Discuss about the HIV in Malaysia for Ministry of Health.
HIV/AIDS has remained a global epidemic since its discovery in the late 20th century. Although some regions such as Sub-Saharan Africa have been severely affected, there has been a promising battle to combat this epidemic (United Nations, 2015). Globally, there are more than 34 million people with HIV and another two million who die of AIDS (Ministry of Health, 2011). The decrease in new infections across the globe is a sign of the commitment in most countries to combat HIV.
Malaysia has not been an exception in the spread and preventive measures to fight this epidemic. Since the diagnosis of the first case of HIV in 1986, countless efforts have been put in place to contain it (UNICEF, 2009). The government and other non-governmental organizations have continuously shown their concern in combating the spread of HIV in Malaysia, with a particular focus on the most at-risk population (Ministry of Health, 2011). Consequently, the number of new infections has been on a steady decline since 2002. As at 2010, there were ten new reported cases of HIV daily with a ratio of two females for every eight males (Ministry of Health, 2011). As a contemporary health issue, HIV affects Malaysians differently based on the determinants of health. This analysis focuses on how HIV has impacted the health of Islamic males aged between 15 and 24 years.
The efforts to prevent HIV infections among people aged between 15 and 24 years has shown moderate progress. As far as HIV is concerned, various determinants have affected these efforts, most of which revolve around the Health Belief Model. The Health Belief Model involves an assumption that individuals take preventive action when they are susceptible to a disease and acknowledge the consequences as severe (Lanz & Becker, 2016). Therefore, it is based on the conviction that the acquired information about a disease reduces the threat of acquiring the disease (Lanz & Becker, 2016).
There are many variables allied to the Health Belief Model such as the demographic and socio-psychological variables of the target group. Narrowing down to the specifics, culture is one of the demographic variables. The youth are known for their adventurous nature because of peer pressure or the feeling of a first-hand experience. However, most of these risky behaviors such as premarital sex are not guided by an existing knowledge capable of weighing the risks against the perceived benefits (World Health Organization, 2012). In a study conducted by the Ministry of Health in Malaysia, it was found that 5.2% of the youth aged between 17 and 24 already had more than a single sexual partner, and 50% had engaged in sex before marriage (World Health Organization, 2012). In a different survey conducted among school-going respondents, it was found males were two times more sexually active than their female counterparts (World Health Organization, 2012). These statistics point towards some of the reasons why these target groups are particularly vulnerable. These risky behaviors can be attributed to the youthful culture and explain the disparities in the prevalence of HIV in Malaysia.
The majority of new HIV transmissions in Malaysia are attributed to heterosexual transmissions followed by bisexual transmission and injection drug use(42%, 36% and 17% respectively) (Malaysia AIDS Council, 2015). This information shows the rapid rate of change since a different report by IAS in 2013 had shown that injecting drug user was the leading cause of HIV. Most of the injecting drug users are males, and this explains why this gender has constantly represented the majority of cumulative HIV cases in Malaysia. In all these reported infections, those aged between 13 to 19 years account for approximately 2%. Unfortunately, females lead among those infected through heterosexual intercourse and this explains why the number of housewives and sex workers is one the rise (UNICEF, 2009).
Religion is the other health determinant that has affected the target group. Islam is the official state religion, and it has certain religious and cultural norms that have affected the spread of HIV in Malaysia (Sern & Zanuddin, 2014). To date, most of the people associate HIV/AIDS with immorality, dangerous lifestyle, and illegal drug use. Religion comes in handy with these myths and misconceptions because of its role in teaching morality and clarifying any doubts that might lead to the discrimination towards those infected and affected by the disease. For instance, some people might refuse to share utensils, greet, or hug people with HIV because of the misconception that any form of contact can spread the virus. Such kinds of discrimination negatively affect people with HIV. Therefore, any loophole from the religious perspective can be a major blow, more so among countries with an official state religion like Malaysia.
The sharing of information about sexuality remains a private subject and a taboo among the Muslims (Sern & Zanuddin, 2014). The positive side of this culture is the overemphasis on chastity and the sinful nature of sexual intercourse outside marriage and homosexuality (Sern & Zanuddin, 2014). Malaysia is an open economy, and with the infiltration of new communities, the rampant enculturation affects the religiosity of most Malays despite having organizations like JAKIM which mobilize the development and progress of Muslims in Malaysia (Sern & Zanuddin, 2014).Consequently, most of the adolescents have ended up dating and engaging in unsafe sexual intercourse despite the domination of conservative and traditional values in Malaysia (Wong, Chin, & Low, 2010).
