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Mandatory testing flawed


1,000 crosses put up by World Concern, USA, in support of World AIDS Day (© Andrew Conn / sxc.hu)

STARTING from 2009, Muslim couples intending to marry must undergo mandatory screening for the Human Immunodeficiency Virus (HIV). We don’t know how this became official, but it now is, with the cabinet’s approval.

Deputy Prime Minister Datuk Seri Najib Razak said the measure was the government’s response to the increase in HIV infections among women, who are more vulnerable than men. Najib also said that according to the United Nations Programme on HIV/AIDS (UNAIDS), although Malaysia has a concentrated HIV epidemic, we are recognised as having “high political will”.

Political rhetoric aside, the fact is mandatory HIV testing is flawed.

It is, for example, curious how the deputy prime minister appeals to UNAIDS’s authority to legitimise the programme, but does not tell us what else UNAIDS recommends.

Most pointedly, UNAIDS does not support mandatory testing. Instead, it recommends for all testing to conform to the “Three Cs”: involved informed consent, confidentiality, and pre- and post-test counselling.

In fact, the Malaysian AIDS Council (MAC) and the Malaysian Positive Network (myPlus) both go one step further, saying that mandatory testing actually does more harm than good. These AIDS organisations also call on the government to adhere to international human rights standards. An individual’s right to privacy, individual security, and personal autonomy must not be compromised.

Even the Malaysian Family Physicians, in its official journal, carries a commentary warning against confidentiality breaches. The commentary also questions the cost-effectiveness of mandatory testing. It concludes that mandatory testing does not guarantee a sustainable reduction in HIV transmissions.

That is only logical. After all, just because a person tests negative (for HIV) before marriage doesn’t mean that he or she will not expose himself or herself to HIV down the line. Having unprotected sex with another partner can, and in some cases will, happen no matter what a person’s test results say before marriage. How useful then is it to enforce one-off testing in the first place?

Stigma and discrimination

Furthermore, the larger environment in Malaysia stigmatises and discriminates against communities most vulnerable to HIV — sex workers, drug users, gays, bisexuals, and transsexuals.

According to MAC and myPlus, the only way around this is to ensure that the “Three Cs” are part of a larger comprehensive package that promotes HIV prevention, treatment, care, and support. Imposing mandatory testing even before such stigma and discrimination is addressed will only discourage individuals from testing, for fear of subsequent persecution.


(© Sebastian Czapnik / Dreamstime.com)

On the other hand, giving mandatory testing a veneer of moral righteousness will give those who do screen a false sense of security. If we do not arm the public with full and frank information about HIV, what’s to stop an uninformed person from thinking, “I am safe and don’t have to do this again?” It is precisely this “I am safe” mentality that causes rising infection rates in the first place.

Cloaked in secrecy

There is a history to controversial suggestions by the authorities on dealing with HIV. On 8 Oct 2008, Islamic Development Department (Jakim) director-general Datuk Wan Mohamad Sheikh Abdul Aziz said all state religious authorities had agreed to enforce mandatory HIV testing. Apparently, they all agreed in a meeting in July 2008.

What public consultation and research the authorities embarked on to arrive at this decision was never revealed. And why such testing should be put under the purview of the religious authorities and not the Health Ministry was never discussed.

The 8 Oct Jakim announcement was therefore slammed by various AIDS advocacy and service organisations in a 1 Dec joint statement on World AIDS Day. MAC president, Prof Dr Adeeba Kamarulzaman, called the announcement “alarming”.


(© Irineu I Degasperi / sxc.hu)

In 2005, then Health Minister Datuk Seri Dr Chua Soi Lek drew the ire of various Islamic groups, including PAS, for suggesting distribution of condoms, needle exchanges and methadone treatment for drug users, in order to address rising HIV infections. Chua was accused of legitimising immoral behaviour and violating Islamic laws.

