Winning the war against HIV/Aids

I read with some reservations about the direction the Malaysian Aids Council (MAC) plans to take in addressing the HIV situation in Malaysia.

Firstly, let me say that Dr Adeebha, Dr Christopher Lee and Dr Ismail Baba, as well as the many volunteers who operate shelters and outreach programmes, are selfless and continue to do important and life-saving work where it matters most - on the ground.

MAC and its partners have over the years won the battle to make drugs free, if not almost free, to improve the quality of life of people with HIV.

It has fought tirelessly to shift the perception of HIV as a disease afflicting the marginalised - such as sex-workers, transvestites and homosexuals - and focused attention on middle-society: us.

The HIV infection rate in Malaysia is growing and shows no sign of abating. We have an official count over 80,000 HIV cases. If I remember correctly, the number was over 60,000 in 2003.

In the five years since, 20,000 people have become infected - about 4,000 new cases a year, or about 11 people on a daily basis.

When it was made compulsory for pregnant women to be screened for HIV, we started to see an increase in infections in this group. And now, the opinion is that perhaps four out 10 of sex-workers are HIV-positive.

It makes sense for MAC to work with all these sectors. Perhaps sex workers and their clients should not be the only target.

The idea of sex work and engaging in sex as a consumer in Malaysia is very fluid - it isn't just concentrated in the brothels of Chow Kit, Bukit Bintang, Pudu, Brickfields, Johor Baru or Klang.

Rather, the situation has morphed, as in other parts of the region, to make things more complicated. Sex is an industry. People work in these industries and people pay for sex. It feed families, it feeds desires and it meets demand.

Sex, like many of our activities today, is action taken less through a rationalising process but more predicated on our class, knowledge, ideas of ourselves be it masculinity or femininity, and of course the economy. At least that is my opinion.

Australia which has about the same population as Malaysia had less than 20,000 HIV cases in 2003. The following year, there were about 6,000 new cases in Malaysia, while Australia recorded only 600.

If we look at the distribution of newly-reported cases in Malaysia that year, Kelantan had about 600 new cases, Johor had more than 900 and, Selangor had over 1,000.

Teaching safe sex

Australia has a sex industry and probably, too, men and women who travel out and engage in sex elsewhere. But how do they keep their numbers so low? One way is by teaching sex education in schools and from an early age.

The challenge now facing Malaysians is how to address HIV prevention. Treatment and care are being provided through the MAC and their partners who are doing a wonderful job.

I am advocating that Malaysia starts sex education in schools and colleges, and even for the general public.

But we must first engage our social sciences and medical sciences to truly understand the challenge of teaching safe sex in Malaysia.

By this, I mean the need to understand the reservations of various quarters including the government and civil society. The broader cultural and social taboos must also be considered across all religion-based groups.

Sex education should not normalise free-for-all pre-marital sex as this is counter-productive to safe sex. It should instead encourage responsible sexual practices that is predicated on Malaysian social norms - and here we need to broaden it beyond the narrow limits of political ideology.

If our youths are engaging in premarital sex and do not use condoms, we need to understand why. If we understand it as simply being an issue of masculinity, our message may then take a gender approach, or if pre-marital sex is seen as risky, then we may need to assess and understand risk-taking behaviour.

But if research shows that youth engage in sex because they want to share intimacy and that they don't wear condoms because it is part of a more complex network or relationship building, then obviously our message will have to be different. In this case teaching people the facts about HIV alone will not be sufficient.

A colleague suggests that, if youth think and behave as a group, than perhaps the practice of encourage people to use condoms should emphasise the protection of one's friends, rather than protecting oneself which may be interpreted as being selfish and rather anti-social.

By understanding why people have sex, we can start to understand the broader risk to the spread of HIV in Malaysia in order to reduce new infections.

While addressing treatment and combating prejudices is half the battle, effectively addressing prevention will ensure that the war is won against the spread of HIV.

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KAMAL SOLHAIMI FADZIL is attached to the Department of Anthropology and Sociology,

Universiti Malaya.