MALAYSIANS are rightly baffled at the sudden move from an all-out war against drug abuse by promoting prevention, treatment of drug users and the prosecution of drug traffickers, to an initiative that is perceived to be accepting, or even encouraging and promoting, drug abuse. There is an urgent need to answer the question: "How does harm reduction, especially in the context of providing free needles, fall into place with Malaysia's more than 30 years of aggressive fight against drug abuse?" Advocates of harm reduction must take the time to answer this question.
After decades of government ads, messages and images, living through campaigns with themes such as "dadah musuh negara", "dadah cegah sebelum parah" and "dadah membawa padah", it is unacceptable to assume that Malaysians should and can switch their perception to a tolerance of drug use practically overnight.
How do you reconcile the act of distributing needles for the purpose of HIV-prevention with the act of preventing drug abuse, which accounts for more than 150,000 people in the country? Though it is clear to those working in the field of HIV/AIDS prevention that preventing the spread of this disease and the prevention of the actual act of drug abuse are two separate areas of public health intervention, it is less clear to the public at large. This issue must be addressed in order for it to be understood.
Former drug user associations engaged in treatment such as Persatuan Pengasih Malaysia have clearly stated their opposition to such harm-reduction initiatives which tolerate continued drug abuse. Instead, they advocate a therapeutic approach to rehabilitation with the objective of total abstinence. This is in clear contradiction to the approach of harm reduction. Not addressing this dilemma of mixed and contradictory messages dooms any public support for harm-reduction aimed at preventing new HIV cases. The distribution of needles and condoms, as part of harm-reduction, has been successful in many countries around the world, including Iran and Pakistan. But it is not enough to say that other countries have done it and succeeded.
We have learnt from our HIV/AIDS medical experts and their experience in dealing with the disease among drug users that harm-reduction can work.
However, the programme must first be given a fair trial.
Therefore, I was dismayed that its fate could rest on the Government's decision to rely on the edicts of the National Fatwa Council. The treatment and, most importantly, the prevention of HIV/AIDS is, and has always been, first and foremost a public health issue that has required the participation of all sectors to ensure its success.
But this should not obscure or supplant the valuable lessons that have been learnt by our medical experts at considerable expense and loss of lives after dealing with this phenomenon for 19 years. We know what works and what doesn't. We need to trust our HIV/AIDS medical experts and their evidence, to guide our policies in addressing this epidemic. We know from other countries, particularly our neighbours Indonesia and Thailand, that it takes courage and long-term commitment to the make bold and often unpopular decisions that are necessary to effectively address and prevent the spread of AIDS.
I pray that our Government will remain steadfast in in its determination to begin the harm-reduction programme, for it is long overdue.
Friday, 3 June 2005
Monday, 21 February 2005
Losing the fight against mandatory premarital HIV testing in Malaysia
Four states within Malaysia (Johor, Perlis, Malacca and Perak) have now either decided to implement or are currently implementing mandatory premarital HIV testing for Muslim couples. There is even talk of making it mandatory for all ethnic groups in the country.
Are we losing the fight against mandatory premarital HIV testing in Malaysia? Has the research into HIV/Aids, the reasons and rationale against this form of testing as well as concern for Malaysians living with HIV/Aids gone out the window?
Despite both the authorities and religious leaders being engaged to increase the level of HIV/Aids awareness and understanding in the country, we now see the latter teaming up with state health directors (who are doctors) and politicians to push forward this policy.
A ploy being used in the attempt to neutralise opposition to the forced testing is the phrase ‘... if one has been confirmed to be HIV positive, it is then up to them if they want to marry after that’. The overlooked fact is that in a Muslim wedding, the women must obtain the consent of the father, who in turn, will definitely want to know the results of the test.
The results will be known among the family members. In other words, despite ‘counseling’ for the couple, a breach in confidentiality (which will happen) will almost definitely result in discrimination and ostracisation of the HIV positive person.
The test could be used to deny the HIV positive the right to marry. It could be used to weed out the ‘unsuitables’. And once found positive, what then? The procedure (as implemented in Johor) is silent on the issue of accidental HIV infection (wife or child) within marriage as a result of false results during the premarital phase. It is silent on assisting those found to be positive.
The testing procedure used totally ignores any possibility of the ‘window period’ for false results and the possibility of becoming HIV positive during marriage. The prevalent and dominant belief is that testing for HIV will result in prevention against infection.
For acceptability, the HIV testing is being sold as a measure to ‘protect’ women from HIV infection but I fear that women will end up being at the receiving end of mistakes, ill-conceived and unsupported policies, ignorance and fear.
Yes, we should test for HIV. But such testing must be based on full information, knowledge of the consequences of testing, how to deal with the results and, most importantly, with the voluntary consent of the individual.
We must continue to promote awareness of the disease and the need ‘to know your status’ through voluntary testing. Effective HIV/AIDS policies must be based on the science and reality of the epidemic in Malaysia.
