Awareness On HIV/AIDS

Need For More Awareness On HIV/AIDS
By Melati Mohd Ariff

KUALA LUMPUR, Nov 17 (Bernama) -- In 1981, the US Centre for Disease Control and Prevention (CDC) issued a warning about a rare form of pneumonia that hit a community of gays in Los Angeles.

That illness, has turned out to be what is now known as the Acquired Immune Deficiency Syndrome (Aids) and in 1984, Human Immunodeficiency Virus or HIV was identified as the virus that caused Aids.

Malaysia's first case of HIV was diagnosed in 1986. A year earlier, the Malaysian government set up the National Aids Task Force to create policies and coordinate Aids prevention and control activities.

An Inter-Ministerial Committee to advise the Cabinet on policies, issues and strategies related to HIV and Aids was set up in 1992.

Also established in the same year was the Malaysian Aids Council (MAC), an umbrella body of Non-Governmental Organizations, to spearhead the fight against HIV and Aids.

Almost three decades since the world woke up to the harsh reality of Aids, it has not seen the last of the virus as UNAids 2008 statistics showed some alarming trend.

GLOBAL HIV AND AIDS IN 2007

The alarming fact is that HIV is not only gaining a feminine face (infecting more women) but also more young people and children around the world.

Based on UNAids Report 2008, 33 million people throughout the world have been infected with the virus in 2007 which works out to one in 180 people, considering the world population of about six billion people.

Overall, an estimated 2.0 million people died because of Aids in 2007.

Globally, women accounted for half of the people living with HIV and those aged 15-24 years old made up some 45 percent of new HIV infections worldwide.

According to the report, an estimated 370,000 children younger than 15 years old became infected with HIV in 2007.

"Outside Africa, the next hot spot is South Asia and South-East Asia. If it hits Asia the way it hits Africa, I think it could probably be worse than the financial crisis that we have now.

"UNAids and WHO (World Health Organisation) are also worried about this. That is why a lot of emphasis is put into Asia because it can really explode here," said Dr Christopher Lee, President of Malaysian Society for HIV Medicine (MaSHM) at a media workshop on Children and HIV and AIDS held here recently.

MALAYSIA'S SCENARIO

On the home turf, the picture is not rosy either. Based on the 2008 Ministry of Health's figures, between 1986 and 2007, 80,938 people tested positive for HIV.

As of Dec 31 in 2007, 10,334 people have died due to Aids.

The most number of reported HIV cases (71.8 percent) in Malaysia were among injecting drug users (IDU).

About 36 percent of reported infections were among young people between the ages of 13 to 29 years old.

There is also a worrying rise in the number infections among women and girls through heterosexual transmission.

In 1998, only 6.0 percent of new reported HIV cases were among women and girls. Ten years later, this figure rose to 16 percent.

"IDU at one time was the driver for this HIV infections but over the years the trend has stabilised. Now, the heterosexual infection is slowly gaining ground.

"Globally, heterosexual transmission is the main route for HIV infections. And when women get the HIV children could also get the virus," said Dr Kamarul Azahar Mohd Razali, Pediatric Infectious Diseases Consultant, Pediatric Institute, Kuala Lumpur Hospital.

FEMINISATION OF HIV

Commenting on the feminisation of HIV, Dr Lee who is also the Head and Senior Consultant of Infectious Diseases Unit, Hospital Sungai Buloh said that is not only a bad sign but a worrying trend as well.

"Today the piece of the pie that represents women has gone bigger. From the cumulative figures of about 81,000 people infected with HIV in Malaysia, 91.5 percent or 74,104 were men while 8.5 percent or 6,834 were women.

"In the early days, the proportion of HIV positive people in Malaysia was 99.5 percent males and only 0.5 percent involved women," he said.

He added that if the cases in Malaysia continue to increase, then the major factor could be due to sexual transmission.

"Most of us would have sex somewhere along our life. Besides using condoms, if people are monogamous, the risk is lower. If people are not monogamous but they used condoms, the risk is also lower.

"But of course the risk goes higher and higher if the amount of virus flying around the community goes higher and higher because the risk of encountering people with HIV via various risk behaviours is higher.

"As more women get infected that is the sign the virus might be spreading within the wider community. A large proportion of infected women are housewives. They might be working but they are also wives and their husbands are good provider and may infect them," Dr Lee told Bernama.

He said under the Infectious Disease Act, a doctor who diagnosed a HIV case must report it to the Ministry of Health.