In 2001, Johor was the first state to introduce mandatory testing via its religious affairs department. This was done without public consultation. There was also no disclosure of any comprehensive studies by the state authorities which caused them to arrive at this decision. Yet, since then, Kelantan, Negeri Sembilan, Sabah, Sarawak, and Selangor have followed Johor’s lead.

Islamisation’s role

It is ironic that the only time the Malaysian government actually tried to implement something conforming to international best practices and human rights standards, it was shot down by a group of religious moralists.

The irony continues. It is the Islamic groups that are now acclaiming the deputy premier the most for his announcement on mandatory testing, a measure that is clearly flawed by international standards. Muslim Consumer Association secretary-general Datuk Dr Ma’amor Osman is even suggesting extending mandatory testing to non-Muslim couples.


Katagender parodying the whip invoked on women senators to pass the Islamic Family Law Bill in 2006
(pic courtesy of Ezrena Marwan)

This demonstrates that the power struggle is not solely within the domain of the HIV discourse. It is also embedded in the larger matrix of Islamisation in Malaysia, and the accompanying warnings not to question policies and laws inspired by certain interpretations of Islam.

The power struggle is not just limited to discourses within the country. In 2001, Malaysia led a bloc at the UN to deny a general assembly resolution that would protect the dignity and rights of lesbians, gays, bisexuals and transsexuals.

Nevertheless, it is disingenuous to blame Muslims or Islam for regressive approaches to HIV. The world’s most progressive HIV harm reduction programme has been implemented in none other than the Islamic Republic of Iran, a regime seen by many as fundamentalist Islamist.


(© Jan Roger Johannesen / sxc.hu)

Because of regular consultations with conservative ayatollahs, Iranian activists have managed to give clean syringes and needles to heroin users, and distribute condoms to sex workers. Government clinics nationwide offer free counselling, testing and treatment. Tehran has even allowed condoms and needles to be available in its prisons — acknowledging tacitly that the more humane solution is to protect inmates from HIV rather than judging their sexual activities and drug-taking. 

The way forward

Malaysia still sees alarming rates of violence against women, including marital rape and domestic violence. There is still widespread stigma against sexual minorities  — the October 2008 fatwa banning tomboys is but a recent example. Condom use is nearly impossible to promote in the mass media.

Also, the class dimension of HIV infections has scarcely been addressed. The most economically vulnerable do not have the means to access counselling, testing and treatment.

Meanwhile, Malaysians who question decisions by the Islamic authorities are also routinely warned, threatened, and harassed. The government even uses “insulting Islam” as an excuse to detain citizens without trial under the Internal Security Act.

Having said this, it is so easy for opponents of mandatory testing to lose the moral high ground. After all, an ordinary citizen would ask, isn’t mandatory testing only logical and good for the couples involved?

The answer, unfortunately, is a resounding no. In Malaysia’s environment, rife with stigma, discrimination, and impunity, it is a mistake of catastrophic proportions to impose mandatory testing for HIV. The better solution would be to educate the public — fully, frankly, and without discrimination — on the facts of HIV transmission and the many ways to prevent and treat it.

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6 Responses to “Mandatory testing flawed”

  1. There are also I think constitutional questions involved here. Health policy for the whole country is under the purview of the Ministry of Health (MoH). But here you have another agency making health policy which has budgetary implications on another agency altogether (only doctors or nurses are allowed to draw blood from anyone, for instance).

    The reason this is only for Muslims is very simple. Religious issues come under state control. Therefore HIV is being treated here as a religious issue, not a public health issue. This is why no public health arguments work with the state religious departments (I should know, I led a delegation to meet with the Johor religious department in 2001).

    Bringing in religion into AIDS then puts a complete different colour to discussion on it. One which will ultimately lead nowhere and will probably cause more infections and more deaths.