Our policy and decision makers must learn from other countries as well as listen to those already living with the disease. They should not formulate polices based on ignorance, fear, politics and well-intended but misguided motives.
In the midst of all this, I must ask why are the HIV/Aids NGOs, community groups, People Living With HIV/Aids activists in Malaysia mostly quiet on this issue? Almost nothing has been said in opposition to this ill-advised move of forced HIV testing.
The Malay language media has been overwhelming in their support for this mandatory procedure. But I must ask, is mandatory premarital HIV testing of Muslims an inevitable reality for Malaysia?
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Mandatory HIV/AIDS screening for Muslims marrying in Perak
New Straits Times (www.nst.com.my) (24/02/05) M. Hamzah Jamaludin
Muslims planning to marry in the State will soon have to go for mandatory HIV/AIDS screening. They will, however, decide on whether to marry if found HIV-positive. Perak Menteri Besar Datuk Seri Tajol Rosli Ghazali said the State Religious Council had approved the move at a meeting today chaired by Raja Muda Raja Dr Nazrin Shah.
He said the State Legal Adviser had been asked to check on the implementation of the requirement with her counterparts in Johor and Malacca which had already enforced the ruling. The move will only be implemented after the green light from the legal adviser. �We will provide extensive counselling for couples if one of them has been confirmed HIV-positive. It is up to them if they want to marry after that," he told reporters after the council's meeting.
Muslims In Perak Must Undergo HIV/Aids Test Before Marrying
Bernama (www.bernama.com.my) (24/02/05)
IPOH, Feb 24 (Bernama) -- After Johor and Melaka, Muslims intending to get married in Perak will soon have to undergo HIV/Aids tests to ensure that the couples and their families are aware of their health status. Menteri Besar Datuk Seri Tajol Rosli Ghazali said the requirement was decided at the State Islamic Religious and Malay Custom Council Conference chaired by the Raja Muda Perak, Raja Dr Nazrin Shah, here Thursday. The implementation of the ruling and its procedure would be decided after studying the rules implemented in Johor and Melaka, he said after attending the conference.
He said State Legal Adviser Datuk Engku Nor Faizah Engku Atek and the Perak Islamic Religious Department had been told to undertake the study to ensure that the ruling would be carried out without any hitch. "Despite the tests, we will not force the couples into making certain decisions about their wedding plans. If they want to go on with their plans (despite being found HIV/Aids positive), they can do so," he said. Tajol Rosli said the department would give counselling to the brides and bridegrooms found to be HIV-Aids positive and their families from the religious, medical and health aspects if they wanted to proceed.
Forced HIV test can be bad
The Star (www.thestar.com.my) (21/02/05)
PENANG: Forcing couples to take pre-marriage HIV/AIDS tests might create a false sense of security should the results turn out negative, said an AIDS awareness group. Instead, Community AIDS Service Penang Dr Ismail Baba said the couples should be encouraged to undergo the tests themselves and those tested positive be given counselling. He said there was the possibility that the test results could turn out negative during the �window period�. �Although the result is negative, the infected person is still able to pass on the virus to his or her partner,� he said.
Dr Ismail was responding to reports quoting Perlis Regent Tuanku Syed Faizuddin Putra Tuanku Syed Sirajuddin Jamalullail as saying that the Perlis religious council should compel all Muslims planning marriage to take the HIV test to combat the rise of HIV/AIDS. Puteri Umno chief Noraini Ahmad had said that the proposal should have been implemented when it was first suggested several years ago to make sure that there were fewer cases of children being born with HIV/AIDS.
Dr Ismail said there were no stopping the couples from getting married in another state or country. He said policy-makers should have the right information on HIV/AIDS before such laws were implemented. �If the virus is passed to a woman, she has a 30% chance of infecting her baby during pregnancy, birth or breastfeeding. This chance of transmitting the virus to the baby could be further reduced to 15% if the mother is treated with medication,� he said. He said people should also have easy access to HIV testing, through NGOs. �The test should be easily accessible to the people to encourage them to take the tests,� he said.
Are we losing the fight against mandatory premarital HIV testing in Malaysia? Has the research into HIV/Aids, the reasons and rationale against this form of testing as well as concern for Malaysians living with HIV/Aids gone out the window?
Despite both the authorities and religious leaders being engaged to increase the level of HIV/Aids awareness and understanding in the country, we now see the latter teaming up with state health directors (who are doctors) and politicians to push forward this policy.
A ploy being used in the attempt to neutralise opposition to the forced testing is the phrase ‘... if one has been confirmed to be HIV positive, it is then up to them if they want to marry after that’. The overlooked fact is that in a Muslim wedding, the women must obtain the consent of the father, who in turn, will definitely want to know the results of the test.
The results will be known among the family members. In other words, despite ‘counseling’ for the couple, a breach in confidentiality (which will happen) will almost definitely result in discrimination and ostracisation of the HIV positive person.