"The number could be more because they did not seek treatment or seek help. Many are stigmatized and many are drug users," said Dr Lee, adding that IDU are also involved with sex workers.

According to him, based on the available statistics, 74 percent of HIV infected people are IDU, 14.4 percent heterosexual groups and 1.5 percent is MSM (Men Who Have Sex With Men).

On the treatment for the HIV positive people in the country, he said: "We have been very responsive but we have a lot of work to do. These infected people, they need treatment, care and support.

"In the early days (1992), back then we have only one of two types of drugs to play with, the most we can prolong one year or two years. By the third anniversary, they all died.

"With the drugs we have now, we help them to live a bit better. Punishing them again is something which is inhumane thing to do."

Dr Lee also said pregnant mothers are offered to be tested for HIV when they come to the clinic. If they are positive, free treatment would be provided and that reduces the risk of mother transmitting the disease to the child.

HIV KNOWS NO BOUNDS

HIV cuts across gender, race, position and ranks, Dr Kamarul Azahar said.

"This virus does not bother who you are. Once it enters a human body, it will infect, transcript, copies, multiplies and eventually kill the white blood cells which are very important in fighting off any infection that comes into the human body.

"But since 1985, the story of HIV is no more a death sentence. It has become a chronic disease just like hypertension and diabetes. There is nothing that can kill the virus but with treatment and medication, you can control it and the quality of life can improve," he explained.

Dr Kamarul Azahar said in adults, it takes between 8-10 years for a person who has been infected with HIV to develop Aids.

"In some who are lucky enough, the duration from HIV positive to Aids can last for 15 years but in children it would be faster," he said.

When HIV patients developed Aids (when the number of white cells have decreased to a level that cannot confer any protection to any infection), they would be given HAART (Highly Active Anti-Retroviral Therapy) to slow down the progress of the viral infection.

Support and care, said Dr Kamarul is very important for HIV positive people "and if the time comes for them to die, we should let them die in dignity."

IMPORTANCE OF COUNSELING AND EDUCATION

Whatever programmes need to be done where HIV and Aids are concerned, there must be awareness and behavioural change.

Dr Lee said sexual transmission must be stopped and sex education in school is one way to empower young people on the knowledge.

"In theory abstinence works. Harm reduction either using needle exchange or drug substitution (in Malaysia we are using methadone) but there is very little data to show abstinence to drug use has prevented HIV.

"In terms of sexual transmission, what is proven to work is through the use of condoms. Total use condoms worked in Thailand, it worked. In a period of 6-7 years, the rate of infection drops four-fold among healthy 21 year Thai men/boys," explained Dr Lee.

Dr Kamarul who regarded HIV and Aids as a social disease resulting from human's own high risk behaviour said the fact that the numbers of HIV positive people is increasing despite it came to be known since the 80's, it goes to show that the information on the virus has not reached the ground.

"You need to empower the young children (upper primary level) especially on sexual rights and sexual responsibility. The situation is becoming out of control because they did not have adequate information. They need to know even with the first intercourse, they can get HIV and chances for females to be infected with the virus is doubled when compared to males," he stressed.

-- BERNAMA

Journey Not Paved With Roses
By Melati Mohd Ariff
Second Of A Three-Part Feature

KUALA LUMPUR, Nov 18 (Bernama) -- For two unfortunate individuals, who we shall identify as Diana Ann and Jamaliah Sulaiman, being HIV positive is like experiencing a never-ending nightmare albeit a painful one.

Both of these women, rather unfortunately, contracted the dreaded Human Immunodeficiency Virus (HIV) from their respective husband.

What is more excruciatingly poignant is the social stigma bestowed on these two hapless persons.

Social discrimination and disgrace thrown against this duo has made matters worse as people living with HIV need all the support and strength they could get from the society.

DIANA'S SAD STORY

The petite Diana Ann, despite being infected with the HIV since 1996, portrays a picture of vigor and health.

The former nurse at a private hospital in Ipoh, Perak said she developed bouts of fever, diarrhoea and vomiting for two weeks before finding out that she had been infected with the HIV.

"When the fever failed to abate, I decided to take a full medical test at the hospital where I worked. However the result was not revealed to me, but I was referred to Hospital Kuala Lumpur (HKL)".

According to Diana Ann, the Matron who accompanied her to HKL did not respond when she queried the former about the medical test result.

Only after meeting the medical officer at HKL's Infective Disease Clinic that she was informed of the true picture, Diana Ann told Bernama after a media workshop on HIV/Aids held here recently.

