Removing our shame about the topic of HIV and stopping the shaming of others would help us to achieve the target.
ANOTHER World AIDS Day has gone by. Routinely around Dec 1st every year, many fundraisers and advocacy events are held, many reports are published, and many government agencies reiterate their commitment to achieving a world where 90% of people who are HIV-infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment (ART) and 90% of those who receive ART will be virally suppressed (that is, the 90-90-90 Target).
This goal is set by UNAIDS to end the global AIDS epidemic by 2030. With barely 12 years to this deadline, AIDS-based research, together with policy responses and policy implementation, should be accelerated.
Yet 34 years since the landmark paper by Barré-Sinoussi et al identifying the cause of a leukaemia-like disease affecting gay men, that later became known as HIV/AIDS (https://www.ncbi.nlm.nih.gov/pubmed/6189183), the language on mitigating the AIDS response remains negative and discriminatory.
Many are still wont to describe HIV/AIDS as a morality disease, rather than a medical one.
A recent statement by SEED, an NGO that advocates for the rights of marginalised groups in the Klang Valley, highlights the continuously discriminatory, bigoted language used by government-affiliated officials when discussing HIV/AIDS. I wish to unpack here why framing the issue around HIV/AIDS in a negative light would deter Malaysia from achieving the 90-90-90 Target set by UNAIDS.
Firstly, some facts. HIV/AIDS in Malaysia remains a concentrated epidemic, predominantly affecting men, with recent data showing a shift in mode of transmission, from it being a medical problem predominant among injecting drug users, to a medical problem that needs to be addressed by any of us who are sexually active.
Framing HIV/AIDS solely in the LGBT prism risks missing women who are at risk of contracting the virus from their intimate partners.
This is backed by UNAIDS data that showed a decrease in the male/female infection ratio of 9:6 in 2000 to 5:5 in 2015 (that is, more women are reported to test positive for HIV).
As the mode of HIV transmission in women is predominantly through sex, women risk contracting cervical cancer from Human Papillomavirus (HPV) that could be transmitted alongside HIV, as well as other sexually-transmitted infections.
Pushing comprehensive sex education under the carpet of moral taboo thus risks exposing half of the nation’s population to diseases that could easily be prevented.
Further, discriminatory language and practices could deter those at risk of HIV from getting tested and receiving treatment.
According to a recent UNAIDS report, only 39% of those who tested positive for HIV sought treatment.
This fact is exasperating for those of us in the medical and health policy field. Public hospitals provide first-line ART for free, with nominal charges for monthly CD4 and viral load testing; and available programmes to access Pre-exposure prophylaxis (PrEP, an antiviral taken daily that lowers risk of contracting HIV) and Post-exposure prophylaxis (PEP, an antiviral taken within 72 hours post-suspected exposure to HIV).
Having kept the cost low and accessibility high, one would expect a higher turnout for treatment. Yet due to the stigma surrounding LGBT and people living with HIV, many do not want to risk being “exposed” as living with the infection when they are seen to be taking daily pills and accessing sexual health clinics.
There is no one magic solution to complex issues, but in the case of HIV/AIDS, the obvious vacuum remains lack of comprehensive sex education. It is time to shift our mindset when it comes to sex, viewing it mainly as a component of health rather than a moral one.
Breaking taboos is challenging, yet the debate on whether we should have sex education in the school curriculum has been ongoing for far too long.
The burden of responsibility should be equally shared between parents and teachers, with a need for inclusive, positive language in sex education that emphasises consent, knowing the risks and how to mitigate them (e.g., use of condoms, where to access PrEP/PEP should one suspect exposure to HIV), and educating boys that “no means no”.
Armed with this information, it should be up to individuals whether they want to compliment their decisions with morality.
Abstinence should be an empowered individual choice; with victims of rape and incest no longer shamed for reporting and for seeking sexual health treatments.
Only when we remove our own shame about the topic and stop shaming others would we be able to achieve the 90-90-90 Target. Only when we have empowered citizens would we be able to observe the benefits of well-intentioned policies, such as access to ART and PrEP/PEP, and implementing comprehensive sex education.
Ending AIDS is a collective responsibility.
One can easily be responsible by seeking knowledge about risks of HIV, being inclusive of others, and of course, donating to the Malaysian AIDS Foundation or other local NGOs running programmes to assist those who are marginalised.
This World AIDS Day, may we progress in our efforts to end AIDS once and for all.
- Lyana Khairuddin is a Chevening-Khazanah Scholar pursuing a Master of Public Policy at the Blavatnik School of Government, University of Oxford. The views expressed here are entirely her own.
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