Categorised | Letters to the Editor

Preventing the spread of HIV

World AIDS dayI read with some reservations on the future direction the Malaysian AIDS Council (MAC) plans to take in addressing HIV in Malaysia. Firstly, let me say that Dr Adeeba Kamarulzaman, Dr Christopher Lee, Dr Ismail Baba, and many others from various sectors, be it the medical, social sciences, as well as the many volunteers who operate shelters and outreach programmes, are selfless and continue to do important and life-saving work where it matters most — on the ground.

MAC and its partners have, over the years, won to make drugs necessary to improve the quality of life for HIV patients free, if not almost free. Also, they have fought tirelessly to shift the perception of HIV as a disease afflicting the marginalised — sex-workers, transvestites, homosexuals and others — and brought the attention to the middle society. 
 â€¨However, as trends show, HIV in Malaysia is growing and shows no sign of abating. We have on the official count over 80,000 HIV cases.

I remember that in 2003, I got together with a friend and we photographed people living with HIV/AIDS, including of course the medical teams because we felt indebted to and awed by their contribution to society — truly stories of Malaysian heroism.

Then, the statistic was over 60,000 HIV patients. In five years since, 20,000 people were infected by the disease. That is approximately 4,000 new cases yearly or about 11 people getting infected daily.
 â€¨When it was made compulsory for pregnant women to get HIV screening, we also started to see an increase in women being infected. With the opinion that perhaps four out of 10 sex workers are HIV positive, it makes sense for MAC to work with these sectors. Although, as statistics show, perhaps sex workers should not be the only target.

And here I don’t mean to narrow the scope to clients. The idea of sex work and engaging sex as a consumer in Malaysia is so fluid. It isn’t just concentrated in the red light areas in Chow Kit, Bukit Bintang, Pudu, Brickfields, Johor Baru, Klang, or where have you. Rather, the sex industry has morphed to make things more complicated; it isn’t concentrated locally. 
 â€¨Sex is an industry. People work in these industries and people pay for sex. It feeds families, it feeds desires, and it meets demands. But sex is also a way people demonstrate their most sensitive loyalties or trusts. And so, people have sex with their partner be it in a marriage or otherwise, not only to satisfy a need but also to reinforce the intimacy of a special relationship.

PT Foundation's hotline
PT Foundation’s hotline card for questions relating to
HIV/AIDS and sexuality (source:

And, sex, like many of our activities today, is action taken less through a rationalising process but more predicated on our class, knowledge, ideas of ourselves — be it masculinity or femininity — and, of course, economy. At least that is in my opinion. â€¨ â€¨Australia, which has about the same population as Malaysia, had less than 20,000 HIV cases in 2003. In 2004, there was a rise of about 6,000 new cases in Malaysia. In Australia for the same year, there were only 800 new cases.If we were to look at the distribution of newly reported cases of HIV in Malaysia in that year, Kelantan had about 600 new cases, Johor had more than 900 new cases and Selangor had over 1,000 new cases.

Australia has a sex industry as well, but how does it keep the numbers so low?
 â€¨I would like to point out that in Australia, as I was told, sex education is taught in schools and from an early age. I am advocating that Malaysia includes sex education. But we first need to engage our social sciences and medical sciences to understand the challenge for teaching safe sex in Malaysia. By this, I mean to understand the reservation of various quarters, including the government and civil society, the broader cultural and social taboos — and this is not just the Muslims, but also other religious groups.

And finally, the youths themselves. Sex education should not normalise free-for-all premarital sex. That is counter-productive to safe sex. It should instead encourage responsible sexual practices, predicated on Malaysian social norms — and here we need to broaden it beyond the narrow limits of political ideology. Malaysians do have sex; Malaysians do pay for sex; Malaysians do earn from sex; and Malaysians do express love and loyalty through sex. It is not a taboo among sub-cultural groups, such as youth groups (and here youth refers to the broader category from 15 to 40 years old). That we have a thriving sex industry in the country as well as in the region should be a wake-up call to this reality. 

Safe Sex
Safe sex package with 2 condoms and 1 water-based lubricant

The challenge facing Malaysians is: How do we address prevention? Treatment and care are actively being engaged by MAC and their partners. However, if society is slow in its uptake of feeling compassionate and discriminating less against people living with HIV/AIDS, then I would suggest the problem has less to do with the effectiveness of treatments or outreach programs. Rather, it reflects our poor engagement with a consistent and integrated approach in awareness raising.

To be effective in addressing awareness or safe sex education (be it in schools, colleges or for the general public), the tools and message cannot be imported; they need to be tailored to suit local realities and values (and again I am not referring to the ideals of our values but of our values as determined through our practices).

If our youths are engaging in premarital sex and do not use condoms, we need to understand why. If we understand it as simply being an issue of masculinity, our message may then take a gender approach. Or if premarital sex is seen as risky, then we may need to assess or understand youth and risk-taking behaviour.

But if research shows that the youths engage in sex because they want to share intimacy and that they don’t wear condoms because it is part of a more complex network or relationship building, where notions such as one’s “own” or social class is reinforced with ideas of trust, then obviously our message will be different. In this case, teaching people the facts about HIV alone will not be sufficient.

A colleague suggested if the youths think and behave as a group, then perhaps the practice of encouraging people to wear condoms should be addressed with emphasis on protecting one’s friends, rather than the idea of protecting one’s self, which may be interpreted in such a group setting as being selfish, and even anti-social.

By understanding why people have sex, we can start to understand the broader risk to the spread of HIV in Malaysia, in order to work towards reducing the numbers of newly infected cases in the years to come. 
 â€¨Addressing treatment and combating prejudices is half the battle. Effectively addressing prevention assures that victory over the spread of HIV is won. â€¨ 

Kamal Solhaimi Fadzil
Department of Anthropology and Sociology
Universiti Malaya

Note: World AIDS Day is commemorated on 1 Dec.

See also: Rising HIV infection among housewives

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