The Human Immunodeficiency Virus (HIV) is the cause of the condition known as Acquired Immunodeficiency Syndrome (AIDS) and has been one of the most stigmatised conditions in the world, especially in conservative Malaysia.
In conjunction with the recent World AIDS Day, Monash University came together with the Malaysian Health Ministry, Malaysian AIDS Council and several other AIDS foundations in Johor Bahru and hosted the first ever AIDS forum. Aptly titled “Community makes a difference”, the event was carried out in an effort to educate and spread awareness on key factors that affect those living with AIDS and what can be done to help control and minimise the spread of AIDS in Malaysia.
Dr. Suresh Kumar from the Sungai Buloh hospital outlines the Malaysian goal of the “90-90-90” approach whereby, by 2020, 90% of those living with HIV will be aware of their HIV status, 90% of those with HIV will be on antiretroviral therapy and 90% of those receiving antiretroviral therapy will have viral suppression, allowing them to lead a normalised life.
He also point out the biggest factors in ensuring a near normal lifespan is early detection and treatment. A study in 2016 by the National AIDS Program in Thailand shows that when patients are diagnosed and treated when their CD4 (cluster of differentiation 4) protein counts are around 350, their life expectancy is around 81 years of age. This number severely declines for those who are diagnosed later; CD4 count 200 have a life expectancy of up to 69 years old and those at CD4 count, up to 50 to 49 years old. Thus it is imperative for people to be diagnosed and treated as early as possible.
Malaysia has a 35% rate of diagnosed patients who are under the 200 CD4 count level, one of the higher figures in Asia Pacific and in contrast to Africa and Afghanistan that have a lower late diagnosis number than Malaysia. This can be contributed mainly to lack of knowledge and the stigma associated with HIV in our country. A key issue is that many face lack of employment due to having the condition which leads to an increase in sex work for them to try and support themselves financially.
The general population must understand that advancements in treatment have led to normalised lives for those living with HIV, where couples can conceive children without transmitting the virus and even without artificial insemination. The National Institutes of Health in the U.S have documented that by adhering to treatment, it is possible to achieve an undetectable viral load within the first 6 months. By continuing the treatment to maintain the numbers for another 6 months, there is effectively no risk of transmitting HIV to a sexual partner.
Another study in the United States points out that 20% of the HIV positive population are unaware of their status and these people are responsible for 49% of all new infections. It is also noted that those who are diagnosed do change their behaviour accordingly – lowering the risk of transmission. As for those worried about the cost, early detection and treatment will cost less than late detection and treatment, leading to the increasing importance of raising awareness of early detection.
Dr. Masliza Zaid from Hospital Sultanah Aminah point out that even though self-testing kits are more abundant and accessible which allow people to minimise awkward situations such as bumping into relatives at the hospital, people must be aware of false negatives and be vigilant in their testing. She also likened those who do walk-ins for testing and treatment to warriors due to having huge amounts of courage.
For those affected by HIV, there are several welfare societies such as Lifezone and the Malaysian AIDS Council (MAC) which provide shelter, support and guidance for those living with the condition.