HIV/AIDS in Malaysia

The first HIV/AIDS case in Malaysia made its debut in 1986. Since then, HIV/AIDS has become one of the country's most serious health and development challenges.[1] As of 2020, the Ministry of Health estimated that 87 per cent of an estimated 92,063 people living with HIV (PLHIV) in Malaysia were aware of their status, 58 per cent of reported PLHIV received antiretroviral therapy, and 85 per cent of those on antiretroviral treatment became virally suppressed. Despite making positive progress, Malaysia still fell short of meeting the global 2020 HIV goals of 90-90-90, with a scorecard of 87-58-85.[2]

Malaysia is ranked seventh highest in adult prevalence of HIV/AIDS in Asia after Thailand, Papua New Guinea, Burma, Cambodia, Vietnam and Indonesia with a 0.45% prevalence rate.[3] According to the United Nations, Malaysia is one of the ten countries which together accounted for over 95% of all new HIV infections in the region of Asia-Pacific in 2016.[4]

In 2020, Malaysia recorded an incidence rate of 8.5 cases per 100,000 population, a 70 percent drop from 28.5 cases per 100,000 people in 2002.[5]

Prevalence
Total Number of new HIV infections and AIDS death for each year between 1986 and 2010, by gender
Number of new infections and percentage of new infections per State population in 2006,2007 and 2008

Malaysian HIV/AIDS cases have been reported since 1986 by the Ministry of Health. Since then, the national surveillance system had reported a cumulative of 105,189 HIV cases, 21,384 AIDS and 17,096 deaths related to HIV/AIDS giving total reported PLHIV of 88,093 cases or 96% of estimated PLHIV.[6]

Males still make up the majority of HIV cases (89%), but the number of women with positive status of HIV has been increasing. This is shown by the decreasing trend of male:female ratio of 10:1 in 2002 to 4:1 in 2014.[7] 42% of HIV transmission by age group occurred in 30–39 bracket.[7]

Between January to June 2014, 1,676 cases of HIV and 598 cases of AIDS with 402 deaths were recorded.[8] Out of this new infection, 79.7% are men.

Reported New HIV Infections in Malaysia by Ethnic Groups (2016)[9]
Percentage %
Malay
 
 57.5
Chinese
 
 20.9
Indian
 
 6.9
Foreigner
 
 1.8
Others
 
 12.9

Means of Transmission

In 2013, heterosexuals transmission recorded the highest (51%), followed by Injecting Drug User (22%) and Homo/Bisexual transmission (22%). The scenario shifted gradually whereby in 2016, the means of transmission of new HIV cases were highest among Homo/Bisexual (46%), followed by Heterosexual (39%), Injecting Drug User (11%), Others (4%) and Mother-to-Child (1%).[9]

In October 2018, Malaysia becomes the first country in the Western Pacific region to eliminate mother-to-child transmission of both HIV and syphilis, officially validated by the World Health Organization (WHO). [10]

HIV Transmission by Risk Factor in 2016
(% of 3,397 new infections)[9]

  Homosexual/Bisexual (46%)
  Heterosexual (39%)
  Injecting Drug User (PWID) (11%)
  Others (4%)
  Mother-to-Child (1%)

HIV Transmission by Age Group in 2016
(% of 3,397 new infections)[9]

  20–29 (40%)
  30–39 (31%)
  40–49 (16%)
  > 50 (9%)
  13–19 (3%)
  < 13 (1%)

Incidence & Mortality Rate
Incidence & Mortality Rate, 2016 (per 100,000 population)[11]
Disease Incidence Rate Mortality Rate
HIV 10.730.53
AIDS 3.86 2.34

At-risk group

The HIV epidemic in Malaysia is concentrated in these key populations;[7]

Sex workers

Sex worker accounts for 0.6% of total reported cases thus far. However, the number of cases reported among sex workers are grossly under reported.[1] In 2014, Integrated Bio-Behavioral Surveillance (IBBS) in female sex workers shows an increase of sex workers living with HIV to 7.3% from 4.2% in 2012.[6]