  2. Yin Shao Loong says:

    So glad you wrote this Shanon. The announcement sent civil liberties alarm bells ringing in my head. This mandatory testing overrules years of struggle by HIV/AIDS campaigners and opens the way to an authoritarian approach to public health.

  3. Kamal says:

    It is disturbing to know that HIV is fast becoming a platform for Islamic agencies to branch out from what was seen ordinarily as Islamic matters (in the past I used to think this was mostly family or perhaps ritual matters).

    Today, Islamic agencies are everywhere – but here in regards to HIV they appear a little more concerted. I agree that HIV is a public health issue. However, because it does relate to social issues – such as sex, trust ,and gender relations, it should have a broader dimension.
    Rather than limit it to public health (and the assumption that it is a matter solely for MoH), it should be something that almost all ministries should engage in. Here at least, the more the merrier. For instance, there is room to talk about HIV among youths, in the labour ministry, among women and children, in the foreign ministry, in the home ministry, etc.

    And the public should get involved. Furthermore, I find it very disheartening that at the heart of this issue, people are not asking PLWHA what they feel. They certainly are important as the actions taken effects them directly.

    It is also sad to read in a related story that once found positive, couples are advised by the physicians/authorities not to get married. If a couple chooses to marry, the blood test, like the kursus kahwin in my opinion is just formality. The authorities have no right to discourage marriage but having done so it reflects the continued stigmatisation that some physicians and other people in authority have towards those infected.

    Would the authorities also advise someone who has had TB not to follow through with plans to get married? With such attitudes among those in authority towards HIV, are we to expect that the issue will be address objectively and without prejudice?

  4. pilocarpine says:

    “Bringing in religion into AIDS then puts a complete different colour to discussion on it. One which will ultimately lead nowhere and will probably cause more infections and more deaths.”

    Couldn’t have agreed more. Health matters must be handled by health personnel. Would they have liked it, if health personnel made a policy or two on religious matters?

  5. Jessie Seng says:

    And given the government’s poor accountability record in the handling of both public and private matters – more pointedly, the leak of Saiful Bukhari Azlan’s medical report – the confidentiality factor is a big question mark.

  6. Born2reign says:

    As usual the govt is good at initiating a policy but not implementation and maintenance (follow through) of a policy.

    I believe that HIV affects those who promote polygamy and have weak protection for victims of sexual crimes and for women. That is the reason the government wants to appear to be protecting the Muslim community without revealing too much, hence going through the Islamic channels.

    Again, it fails to address both the preventive AND the detective measures. What happens after positive detection? How can we prevent that HIV from infecting the next person he/she has sex with, or shares the needle with?

    On lack of confidentiality – do both partners have the right to know of each other’s test results? And if one tests positive, will the rest of the family members and extended members be highlighted of the “real reason for cancellation of marriage”? Even if they are not told, will these relatives be nosy and start gossiping hence create a stigma for the unwed couple?

    I myself was tested for HIV when pregnant however no consent was sought and the nurses just went ahead anyway. Is that our health policy? Just detection, detection, detection?

    AIDS is the outcome of a certain lifestyle. Yes, some may have got the HIV through innocent blood transfusion, but the main reason in Malaysia is drug use and unsafe heterosexual intercourse. Will this be a generation curse for those who indulge in extra-marital affairs?

    Should not the policy be HIV testing for Muslims on an ANNUAL BASIS, if the government is serious about identifying those with HIV?

    AIDS is not prejudiced, unlike Malaysian education and housing and politics. AIDS affects all who choose an unhealthy way of living and is a generation-curse due to the actions of the heads of families (parents). In many developed countries, they have very strong awareness campaigns to prevent the stigma against people with AIDS. Here in Malaysia, just a song or two on RTM is called awareness? Just take a look at the awareness of safety-belt usage for car passengers – non-existent and pathetic.

    All I believe of the Mahathir/Badawi/Najib regime is detective tests means more money for the cronies. Healthy citizens do not put money in cronies’ pockets.


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