and stigma.” 

He said harm reduction could be implemented successfully if it was viewed in a scientific manner. 

“Don’t judge or stigmatise. There needs to be an openness for it,” he said, adding that success to a harm reduction programme was also dependent on whether the needs of clients such as housing, legal aid and child custody were looked into. 

Dr Lines sounded the same warning that sexual transmission needed to be addressed and prevention is by way of condom usage. 

Condoms at beauty product stores

Condoms have been sold at The Body Shop outlets in Malaysia for more than 20 years, during a time when condoms were hardly available elsewhere. 

“There was a period when it was our top selling item,” said Datin Mina Cheah-Foong, managing director of Rampai-Niaga Sdn Bhd, the franchise holder for The Body Shop in Malaysia.

Cheah-Foong said the rationale behind selling condoms was to provide a safe environment where women themselves could buy it without being judged. 

“Women often play the passive role when it comes to sex. It’s not just about AIDS but also about STDs, hygiene and self awareness,” she said.

Cheah-Foong said the environment could also provide an avenue for parents to talk about the subject to their children. 

While pointing out that the principles of abstinence and faithfulness remained, she said if one was unable to do that then “use a condom”.

After a hiatus of a few years, The Body Shop relaunched its sale of condoms, with the Malaysian AIDS Foundation (MAF) and ESP Condoms through #PutItOn, a year-long social media-driven campaign that was aimed at raising awareness of the disease and to evoke social change.

This is a response to the increase of sexual transmitted infections in the country. 

“We stopped it for a while because we thought the numbers were declining. But now, it is rising again,” said Cheah-Foong, a former MAF trustee. 

Each box has three pieces of condoms and will be sold at RM5. All proceeds will go to MAF. 

As with the previous time when it sold the product, The Body Shop also includes vital information about HIV and safe-sex.

“It is to cater to a new generation that has more access to the Internet,” she said.