Transgender

An IBBS done in 2009 found HIV prevalence among the group at 9.3%, and was decreased to 4.8% in 2012.[6] However, in 2014, the IBBS shows an increase of HIV prevalence to 5.6%.[6]

Injecting Drug Users

At the beginning of the epidemic, injecting drug user (PWID) accounted for 70–80% of all new reported cases. This has started to decline since 2004. In 2011, PWID accounts for 39% of new reported cases.[1] In 2014, 16.3% of the PWID are reported living with HIV.[6]

Men who have sex with men (MSM)

IBBS conducted in 2012 shows 7.1% of MSMs is living with HIV. In 2014, the figure has increased to 8.9%.[6]

Laws and regulations

In 2001, the Department of Occupational Safety and Health developed a non-compulsory ‘Code of Practice on Prevention and Management of HIV and AIDS’ which supports the creation of a non-judgemental and non-discriminatory work environment. [12]

During the 2011 Nineteenth ASEAN Summit, Malaysia together with other ASEAN nations, adopted the "ASEAN Declaration of Commitment: Getting To Zero New HIV Infections, Zero Discrimination, Zero AIDS-Related Deaths, Bali, Indonesia, 17 November 2011" to reaffirm their commitment in working towards realizing an ASEAN community with Zero HIV Infections, Zero Discrimination and Zero AIDS-related Deaths.[13]

On 13 October 2017, the then-Ministry of Human Resources Minister, Datuk Seri Dr Richard Riot Jaem announced that the government wants to draft a new regulation in an effort to eliminate discrimination against people living with HIV or AIDS at the workplace. The ministry plans to legislate the HIV and AIDS in Workplace Policy by 2020. [14] In October 2018, it is reported that the Malaysian AIDS Council (MAC) is currently working with the Ministry of Human Resources on a policy to ensure that people with HIV/AIDS including those receiving treatment are not discriminated when it comes to employment. [15]

Mandatory pre-marital HIV test

Mandatory pre-marital HIV screening for Muslim couples was made mandatory by the Religious Department of State Government in 9 states, beginning in November 2001 in Johor, followed by Perak, Perlis, Kelantan, Terengganu, Kedah, Pahang, Selangor, and possibly Melaka. Beginning January 2009, Muslim couples in the entire country are required to submit to premarital HIV testing.[16]

In 2018, the Ministry of Women, Family and Community Development mulls to make HIV testing mandatory for non-Muslim couples seeking marriage as well.[17] The proposal is strongly opposed by NGOs such as the Malaysian AIDS Council and the Sarawak AIDS Concern Society (SACS) citing the stance of World Health Organization (WHO) and UNAIDS that do not support compulsory screening of individuals for HIV.[18]

Treatment

The first line of highly active antiretroviral therapy is provided for free in Malaysia by the Ministry of Health since 2006.[19] By the end of 2020, 58 per cent of reported PLHIV received antiretroviral therapy, and 85 per cent of those on antiretroviral treatment became virally suppressed.[2]

In September 2018, "HIV Connect", a self–paced, online learning platform that is designed for primary care physicians and other healthcare practitioners in Malaysia was launched. The online learning platform is a joint effort between the Malaysian AIDS Foundation (MAF) and the Malaysian Society for HIV Medicine (MASHM) to educate doctors regarding care and management of HIV/AIDS patients. [20]

