Groups want HIV prevention treated as a health issue

PETALING JAYA: Several AIDS related foundations have spoken out against the call by a group of local medical experts for the Health Ministry to review its plans to scale up the use of pre-exposure prophylaxis (PrEP) to curb the spread of HIV.

In a joint statement, the Malaysian AIDS Foundation (MAF), the Malaysian AIDS Council (MAC) and Malaysian Society for HIV Medicine (MASHM) argued that HIV prevention should be treated as a health-related issue.

And, that it was wrong to discriminate when it came to the provision of PrEP, which is an oral medicine that reduces significantly one’s chances of getting HIV from sex or injection drug use.

The Health Ministry is planning to dispense PrEP for free at public health clinics in the Klang Valley, Selangor, Johor, Penang, and Sabah beginning next month.

“MAF, MAC and MASHM strongly disagree with the position taken by Dr Rafidah Hanim Mokhtar and her colleagues that effectively discriminated against the men who have sex with men (MSM) community from accessing PrEP for HIV prevention,” said MAF chairman Prof Datuk Dr Adeeba Kamarulzaman.

Besides asking the ministry to review its plan to scale up the use of the PrEP, the professors have wanted it to instead implement an abstinence-based approach to deal with the issue.

Dr Rafidah Hanim and several university professors published a statement in an online portal on Dec 6, expressing concern that scaling up the use of PrEP among MSM would disrupt the moral fabric of Malaysian society, including resulting in high economic cost.

“Abstinence is the only key message that we should repeatedly promote to prevent HIV infection among the MSM community,” the group advocated.

Apart from Dr Rafidah Hanim of Universiti Sains Islam Malaysia, the statement was also signed by Prof Dr Samsul Draman from the International Islamic University Malaysia, Prof Dr Anis Safura Ramli from Universiti Teknologi MARA, Prof Dr Harmy Mohamed Yusof from Universiti Sultan Zainal Abidin, Assoc Prof Dr Rosediani Muhamad from Universiti Sains Malaysia and Assoc Prof Dr Ani Amelia Datuk Zainuddin from Universiti Kebangsaan Malaysia.

Prof Adeeba noted that the blatant objection to the use of PrEP for the MSM community did not reflect the current reality of the HIV epidemic in Malaysia.

“In 2021, 96% of new HIV cases were caused by sexual transmission, concentrated largely among the MSM community.

Despite the weight of their vulnerability to HIV, the MSM community is also among the hardest to reach with HIV prevention services,” she said, adding this was due to the punitive legal system that criminalises their behaviour.

She cited a recent study in Australia involving 10,000 PrEP users which showed that the new rate of HIV transmission decreased by almost 90%.

The group noted that MAC faced similar objections from detractors a decade ago when pushing for the Needle Syringe Exchange Programme (NSEP) under the Harm Reduction Initiative.

“A study conducted by the Centre of Excellence for Research in AIDS revealed that more than 13,000 new HIV infections were prevented in the first eight years of NSEP (2006-2013), which helped save some RM47mil in health care cost,” the joint statement read.

“We need to treat HIV prevention and care as a health-related issue, not a moralistic one and recognise history is repeating itself here with previous discussions around condoms and antiretroviral treatment and risk compensation,” added MAC president Assoc Prof Dr Raja Iskandar Raja Azwa.

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