One good example of positive change is the set of guidelines put out by the Malaysian Medical Council that allow HIV positive healthcare professionals on treatment with suppressed HIV viral loads to continue to work , including surgeons .
Malaysian health minister Dr �aliha Mustafa who said that new HIV infections in the country had declined at a slower pace between 2010 and 2022 compared to the previous decade . �An average of 3,000 new HI� cases are reported annually , threatening Malaysia ’ s ability to achieve its commitment to end AIDS by 2030 , � she said in a written response to the Malaysian Parliament , as reported by CodeBlue .
Community-led initiatives are the way to go Empowering communities at risk of or living with HIV to get people to come forward to get tested and offer prevention or treatment is the best approach to tackling stigma and discrimination , thus making it easier to eliminate AIDS , says Dr Iskandar . In his stint as president of the Malaysian AIDS Council , he said he often listened to the concerns of many activists from HI� organisations and the communities they serve .
“ The community at risk of HIV , especially men who have sex with men and transgender women , have more confidence and feel most comfortable to go where there are people who look like them and think like them . As a result , community-based organisations are able to test more people at risk of HIV than traditional facilities like primary care clinics or healthcare settings because they have no fear of them being judged or being questioned as to why they want HI� testing , � he explained . He also stressed that organisations that provide HI� services , like NGOs , are often staffed with people living with HI� or at risk of developing it , like men who have sex with men and transgender women .
The success of this approach , he added , was exemplified by Thailand where community-based organisations play a significant role in supporting health professionals with HIV testing and prevention services , while about �0 percent of PrEP is provided by these organisations . Unsurprisingly , the country is also on track to meet some key UNAIDS targets by 2025 � �5 percent of people living with HI� are aware of their diagnosis , �5 percent of those who are aware of their diagnosis are also on HI� treatment , and �5 percent of those on treatment are virally suppressed . These targets are considered instrumental to ending AIDS .
Dr Iskandar would like to see a similar approach implemented in Malaysia but acknowledges the challenges in collaborating with health authorities to replicate it . And yet Malaysia has pursued a different model which has merits in its own right . Launched by the Ministry of Health several years ago , the national Differentiated HI� Service Delivery for Key Populations ( DHSKP ) programme will allow people from community-based organisations to support health workers in providing HI� services .
�Outreach workers have a visible presence in primary care clinics so that there ’ s more trust with the doctors while also assisting HIV counselling and testing , � he said . �That seems to be working so far , but personally I would like to see that pushed further . � He believes that the community should be able to do more than just HIV testing such as dispensing PrEP , while doctors should mostly focus on more complicated HIV cases involving advanced HIV or multiple infections .
Another approach that Dr Iskandar says may be launched soon in Malaysia will allow community pharmacies to dispense HI� self-tests and PrEP so that people who want to access those services don ’ t have to visit clinics .
“ These are just other avenues to look at that because traditional health facilities may exhibit stigmatising or discriminatory behaviours . �ou really need to think outside the box , � he said .
We need to update the narrative around HIV Experts say it ’ s paramount to raise awareness about the medical progress that has made HIV a treatable disease and the potential to eliminate it with the tools currently at our disposal , as this will also contribute to reducing stigma and discrimination .
“ There is a lot of misinformation and misconceptions , a lot that the public has not been updated about advances in HI� treatment , � said Dr Iskandar , adding that many are still unaware that people who take HIV treatment regularly with undetectable HIV viral loads cannot spread the infection sexually to their partners .
He believes it ’ s crucial to get such a message out because that would make the public less afraid of HIV given that fear and discrimination still linger due to misconceptions about the early epidemic . �A lot of peoples ’ understanding of HI� and how it ’ s transmitted largely stems from the 1��0s and
Currently , we don ’ t have a vaccine against HIV .
50 ISSUE 6 | 2023 GlobalHealthAsiaPacific . com