Friday, July 9, 2010

Kelantan Government to HIV Sufferers: Don't Fall in Love, Don't Have Kids

Friday, July 9, 2010

Earlier this year the Kelantan government launched a health campaign that asked people not fall in love with HIV sufferers. This was part of a drive to curb increasing HIV infection rates in the northern-most state of Peninsular Malaysia.

Now reports claim that last week a top women's health official for the Islamic party run state developed this line of action further by urging HIV sufferers not to procreate:

Its Women Development, Family and Health committee chairman Wan Ubaidah Omar, in issuing the advice, said the number of HIV/AIDS cases in the state was on the rise, adding that this was the reason why more education was needed for target groups.

“Couples with HIV should not have children. This will give rise to the unwanted statistics, which are already alarming,” she said during the question-and-answer session yesterday.


Wan Ubaidah was answering a question from Datuk Noor Zahidi Omar (BN-Pengkalan Kubor), who asked whether the state government was aware that Kelantan had the highest number of HIV/AIDS patients in Malaysia.

The chairman also repeated the government's previous message, telling the State Assembly: "My other advice is not to fall in love with anyone suffering from the disease.”

As of 2006 Kelantan health policy has mandated HIV testing for those who wish to get married, but it does not actually restrict HIV infected people from being joined in marriage once their HIV status is discovered.

The dire need to get infection rates under control in Kentalan was highlighted in 2009 when the Women Development, Family and Health committee released statistics that showed a sharp rise in infection rates through sexual activity with a reported 49% rise in adults aged 30 to 39.

A 2007 article which features a discussion with Datin Paduka Marina Mahathir, president of the Malaysian AIDS Foundation, highlights a startling lack of knowledge over HIV/AIDS and how the virus was transmitted. In the article, Marina Mahathir discusses the findings of a recent study involving HIV-positive widows in Kota Baru, Kelantan:

“The women said they always reminded their husbands to use a condom but they do not always use it because they dislike condoms, do not have one at hand, or want to have a child,” said Malaysian AIDS Foundation advisor Datin Paduka Marina Mahathir at the Eighth International Congress on HIV/AIDS (Icaap) here in Sri Lanka at a session on married women’s vulnerability towards HIV/AIDS.

At the conference, married monogamous women have been cited as an emerging group most vulnerable to HIV infection, and among the most silent sufferers of the epidemic.

Marina was citing a study that she carried out with University Malaya post-graduate student Sumathi Govindasamy of 56 HIV+ widows in Kota Baru, Kelantan, to explore the issues and challenges they face.

Interestingly, the article notes that many women will not remarry because they would have to disclose their HIV status as per the 2006 mandate. This risks them being twice shunned, first as single women and second as HIV sufferers. The article continues:

“All of the women surveyed were infected by their late husbands, and 80% were married to injecting drug users. However, they continued having unsafe sex with their husbands even after learning about their injecting behaviour," said Marina.

“Some 53% of these women were still not sure if it was the drugs, or the act of injecting that caused the HIV infection. It was evident that basic knowledge on HIV transmission risk is low even now among these women,” she added.

Rather than educating on how the virus is contracted, it seems that the government's approach is to plead with married HIV sufferers that they abstain from having children, while asking single HIV sufferers to simply abstain from sexual relationships completely. At the same time, the government has been trying to reinforce its perception of moral standards, especially among Kelantan's youth, all in the hope that this will curb infection rates. This is something that the Women Development, Family and Health committee chairman also drew on last week during the aforementioned conference:

"Among the reasons for such occurrences [of increasing HIV infections rates] are the Internet and television and entertainment activities that contribute to sexual activities among the younger generation and the government will continue with its campaign to educate the younger generation about the ills of illicit sex."

The government's advice that people should shun falling in love with someone who is infected with HIV is degrading to the individual and, to my mind, oversteps the mark of prudent policy. So too does it seem rather futile to point a finger at things like the Internet and television as being the cause of increasing HIV infection rates only to try to remedy the issue with lessons in morality against "the ills of illicit sex" even though they have so far failed to yield a desirable result and most likely won't do any better in the near future.

Rather than this, improving female health education seems paramount to stemming HIV rates, as is the need for increasing HIV screenings so as to detect asymptomatic carriers in the first place. But all this must be considered alongside the cultural context of the predominantly Muslim state.

Inescapable, of course, is the issue of polygamous marriage which is accepted in Kelantan. Therein lies the importance of educating men about HIV and condom use. Despite information to the contrary, it is not necessarily against the tenets of Islam to use condoms within marriage as this second interview with Marina Mahathir points out. Getting that message out to men through first calling on local religious leaders and educating them is one solution that Marina Mahathir suggests, with the hope that this information will, in turn, trickle down to men with multiple wives who are at an obvious risk of both contracting and spreading the virus.

Yet through it all, educating women so that they can manage their own sexual health, maternal health and HIV exposure risk must be a central focus. As Marina Mahathir notes about her relatively small study:

"The most alarming thing about the study is the low level of knowledge on HIV in Kelantan. They don't know anything about HIV. It's as simple as that. And yet, the government in Kelantan is testing people and these people don't understand why. They think it's just a routine or another step before getting married. They just do it. There's an opportunity lost there."


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