Stigma and discrimination kills, not HIV

MOH must immediately end non-evidence and rights-based strategies and responses in order to end AIDS by 2030.

Justice for Sisters is appalled by the media sensationalism and the panic incited based on the 2017 HIV data by the Ministry of Health (MOH) in Utusan Malaysia on 2 August 2018.  Not only that headlines such as ‘LGBT paling ramai hidap HIV’ are sensationalistic, they are also extremely irresponsible, counter productive to public health initiatives and increase barriers to access to healthcare services.

The increasing statistics call for a serious and long overdue review of the efficacy of the government’s policies and programmes on HIV and AIDS, especially in relation to sexual transmission.

In addressing the increasing prevalence of sexual transmission of HIV, especially amongst transgender women and gay men, MOH has adopted some misguided, widely discredited, harmful, and non-evidence and rights-based approaches and programmes. This includes programmes such as mukhayyam, a spiritual camp for LGBT persons by JAKIM, aimed at changing and rehabilitating LGBT persons, who are deemed as social ills. The Global AIDS Response Progress Report 2016 notes that there is no evidence to prove the efficacy of this programme.

Mukhayyam is a special program aimed at creating awareness on principles of Islamic teaching, self enhancement apart from HIV awareness. Targeting key populations, enrolment to this program is voluntary. Many who attended this program have reported change in behaviour to less risky or risk free but there has been no data to support this claim. (page 17, Global AIDS Response Progress Report 2016)

In addition, the National Strategic Plan on Ending HIV/AIDS 2016-2030 (NSP) outlines a few strategies specifically for Men who have sex with Men (MSM) and trans women. While not all activities in the plan have been budgeted for, some of the strategies and activities include programmes that “provide guidance and motivation through religious approach (tauhid) to face the challenges of life and abandon the practice of unnatural sex”, essentially efforts to change sexual orientation and gender identity. These activities are not only blatantly non-evidence and rights-based, but they also have long-term harmful impacts and are counterproductive to achieving the goals to end AIDS by 2030 and the 90-90-90 goals by 2020.

We remind everyone, namely the Ministry of Health (MOH) that stigma, discrimination, lack of access to information, skills and services kill. It is important to note that sexual transmission has steadily increased since 2010. The Global AIDS Response Progress Report 2016 reports a shift in trend of prevalence from transmission through unsafe injecting practices to transmission via sexual intercourse. Additionally, the report also notes that the bulk of infection involves young people between ages of 20 and 39 years old. A media release by the Malaysian AIDS Council in October 2017 notes:

“Malaysia is facing a sexual health crisis…. The rise in sexually transmitted HIV has come to characterise the national AIDS epidemic since 2010 when, for the first time, new HIV infections attributed to sexual transmission superseded unsafe drug injecting practices and other modes of transmission.”

However, no meaningful measures have been introduced to address the sexual health crisis. There is no comprehensive sex education in educational institutions currently, a cost effective measure that could address a range of issues in relations to sexual reproductive health and rights, including the increasing prevalence of HIV. The increase of HIV prevalence based on sexual transmission reflects the failure of the government to take meaningful measures to address this matter and government’s attitude regarding sex education. The abstinence-based policies, lack of comprehensive sex education and the increasing allocation of public funds for anti-LGBT activities not only contribute to higher rates of HIV but also result in adverse socio-economic and health impacts. The management of these adverse impacts will place significant economic costs on the government.

Decriminalization is the solution

Populations such as drug users, sex workers, gay men, trans women, others have increased vulnerability to HIV due to criminalization of these populations. Multiple evidence show criminalization or having criminal laws against groups of people merely based on their identities effectively increase vulnerability and health risks, including HIV, STIs, and mental health issues amongst others due to the multiple forms of discrimination, stigma and marginalization. Decriminalization can effectively reduce prevalence of HIV up to 33%-46% amongst some key affected populations.

It is imperative to examine the correlation between the rise in prevalence of HIV among gay men and transgender women and the increasing of anti-LGBT activities and narratives, criminalization, as well as the legal, socio-political and economic barriers and discrimination faced by LGBT population in general.

A report by the United Nations Country Team in 2014, “The Review and Consultation on the Policy and Legal Environments Related to HIV Services in Malaysia” provides an overview of the HIV epidemic in Malaysia. Notably, the removal of criminal laws and discriminatory practices being critical in transforming the global AIDS response:

“In Malaysia, the HIV epidemic continues to be concentrated among key populations, who often represent highly ostracized and stigmatized segments within all societies. Members of these communities are not only rejected socially, but further marginalized through legal frameworks that cast them as criminals. Criminal laws and discriminatory practices based on moral judgment, superstition, ancient beliefs, fear and misinformation, punish instead of protect. They drive at-risk communities underground, preventing them from accessing lifesaving treatment and prevention information and services, heightening their risk for HIV.

The Global Commission on HIV and the Law (2010-2012), a high-level initiative launched in 2010 by UNDP Administrator, Helen Clark, examined how law and practices can transform the global AIDS response. The Commission’s findings and recommendations reveal that evidence-based laws and practices firmly grounded in human rights are powerful instruments for challenging discrimination, promoting public health, and protecting human rights. The benefits are felt beyond HIV responses to encompass health and development outcomes more broadly.

Furthermore, United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) Resolutions 66/10 and 67/9 recommended that punitive laws and policies targeting key populations be abolished to reduce levels of social stigma, discrimination, violence and broader human rights violations.

RECONSIDERING PRIMARY PREVENTION OF HIV NEW STEPS FORWARD IN THE GLOBAL RESPONSE, September 2017 http://mpactglobal.org/wp-content/uploads/2017/10/Reconsidering-Primary-Prevention.pdf

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