Education is also a health determinant that has shaped the prevalence of HIV/AIDS among the youth globally and in Malaysia. In Sub-Saharan African countries with available data, only 30% of young women and 37% of young men had comprehensive knowledge of HIV in 2014 (United Nations, 2015). This shows that most of the developing countries have not invested as much as the developed countries mainly due to budgetary constraints. Education is related to the occupation which has been a good indicator for the variations among different gender. At the start of the new millennium, the ratio of HIV positive men to women in Malaysia was 10:1. In 2015, a new study showed that the ratio had decreased to approximately 8:1(89%: 11%) (Malaysia AIDS Council, 2015). The decrease has been attributed to the certain occupations dominated by women like sex work, low levels of knowledge and the submissive nature of women which men misuse to coerce them into unprotected sex that increases their infection rate (UNICEF, 2009).
The Millennium Development Goals report in 2015 showed that income and location affect the disparity in the knowledge of HIV/AIDS. Focusing on income, the disparity among between rich and poor households was 17% vs 35% for young women and 25% vs 48% for young men globally (United Nations, 2015). In addition, the high prevalence of HIV in developing countries in the Sub-Saharan Africa (approximately 70% of total infections) compared to the rest of the world (30% of HIV infections) shows that the low income is a risk factor (World Health Organization, 2012). Based on location, the global disparity between rural and urban households was 23% vs 36% for young women and 32% vs 46% for young men (United Nations, 2015).The level of knowledge is connected to other problems such as stigmatization and discrimination towards people with HIV enacted from such societies (Balagun, 2010). In addition, a low level of understanding and the misconception that HIV is associated with the immoral people contributes to risky sexual behaviors. This trend which is a reflection of Malaysia’s case can be attributed to the overemphasis on traditional values in rural villages which limit the sharing of explicit content about sex and HIV/AIDS (Ng & Kamal, 2012).
Education is closely related to the environment as a health determinant. In some rural areas, inequalities in HIV transmission have mainly been affected by the inadequacy of reproductive health services (Balagun, 2010). Most of the organizations providing these services focus on the urban population, leaving the rural areas prone to more infections. The rural population has also experienced an increase in new HIV infections due to fewer HIV awareness programs (Ng & Kamal, 2012). Therefore, the best way to combat the rising numeber of infections in rural areas is through increasinh health awareness and initiating programs like couple testing which JAKIM has tried to do (Sern & Zanuddin, 2014). However, there are some states such as Kelantan have constantly recorded the highest rates of HIV due to their location close to the borders with Sungai Golok and Hat Yai, and men easily acquire the virus from the neighbouring countries (UNICEF, 2009). These geographical distinctions affirm that the environment plays a significant role in the HIV epidemic.
The youth aged between 15 and 24 years contribute a significant proportion of the Malaysian population. This means that any factor that severely affects the health of this population has an impact on the country. The effects of HIV among the youth is an example of a situation that various stakeholders have to solve if the country is aimed at progressing. One of the areas that need attention is increasing the level of knowledge about the disease (Sern & Zanuddin, 2014). However, it should also be noted that knowledge alone may not necessarily be protective against contacting the disease since there are those who might have all the knowledge but still chose to involve in risky sexual behavior (Wong, Chin, & Low, 2010) There has to be an initiative to live what they are taught. In such cases, gender differences in perceptions, beliefs, and attitudes, particularly with regards to sexual behavior are other crucial factors worth considering. Therefore, the solution to the existing HIV menace among the youth can be tackled when all these determinants of health are incorporated in the proposed strategies.
References
Balagun, A. (2010). Islamic perspectives on HIV/AIDS and antiretroviral treatment: The case of Nigeria. African Journal of AIDS Research, 9(4): 459-466.
IAS. (2013). Factsheet: HIV and AIDS in Malaysia. 7th IAS Conference on HIV Pathogenesis, Treatment, and Prevention (pp. 1-5). Kuala Lumpur: IAS.
Lanz, N., & Becker, M. (2016). Health Belief Model: A Decade Later. Sage Journals, 44(3): 94-127.
Malaysia AIDS Council. (2015). Snapshot of HIV and AIDS in Malaysia 2015. Malaysia AIDS Council.
Ministry of Health. (2011). Malaysia National Strategic Plan on HIV and AIDS 2011-2015. Ministry of Health.
Ng, C., & Kamal, S. (2012). Bridging the gap between adolescent sexuality and HIV risk: the urban Malaysian perspective. Singapore Medical Journal, 47:482-490.
Sern, T. J., & Zanuddin, H. (2014). Affirmative Religious Response Culture to HIV and AIDS: Understanding the Public Relations Role of JAKIM in Curbing the Epidemic among Young Muslim Couples in Malaysia. Asian Social Science, 10(3): 1-8.
UNICEF. (2009). HIV and AIDS in Malaysia. UNICEF.
United Nations. (2015). The Millennium Development Goals 2015 . New York: United Nations.
Wong, L.-P., Chin, C.-K. L., & Low, W.-Y. (2010). HIV/AIDS-Related Knowledge Among Malaysian Young Adults: Findings From a Nationwide Survey. Journal of the International AIDS Society, 10: 148-157.
World Health Organization. (2012). Health of Adolescents in Malaysia. World Health Organization Western Pacific Region.
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