The doctor's words made Diana Ann to feel numb and shell-shocked.

Diana Ann's world collapsed and shattered around her, particularly when her husband vehemently denied that he had infected her with the HIV.

After the news on her predicament broke out, Diana Ann's colleagues began to shun her and the management had moved her to another department for desk duties.

The misgivings did not stop there. The congregation at the church that Diana Ann regularly attended had also avoided her.

"I thought that I would get the support from the church's community but I was wrong".

All the discrimination and stigma had hurt badly.

"If there is a cut, we could always apply the bandage and medication, but what could we do if the emotion is hurt?" she said.

CLOSE TO SUICIDE

With her deteriorating physical and mental conditions, at that time Diana Ann felt that there was only one way out, by committing suicide.

"I saw no other way out. I invited two companions to go on a cruise ship. At about 2am, I told them that I wished to take some fresh air. I went to the deck and planned to make a jump (into the sea).

"I had left my friends a farewell note and also to my younger sister. As I was about to make the jump, two of the ships security personnel approached me and asked what I was doing at a prohibited area.

"I told them that I was merely taking some fresh air. I returned to my cabin and cried. At that moment, I felt that God was so close to me", said Diana Ann.

Diana Ann returned to Kuala Lumpur and met her doctor, Christopher Lee. Dr Lees reassuring words are still fresh in her mind.

He had said: "Diana, turn all the lemons (sourness) in your life into a sweet drink that you can give to others for them to quench their thirst".

From that moment onwards Diana Ann grew from strength to strength.

JAMALIAH'S HEART-WRENCHING TALE

Meanwhile, for 42-year-old Jamaliah, she came to know that she was infected with HIV after undergoing a medical check-up at a private laboratory in Klang some 10 years ago after the demise of her husband, who was a known injected drugs user.

"I was lost, not knowing what to do after learning that I had been infected with the HIV. I feared telling my family and did not know where to get counseling".

Jamaliah said despite being HIV positive, she remarried as this was the wish of her late mother who was paralysed and vision-impaired.

She said the situation then was so difficult and knew that she would get the blame.

The Klang-born Jamaliah said her husband discovered the real situation when she was about four months pregnant. He was given counseling on how to prevent the transmission of the virus but their marital relation soured and finally the couple had to part ways.

She gave birth to a son, also found to be HIV positive. The small boy was referred to the Kuala Lumpur Paediatric Institute under the care of Dr Kamarul Azahar Mohd Razali.

The institute is the first support organisation that provided Jamaliah with the counseling on her situation.

"From that moment, I realised that there are people who still care for me and the road to the future is still widely clear.

"Before that it was very dark and gloomy for me and I felt guilty for passing on the virus to my son," she said.

Jamaliah said people around her had given tremendous support for her to move on and she was never left in the dark alone.

"I became (emotionally) tough not only due to the assistance from the doctors but my friends did a fine job as well in rebuilding my confidence. They also made my family to welcome me back," said Jamaliah.

HIV POSITIVE BABY

For Jamaliah, life has also presented her with another challenging task as her youngest child also carries the HIV.

From her earlier marriage, Jamaliah has a daughter and she also has an adopted son. Both of them are HIV negative.

She said if her older children got sick, they would be alright after being given medication but for her HIV-afflicted youngest son, the fever would prolong for several days prompting her to seek medical attention.

Jamaliah said she began telling her youngest son, Ujang, about the condition he was in, when the boy reached six years old.

Ujang's plight unfolded when he was not allowed to enroll at a primary school after Jamaliah informed the school management that her son was HIV positive.

However Dr Kamarul stepped in and after explaining the situation and true picture to the school authorities, they relented and Ujang was finally given a place at the school.

But for Jamaliah, the path towards adulthood for Ujang was not paved with roses but instead littered with thorns.

It was heart-wrenching for this young mother when her youngest son started to pose questions, and among the most painful was: "How much longer could I live?(before succumbing to the disease)".

CHARITY WORK

For both Diana Ann and Jamaliah, they understand well the predicament that they were in and had grown tougher meeting the challenges that lie ahead.

Via the "Positive Living" programme organised by the PT Foundation, a non-governmental organisation (NGO) that is active in providing assistance to people living with HIV and Aids, both of these women obtained the much needed moral support that they needed.

Diana Ann is now a full-time volunteer with the foundation and conducts charity work including visiting patients at hospital.

She had been to Durban, South Africa in the year 2000 to relate and share her experience living with the virus with HIV sufferers there.

