Needle and syringe exchange kit used as part of a programme aimed at drug users,
who comprise about 75% of those detected with HIV/AIDS in Malaysia
TWENTY-three years after the first HIV infection was detected in Malaysia and 11,400 deaths from AIDS later, health workers are still facing obstacles from the authorities in preventing the spread of the disease.
There have been about 85,000 reported HIV infections in Malaysia since 1986. Although the number of infections were at first mainly drug-related, the number of transmissions through unprotected heterosexual intercourse has increased from 19% of new infections in 2003 to 26.8% in 2008. In Malaysia, the virus is mostly transmitted through the use of needles by drug users and through unprotected heterosexual sex.
Despite the statistics, however, law enforcement officers continue to thwart attempts to prevent the spread of HIV/AIDS by the government and by non-governmental organisations (NGOs).
Police thwart efforts
Reena, a PT Foundation programme coordinator who has lived with HIV for 15 years, says the police make it very difficult for NGOs to carry out condom distribution programmes. Carrying more than two condoms is used as evidence that the person is a sex worker, she explains.
“I’ve been scolded before (by PT Foundation clients) for distributing condoms. A half hour after my client accepted the condom from us, she was arrested and charged because she had a condom. She had to pay a fine of RM3,000. How could she pay that amount when she only earns enough to survive for the day?” Reena says.
Reena and others were speaking at a media sensitisation workshop organised by the Malaysian AIDS Council (MAC) on 30 Nov 2009. The workshop was held in conjunction with World AIDS Day which falls on 1 Dec.
Manimalar, a 30-year-old sex worker, testifies of personally encountering such problems with the police.
(Pic by zts / Dreamstime)“If I bring a condom to work, I can be arrested by the police. Even if it’s just one condom in my pocket or my bag. The police say keeping a condom is [evidence of my crime], but I want to be safe and to protect myself. Mesti pakai kondom, kalau tidak boleh kena HIV,” she says.
Khairuddin Mahmud, who manages a drop-in centre for drug users, says the police often conduct raids and arrest participants of a government-sponsored needle and syringe exchange programme. The needle exchange is part of a harm-reduction policy targeted at drug users, who comprise about 75% of those detected with HIV/AIDS.
“First, [the drug users] undergo counselling about how not to transmit HIV. We also distribute condoms [in addition to the needle exchange]. Eventually, once they decide they don’t want to inject, and shift to methadone (used in drug replacement therapy and to overcome addiction), you can see the difference. They get jobs and they can take care of themselves,” says Khairuddin.
Khairuddin, however, says it is very difficult to conduct counselling during their outreach programmes as they would frequently encounter police raids.
“Some of the police are okay. They understand, but then they keep on changing personnel and we have to start all over again. I think there should be ongoing refresher courses for the police,” he adds.
To the credit of the police top brass, however, a lot of the top-level police have been sensitised and have been “super responsive”, says Kevin Baker, a consultant with PT Foundation. “We’ve been told to take down the badge numbers of individual police officers if we have problems and that these cases will be followed up.”
Still, that doesn’t resolve the immediate problems on the ground when lower-ranking officers on the beat are clueless about the importance of condoms and needle exchange programmes in the fight against HIV infections.
Worse, Zulkiflee Zamri, who is the drop-in centre coordinator, says drug users also find it difficult to continue their HIV/AIDS medication once they are arrested.
Lack of facilities
Zulkiflee says even if drug users with HIV/AIDS decide to give up their drug habit, there are still challenges. He says that obtaining methadone can sometimes be difficult.
Zulkiflee “When they are overcoming addiction, getting them into a HIV/AIDS shelter is also difficult,” says Zulkiflee. “A lot of HIV/AIDS shelters have strict criteria [that they cannot meet]; the facilities are very limited for them. They just want a place where they can have some peace and rest to recover, but there is nowhere for them to go. The HIV/AIDS shelters that are available don’t want to tackle withdrawal.”
Baker notes that stigma and embarrassment often prevent those who most need help from seeking information about HIV/AIDS.
“Many are not empowered or comfortable enough with their own sexuality to ask for information. So, they don’t take the condoms that we distribute,” says Baker.
Public still clueless
Manimalar says before she came to KL, she did not know about HIV or AIDS. It was only through PT Foundation in KL that she was educated about how to protect herself against HIV/AIDS.
“The aim is to stop the spread of the virus,” says Pax Tan, chairperson of the MAC media sensitisation workshop. “We want to counsel and educate people, so that those with the virus do not spread it by having unsafe sex with their wives, girlfriends or partners.”
But without the understanding and support of the relevant authorities, stopping the spread will continue to be an uphill battle.
Mandatory testing flawed
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