Gender inequality seen as major reason for HIV spread

Dr Adeeba Kamarulzaman.

KUALA LUMPUR: HIV rates among people who use drugs may have dropped in recent years, but the Malaysian AIDS Foundation (MAF) is not letting its guard down, especially in its concern to prevent the infection of women.

When there is gender inequality, it’s hard for women to negotiate for their health and protection, according to Dr Adeeba Kamarulzaman, who chairs MAF.

“HIV thrives on gender inequality,” she told FMT. “And unfortunately, there’s a lot of gender inequality in this country.”

It’s difficult for women at risk, such as sex workers and partners of men who use drugs, to insist on condom use when there’s such a power imbalance, she said.

“By and large, condom negotiation is very difficult between men and women. Whether it’s a female sex worker insisting that her client use a condom or the wife or partner of someone using drugs or who is HIV positive, that power imbalance can be destructive.”

That’s one of the reasons for MAF’s inability to “get a handle of HIV rates” among such women, she added.

MAF is the funding arm of the Malaysian AIDS Council. Together, they have managed to reduce HIV rates among drug users, but have not been as successful when it comes to infection through sexual intercourse.

This is despite the availability of what Adeeba described as “very effective biomedical tools” to prevent HIV infection, which activists like her believe could help to end AIDS by 2030.

Antiretroviral treatment is one example of such a tool. It has been reported that people with HIV who take antiretroviral medication and have a viral load that is undetectable will not infect others.

There is also a pill that can be taken prior to sexual exposure that is also said to be highly effective.

However, according to Adeeba, many who may be at risk are not getting tested for HIV/AIDS even if they know they should be.

The taboo associated with the condition, the discrimination against infected persons and, in many parts of the world, the criminalisation of sex work, drug use and homosexual relations were some of the reasons for this, she said.

“Sex education is important” she added. “But we’ve been shy to do this.”

People would take the necessary actions if they were told when they were still young about the risks of infections and the availability of prevention and treatment options, she said.

“It’s really a sad state,” she said. “The wards are still full of people who were presented late with the disease.

“The reasons for this are many. One is their being afraid to come forward because of the fear of losing their jobs or being ostracised by their families.

“Another is they’d rather not know about their HIV status because they think it means death, not knowing that there is very effective treatment that is free and given in government hospitals.”