PETALING JAYA, 18 Nov 2008: Although the spread of HIV in Malaysia has largely been among injecting drug users, there is growing concern that heterosexual transmission is on the rise. Most vulnerable to this are housewives.
According to data by the Ministry of Health, the number of new reported HIV cases among housewives was 13 times higher than among sex workers in 2007, compared with four times higher than sex workers in 2002.
Dr Christopher Lee, president of the Malaysian Society of HIV Medicine, said the next HIV-related outbreak in Malaysia could be heterosexual-behaviour transmission.
“Malaysia seems to be heading towards the trend in African countries, where more and more housewives are infected with HIV,” he told The Nut Graph.
The trend is worrying as the number of people with heterosexual behaviour is much higher than that of injecting drug users (IDUs). However, Lee said the data on sex workers living with HIV could be under-reported because some women might be part-time sex workers but do not declare this.
He added that some of the housewives could also be married to drug users, which would increase their risk of infection.
Azrul Mohd Khalib, United Nations HIV/AIDS coordinator in Malaysia , said most HIV infections among women in Malaysia occur through heterosexual intercourse, “especially through sex [with] their husbands.”
In 1998, only 6% of the new reported HIV cases were among women and girls. In 2007, the number of new reported cases among women and girls rose to 16%.
The number of reported Acquired Immune Deficiency Syndrome (AIDS) cases among women also increased by 54% between 2002 and 2007. At the end of 2007, there were 70,604 people in Malaysia who were known to be living with HIV, and 10,334 were known to have died of AIDS.
Addressing the problem
Lee said the authorities need to have a good data-collection method, which could, for instance, take into account how many housewives living with HIV are married to IDUs or ex-IDUs, in order to understand the issue comprehensively.
He said empowering women to have more say in practising safer sex is important in tackling the spread of HIV.
“The [women’s ministry] should assist in the HIV programme. It is important to have a targeted HIV programme for vulnerable women, such as wives of IDUs.”
Azrul echoed Lee’s concern, noting that Malaysia should look at the epidemic from a gender perspective.
“More funding for sex-related HIV-prevention projects in Malaysia will benefit women,” said Azrul.
He also noted that marriage is not a guarantee of safety from HIV for women. “Mandatory premarital HIV testing does not provide such assurance either,” he added.
Looking at the rise in heterosexual transmission, HIV education among the younger generation has become more urgent than before.
Dr Kamarul Azahar Mohd Razali, a paediatric infectious diseases consultant at Kuala Lumpur Hospital, said introducing sex education in upper primary schools is important.
“Sex education will teach the future generation on sexual rights and responsibilities, and to engage in a sexual relationship when they are ready and in marriage,” he said. 
