Time to review legal framework of HIV services

AS a medical law and health policy researcher and having begun my pharmaceutical career managing HIV therapies before later representing Gilead Sciences’ antiviral portfolio in Malaysia, I have witnessed the disease evolving from what was once regarded as a terminal illness into a chronic, highly manageable condition.

Today, individuals receiving effective antiretroviral therapy can achieve sustained viral suppression, enjoy near-normal life expectancy and, under the globally recognised principle of Undetectable = Untransmittable (U=U), do not sexually transmit the virus when their viral load remains undetectable.

Malaysia has made significant progress in expanding access to antiretroviral therapy and improving clinical outcomes. However, public health success depends not only on medicines but also on whether people feel safe to seek testing, disclose their status, remain engaged in treatment and continue to participate fully in society without fear of discrimination.

This is where stigma becomes a public health issue rather than merely a social one. Stigma is reinforced not only by public attitudes but also by the laws we enact and the policies we maintain.

Our reliance on mandatory HIV notification under the public health framework was understandable during the early years of the epidemic when treatment options were limited and surveillance was essential.

However, medicine has changed dramatically. Today, early diagnosis, immediate treatment and sustained viral suppression are the most effective tools for preventing onward transmission.

International organisations, including the World Health Organisation and Joint United Nations Programme on HIV and AIDS (UNAIDS), have increasingly advocated rights-based approaches that encourage voluntary testing, protect confidentiality and reduce discrimination because fear remains one of the greatest barriers preventing people from accessing care.

Several countries, including Thailand, have progressively shifted their HIV response towards policies that place greater emphasis on confidentiality, voluntary engagement with healthcare services and the protection of human rights while maintaining effective disease control.

Their experience demonstrates that sound public health and respect for human dignity are complementary rather than competing objectives.

Malaysia has already begun embracing this philosophy, although perhaps without recognising its broader implications.

A notable example is the Malaysian Medical Council’s Guideline on Blood Borne Viral Infections, which adopts a modern risk-based approach for healthcare professionals living with HIV, issued in 2021.

Rather than automatically excluding doctors from clinical practice because of their diagnosis, the guideline recognises that healthcare professionals receiving appropriate treatment may continue practising safely, with restrictions applied only where genuine transmission risks exist, particularly during procedures that are prone to exposure.

This represents a significant evolution in professional regulation. It acknowledges that healthcare professionals should be judged not by diagnosis alone but also by objective risk, adherence to treatment and their professional responsibility to protect patients.

If our own professional regulator recognises that HIV should be managed through risk assessment based on evidence rather than blanket exclusion, perhaps it is time to ask whether our broader legal and public health framework should evolve in the same direction.

Malaysia is undoubtedly in a period of regulatory transition. Clinical practice has embraced advances in HIV medicine, but aspects of our legal and public health framework have yet to fully reflect these scientific developments.

Public confidence is strengthened not by laws rooted in fear but by policies grounded in evidence, proportionality and respect for human dignity.

We often say that law should follow science. In HIV, science has already led the way and clinical practice has followed. The question now is whether our legal and public health framework is prepared to do the same.

RAYMOND CW WONG

Stem cell Medical Law and Health Policy researcher

Adjunct professor at UCSI School of Pharmaceutical Sciences

Founding member of Royal College of Pharmacy (United Kingdom)