According to Diana Ann, she learnt from her friends that her (former) husband had died last year.

"It is sad as I still could not forgive him", she said.

Jamaliah, who is also a volunteer with the foundation, said she would continue with her charity work apart from continuing life with her children.

"I have moved past the dark zone and now I am in the bright stretch. I would continue assisting friends and use my experience to help others," she said.

Jamaliah advised those who have been inflected with HIV as well as people who have risks of being infected with the virus to seek immediate medical attention and supports from the NGOs.

Now this gutsy lady is no longer alone facing the battle as last May, she tied the knot with another volunteer with the foundation, Marhalem Mansur.

Marhalem is also HIV positive.

"My husband helped me a lot. I may reach the Aids stage but I am contented and if I have to go (die), I have a husband who can look after my children including Ujang," she said.

The parting words from Diana Ann and Jamaliah: "Please do not discriminate against people living with HIV".

-- BERNAMA

More Support Needed For HIV Positive People
By Melati Mohd Ariff
The Final Part Of A Three-Part Feature

KUALA LUMPUR, Nov 19 (Bernama) - Malaysians are well known for their kindness and generosity. When a misfortune happens, many would be willing to come forward and show that they care for the unfortunate victims.

But many would shy away whenever any issues related to the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (Aids) cropped out.

The fear that they could be infected with the virus if they come into contact with people who are HIV positive or those living with Aids have prompted them to react in such a manner.

This apprehension has created a social stigma that resulted in the bigotry and continuous discrimination against those who are HIV positive.

What hurts more is that this prejudice is not only limited to the surrounding community but also within the family circle.

POOR AWARENESS

For Indra Kumari Nadchatram, this prejudice rears its ugly head due to the lack of knowledge and poor awareness on HIV and Aids among members of the society.

Indra, who is the Malaysian communications officer with the United Nations Children's Fund (Unicef) has the experience of some 10 years dealing with HIV positive and Aids afflicted people while serving with the Malaysian Aids Foundation.

"There are those who have no knowledge on HIV transmission. That is why they fear to be in close contact with the HIV positive people. They are really scared," she told Bernama.

She called for accurate information on HIV/Aids to be well disseminated among the public, including those from the younger age groups.

Based on the UNAids report issued last August, 45 per cent of the worlds new HIV infection cases belonged to people within the 15-24 years old age bracket, she said.

"In Malaysia, one third of the HIV cases involved individuals aged between 13 and 29 years old. This is a cause for concern.

"We need to educate the younger generation for them not to go wrong in their decision."

Indra said education is the best vehicle in this aspect and the key message is to stay away from high-risk behaviour."

For the youngsters, the priority is for them to strive hard to achieve what they want for their future, apart from gaining experience from people who are around them.

SUPPORT, DISGRACE

According to Indra, social factors like discrimination, stigmatisation and rejection have pushed people living with HIV to become desperate and feel hopeless, to the extent of giving up their life.

Lack of support from family members is also crucial, she said.

"I have actually seen how lack of support and stigma really makes people lose hope. How can they live if nobody is willing to listen to their problems?"

She said many among those who were HIV positive feared consulting the doctors as they did not wish other people to know about their predicament.

"They also refrained from confiding with friends, scared for they may lose their jobs. This made them to live in phobia and their condition become worse as they need proper and adequate treatment that could provide them with better life," she told Bernama after a media workshop on Children and HIV and Aids held here recently.

POIGNANT EXPERIENCE

Indra recounted her experience with a couple, whom she identified as only Zaki and Ina.

Both Zaki and his wife were HIV positive. Zaki, who was an injected drug user (IDU), transmitted the virus to Ina. The couple was shunned by their respective families.

According to Indra, Ina's family placed the fault on Zaki and it was the otherwise for Zakis' family.

Consequently, Zaki and Ina went their separate ways and returned to their respective families. Both had died.

Indra has another interesting recollection. It was about a guy whom she called Zack.

"When the doctor told Zack's mum that she should not share anything that her son used including the plates and bowls, the mother said if my son died I will also die. Never mind, we will eat from the same plate. Mother's love knows no bounds," said Indra.

Indra said Zack lived for 18 years after he was diagnosed as HIV positive and he was very fortunate as his family, particularly the unconditional love from his mother, gave him so much support.

Indra also related another sad happening where a repented sex worker who had contracted the virus was shunned by her family members until she breathed her last. Volunteers from PT Foundation took care of her burial.

