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PreP can reduce the risk of getting HIV from sex by about 99 percent .
Despite the advances , millions of people living with HIV still have little or no access to these potentially lifesaving tests and treatment services , especially in populations at risk of infection . through bodily fluids such as blood , semen , and vaginal fluids . Anal intercourse is one of the riskiest sexual acts because anal tissue is more likely to break thus facilitating viral transmission . But HI� cannot be transmitted through the air , kisses , hugs , or sharing of food .
Breakthrough combination antiretroviral treatments introduced in the mid-1��0s offered great hope for patients , and the new drugs developed since then have been so effective at suppressing the virus that people diagnosed and treated early can live a healthy life without the fear of infecting their partners . The main drawback is that the medications , called antiretroviral drugs ( A�T ), need to be taken for life to ensure the infection stays suppressed .
�The provision of effective treatment has reduced numbers of AIDS-related deaths globally by 51 percent � from 1.3 million in 2010 to 630,000 in 2022 . Improved access to treatment has averted an estimated 20 . � million deaths globally , � a UNAIDS report said .
Despite the advances , millions of people living with HIV still have little or no access to these potentially lifesaving tests and treatment services , especially in populations at risk of infection . According to the report , the main barriers to access include user fees , stigma , discrimination , and criminalisation .
A preliminary UNAIDS analysis has suggested that , while in some countries there was a decrease in new infections among sex workers and clients , other groups have not equally benefitted from HI� prevention and treatment . These include gay men , other men who have sex with men , transgender individuals , and , in some cases , intravenous drug users .
Similarly patchy trends can be observed in Malaysia , an upper-middle income economy that epitomises some of the successes and challenges surrounding the treatment of HI� .
In the Southeast Asian nation , HI� was mostly spread through the sharing of drug needles until around a decade ago . Successful prevention programmes managed to dramatically reduce the spread of the disease so that by 2022 about �6 percent of new HIV infections were due to unprotected sex , especially between men who have sex with men .
“ In Malaysia , we ’ ve had successes in changing the trajectory of the drug use epidemic using harm reduction interventions within this population like needle and syringe programmes and by replacing more harmful drugs , like heroin , with less dangerous opioids like methadone , � Dr �aja Iskandar Shah �aja Azwa , infectious disease consultant at University Malaya and president of the Malaysian AIDS Council , told Global Health Asia-Pacific .
But the country has seen much less success in tackling the spread of HI� through sexual contact , with stigmatisation and discrimination against the LGBTQ population making it harder to reduce the number of new cases .
“ Gay men and transgender women are very stigmatised in Malaysia , and this prevents such populations from accessing services , meaning that they are not getting tested as frequently as they should , nor accessing prevention treatment . This environment provides an epidemic within that population to flourish , � explained Dr Iskandar .
Malaysia is one of 67 countries that criminalise same-sex relations , according to Human �ights Watch . Punishment includes jail time and whipping . Such risks can make people who engage in anal sex � one of the populations most at risk for HI� — reluctant to come forward for prevention and treatment .
To compound the di�culties in accessing medical services , Malaysian LGBTQ people also report experiencing discrimination from healthcare workers . In what appears to be a typical case , trans activist �ania �ara Medina said that she had heard complaints about medical personnel refusing to touch trans people because of their gender identity , even when seeking care for general health problems . �It is not that they are scared ; they do want to go , but they are worried about stigma . Already they ’ re transgender , what more HI� , � she told CodeBlue .
48 ISSUE 3 | 2023 GlobalHealthAsiaPacific . com