Local support
The Malaysian AIDS Council
  • Malaysian AIDS Council (MAC) is a Malaysian non-profit organisation with a mission to represent, mobilise and strengthen non-governmental organisations and communities who were working with HIV/AIDS issues.
  • PT Foundation (formerly known as Pink Triangle) is a community-based organisation "providing HIV/AIDS education, prevention, care and support programs, sexuality awareness and empowerment programs for vulnerable communities in Malaysia". The communities include MSM (men who have sex with men), transgender, sex workers, drug users, and people living with HIV.
  • Kuala Lumpur AIDS Support Services Society (KLASS)
  • APCASO – Asia Pacific Council of AIDS Service Organizations Archived 12 June 2016 at the Wayback Machine
  • Tenaganita is a human rights organisation dedicated in assisting, building, advocating and protecting migrants, refugees, women and children from exploitation, abuse, discrimination, slavery and human trafficking.
  • Persatuan Pengasih Malaysia (PENGASIH)
  • Community AIDS Service Penang (CASP) Archived 5 August 2017 at the Wayback Machine
  • Federation of Reproductive Health Associations, Malaysia (FRHAM)
  • Islamic Medical Association of Malaysia (PPIM)
  • Sarawak AIDS Concern Society (SACS)
  • Women and Health Association of Kuala Lumpur (WAKE)
  • Persatuan Perantaraan Pesakit-Pesakit Kelantan (SAHABAT)
  • Pertubuhan Advokasi Masyarakat Terpinggir, a non-governmental organisation for marginalised communities.

External sources

References
  1. "The Global AIDS Response Progress Report 2014" (PDF). UN Aids. Archived from the original (PDF) on 10 September 2015. Retrieved 12 November 2015.
  2. Alifah Zainuddin (28 July 2022). "How Malaysia Can Meet The 95-95-95 HIV Target". Code Blue. Retrieved 28 July 2022.
  3. "Country Comparison :: HIV/AIDS – Adult Prevalence Rate". Central Intelligence Agency. Archived from the original on 13 June 2007. Retrieved 9 July 2016.
  4. "UN report: Malaysia among top 10 Asian nations affected by HIV". The Star Online. Retrieved 29 December 2017.
  5. Alifah Zainuddin (18 March 2022). "Malaysia HIV Cases Down 70% Since 2002, MOH Says LGBTQ Not Risk Factor". Code Blue. Retrieved 28 July 2022.
  6. "The Global AIDS Response Progress Report Malaysia 2015" (PDF). UN Aids. Retrieved 14 April 2015.
  7. "Annual Report 2014" (PDF). Malaysia Aids Council, Malaysia Aids Foundation. Retrieved 29 September 2014.
  8. "HIV/AIDS claim 16,742 lives in Malaysia since 1986". Astro Awani. Retrieved 29 September 2014.
  9. "Snapshot of HIV & AIDS in Malaysia 2016" (PDF). Malaysia Aids Council. Retrieved 6 March 2019.
  10. Caitlin Mahon (2 November 2018). "Malaysia eliminates HIV transmission from mother-to-child". Avert. Retrieved 21 November 2018.
  11. "Health Facts 2017" (PDF). Ministry of Health. Retrieved 29 December 2017.
  12. "Govt to draft new rules to curb workplace discrimination against people with HIV, AIDS". Malay Mail. Retrieved 15 October 2017.
  13. "Nineteenth ASEAN Summit, Bali, Indonesia, 14–19 November 2011". ASEAN. Retrieved 17 November 2017.
  14. "New regulation to eliminate discrimination against people with HIV and at workplace soon (Updated)". The Sun Daily. Retrieved 15 October 2017.
  15. "No more discrimination of those with HIV/AIDS in employment: MAC". The Sun Daily. 16 October 2018. Retrieved 1 November 2018.
  16. "Mandatory Premarital HIV Testing" (PDF). Open Society Institute. Retrieved 15 January 2019.
  17. "Govt seeks to make HIV testing mandatory for non-Muslim couples seeking marriage as well". New Straits Times. 17 December 2018. Retrieved 15 January 2019.
  18. "NGO opposes mandatory HIV screening for non-Muslim couples". The Star. 21 December 2018. Retrieved 15 January 2019.
  19. "Guidelines for the Management of Adult HIV Infection with Antiretroviral Therapy" (PDF). Ministry of Health. Retrieved 15 April 2016.
  20. "HIV Connect for Primary Care Physicians and Healthcare Practitioners". The Malaysian Medical Gazette. 21 September 2018. Retrieved 1 November 2018.
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