The PT Foundation, previously known as the Pink Triangle, is a NGO created in 1987 to provide counseling on Aids and HIV.

Among the organisations well known activities is the "Positive Living" programme for people living with HIV and Aids.

BUDDIES SOCIETY

Meanwhile, Afizah Bani Hashim, a volunteer with the Ipoh-based Buddies Society, said the organisation handled about 200 cases in Perak of which half involved women.

Afizah herself handles 20 cases, most of whom are HIV-infected single mothers.

She said the fear of being rejected by the society has forced these HIV positive persons not to revel their true position.

"Once, I had to bring a HIV-positive woman to the hospital. Unfortunately, she also had cancer and no neighbours were willing to assist her to get into my car. I had to carry her by myself," said Afizah.

Afizah also related another case where a woman became HIV positive due to her husband. The woman's youngest child was also found to be HIV positive.

"She did not know that her husband had the virus. When he became badly sick, his family took him back to their village where he died. She only learnt the cause of his demise from the death certificate.

"Later, after a (blood screening) test, the woman found out that she and her youngest child also had the virus. The woman later died due to the dengue fever," said Afizah.

She said the woman's uncle took care of the child. Unfortunately the teacher at the child's kindergarten resorted to telling the pre-schooler to stay home whenever the child needed to take the medication for the sickness.

The child was ignored at the kindergarten to the extent that the child had lost interest. According to Afizah, the last time she heard about this unfortunate case was that the child had been sent to an orphanage.

VISITING THE PATIENTS

A full-time PT Foundation volunteer, who wished to be known as Mitch, said the volunteers also visited the HIV patients during their hospital stay including at night.

Mitch, 41, said he decided to become a volunteer at the foundation after reading an article that the remains of the HIV-infected people had to be bathed in disinfectants like clorox.

"I became very sad after reading the article and the article also had information on the PT Foundation and its Positive Living programme," he said.

Among the HIV-positive individuals who received Mitch's attention during his early days with the foundation were an eight-year-old boy and a girl, 6.

Mitch said, "The boy's mum had died and he got the virus from his dad. We saw him every night. On one particular night, we noticed him behaving strangely and a colleague whispered the Al-Fatihah in the boy's ears".

That happened to be Mitch's last visit to see the boy as the child died the next day.

As for the girl, Mitch remembered that she was a jovial kid.

Mitch recalled that the girl had sores on her head and he was not happy to see how the hospital staff treated this unfortunate child.

"The way they bathed her, sometimes they put back the wet and soaked garments on her. We would bring her fresh clothes and clean her up again.

"At night when she urinated in her sleep, there was nobody who would care to change her clothes. She was very jovial but God loved her more. She had passed way," said a rather distraught Mitch when recollecting his experience.

DISCRIMINATION AGAINST HIV POSITIVE INDIVIDUALS

According to Mitch, discrimination against those who are HIV positive and people living with Aids is still hugely extensive among Malaysians.

He concurred with Indra's views that this situation was a result of the lack of knowledge in HIV and Aids.

The authorities and the media fraternity have the crucial role to play in this aspect, said Mitch.

He blamed the entertainment industry for falsely portraying the HIV sufferers as people who have no bearings on their life.

"Look at the dramas that depicted the HIV-infected individuals as those who were unkempt, gaunt, thin and emaciated. These are all false. We have cases that have lived for 15, 16 years with HIV but are healthy even without medication."

Mitch said the wrong portrayal had influenced the society, making people to despise and discriminate against the HIV-positive people.

He said slogans like "AIDS is the killer" and "HIV is a threat" should not be used as they carry negative connotations.

At the same time, the family members of HIV-positive individuals should also shoulder the responsibility in providing assistance and support for these people, he said.

DOCTORS VIEWS

For Dr Wong Zhiqin, 28, those afflicted with the virus and syndrome should also strive towards improving their own health.

"The problem is from the younger group. Most of them do not have high education and simply do not care about their life. We have to remind them about HIV not once, but many times.

"They come to the clinic but it depends on their mood. They are still like small kids. When they feel healthy they don't bother to come. We have to repeatedly telling them to take their medicines, not to default," Dr Wong who is a member of the Malaysian Society for HIV Medicine (MaSHM) told Bernama.

Dr Wong, who handles HIV and Aids cases at the Infective Diseases (ID)Clinic said: "With the treatment that we have nowadays, people with HIV can lead a normal life like the others particularly if they receive good support from their family members especially their parents".

-- BERNAMA