The test could be used to deny the HIV positive the right to marry. It could be used to weed out the ‘unsuitables’. And once found positive, what then? The procedure (as implemented in Johor) is silent on the issue of accidental HIV infection (wife or child) within marriage as a result of false results during the premarital phase. It is silent on assisting those found to be positive.
The testing procedure used totally ignores any possibility of the ‘window period’ for false results and the possibility of becoming HIV positive during marriage. The prevalent and dominant belief is that testing for HIV will result in prevention against infection.
For acceptability, the HIV testing is being sold as a measure to ‘protect’ women from HIV infection but I fear that women will end up being at the receiving end of mistakes, ill-conceived and unsupported policies, ignorance and fear.
Yes, we should test for HIV. But such testing must be based on full information, knowledge of the consequences of testing, how to deal with the results and, most importantly, with the voluntary consent of the individual.
We must continue to promote awareness of the disease and the need ‘to know your status’ through voluntary testing. Effective HIV/AIDS policies must be based on the science and reality of the epidemic in Malaysia.
Our policy and decision makers must learn from other countries as well as listen to those already living with the disease. They should not formulate polices based on ignorance, fear, politics and well-intended but misguided motives.
In the midst of all this, I must ask why are the HIV/Aids NGOs, community groups, People Living With HIV/Aids activists in Malaysia mostly quiet on this issue? Almost nothing has been said in opposition to this ill-advised move of forced HIV testing.
The Malay language media has been overwhelming in their support for this mandatory procedure. But I must ask, is mandatory premarital HIV testing of Muslims an inevitable reality for Malaysia?
----------------------------------------------------------------------------------------------------------------------------------------------------
Mandatory HIV/AIDS screening for Muslims marrying in Perak
New Straits Times (www.nst.com.my) (24/02/05) M. Hamzah Jamaludin
Muslims planning to marry in the State will soon have to go for mandatory HIV/AIDS screening. They will, however, decide on whether to marry if found HIV-positive. Perak Menteri Besar Datuk Seri Tajol Rosli Ghazali said the State Religious Council had approved the move at a meeting today chaired by Raja Muda Raja Dr Nazrin Shah.
He said the State Legal Adviser had been asked to check on the implementation of the requirement with her counterparts in Johor and Malacca which had already enforced the ruling. The move will only be implemented after the green light from the legal adviser. �We will provide extensive counselling for couples if one of them has been confirmed HIV-positive. It is up to them if they want to marry after that," he told reporters after the council's meeting.
Muslims In Perak Must Undergo HIV/Aids Test Before Marrying
Bernama (www.bernama.com.my) (24/02/05)
IPOH, Feb 24 (Bernama) -- After Johor and Melaka, Muslims intending to get married in Perak will soon have to undergo HIV/Aids tests to ensure that the couples and their families are aware of their health status. Menteri Besar Datuk Seri Tajol Rosli Ghazali said the requirement was decided at the State Islamic Religious and Malay Custom Council Conference chaired by the Raja Muda Perak, Raja Dr Nazrin Shah, here Thursday. The implementation of the ruling and its procedure would be decided after studying the rules implemented in Johor and Melaka, he said after attending the conference.
He said State Legal Adviser Datuk Engku Nor Faizah Engku Atek and the Perak Islamic Religious Department had been told to undertake the study to ensure that the ruling would be carried out without any hitch. "Despite the tests, we will not force the couples into making certain decisions about their wedding plans. If they want to go on with their plans (despite being found HIV/Aids positive), they can do so," he said. Tajol Rosli said the department would give counselling to the brides and bridegrooms found to be HIV-Aids positive and their families from the religious, medical and health aspects if they wanted to proceed.
Forced HIV test can be bad
The Star (www.thestar.com.my) (21/02/05)
PENANG: Forcing couples to take pre-marriage HIV/AIDS tests might create a false sense of security should the results turn out negative, said an AIDS awareness group. Instead, Community AIDS Service Penang Dr Ismail Baba said the couples should be encouraged to undergo the tests themselves and those tested positive be given counselling. He said there was the possibility that the test results could turn out negative during the �window period�. �Although the result is negative, the infected person is still able to pass on the virus to his or her partner,� he said.
Dr Ismail was responding to reports quoting Perlis Regent Tuanku Syed Faizuddin Putra Tuanku Syed Sirajuddin Jamalullail as saying that the Perlis religious council should compel all Muslims planning marriage to take the HIV test to combat the rise of HIV/AIDS. Puteri Umno chief Noraini Ahmad had said that the proposal should have been implemented when it was first suggested several years ago to make sure that there were fewer cases of children being born with HIV/AIDS.
Dr Ismail said there were no stopping the couples from getting married in another state or country. He said policy-makers should have the right information on HIV/AIDS before such laws were implemented. �If the virus is passed to a woman, she has a 30% chance of infecting her baby during pregnancy, birth or breastfeeding. This chance of transmitting the virus to the baby could be further reduced to 15% if the mother is treated with medication,� he said. He said people should also have easy access to HIV testing, through NGOs. �The test should be easily accessible to the people to encourage them to take the tests,� he said.
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