Malaysian academics want abstinence vows instead of PrEP treatment

A group of six academics from Malaysian Universities have implored the government to hold back from scaling up the availability of PrEP treatment and instead encourage men who have sex with men to embrace abstinence.

“Abstinence is the only key message that we should repeatedly promote to prevent HIV infection among the MSM community,” the group said in their letter to the government, which was reported by local outlet The Star.

Pre-exposure Prophylaxis (PrEP) is a once-a-day medication that prevents people from becoming infected by HIV. Around the world it has made dramatic reductions to the number of new HIV transmissions, the cost for government however is considerable.  The Malaysian academics argue that allow people access to the medication will encourage more homosexual behaviour and damage to moral fabric of the country.

Leading the call to promote abstinence over life-changing medication is Dr Rafidah Hanim of Universiti Sains Islam Malaysia (USIM), the statement is also supported by Professor Dr Samsul Draman from the International Islamic University Malaysia (IIUM), Proffessor Dr Anis Safura Ramli from Universiti Teknologi MARA (UiTM), Proffessor Dr Harmy Mohamed Yusof from Universiti Sultan Zainal Abidin (UniSZA), Associate Proffessor Dr Rosediani Muhamad from Universiti Sains Malaysia (USM) and Associate Proffessor Dr Ani Amelia Dato Zainuddin from Universiti Kebangsaan Malaysia (UKM).

Organisations that support people living with HIV however have spoken out against the suggestion, highlighting the positive effect accessibility to PrEP creates. Leading the charge to have the treatment available is Professor Datuk Dr Adeeba Kamarulzaman, who was the President of the International AIDS Society until earlier this year.

“While we acknowledge the virtue of abstinence, we must also act based on scientific evidence in reducing the sexual transmission of HIV. Four decades of the HIV pandemic have shown that an insistence on abstinence alone is not enough to change the outcome of this global crisis,” Professor Datuk Dr Adeeba Kamarulzaman, who is the Chairman of Malaysian AIDS Foundation.

“In 2021, 96% of new HIV cases were caused by sexual transmission, concentrated largely among the MSM community. Despite the weight of their vulnerability to HIV, the MSM community is also among the hardest to reach with HIV prevention services — largely due to overwhelming prejudice and a punitive legal system that criminalises their behaviour.

“In this time of crisis, taking a moral high ground against key populations runs counter to the basic tenet of human decency. There should be a concerted effort by each and every one of us to mitigate the HIV epidemic using the most powerful prevention tool in our arsenal.” Professor Adeeba said.

The Malaysian AIDS Foundation (MAF), Malaysian AIDS Council (MAC) and Malaysian Society for HIV Medicine (MASHM) have all encouraged the Malaysian government to scale up the availability of PrEP.

“We need to treat HIV prevention and care as a health-related issue, not a moralistic one, and recognise that history is repeating itself here with previous discussions around condoms and antiretroviral treatment and risk compensation,” said MAC President Associate Proffessor Dr Raja Iskandar Raja Azwa.

MASHM president Datuk Dr Chow Ting Soo said proper counselling on other methods of prevention of sexually transmitted diseases must be given on top of PrEP use.

“We should not regard this as a tool to promote sexual activities but rather as part of a prevention tool for HIV transmission,” Dr Chow said.

The Malaysian Public Health department recently released figures that showed the uptake of antiretroviral treatments by people living with HIV and led to a 70 per cent drop in new infections over the last 20 years.

Deputy Director-General of Health (Public Health) Datuk Dr Norhayati Rusli said while the country had seen a big uptake of people getting essential treatment, the figures were still a long way off achieving the desired result of eliminate new infections by 2030.

The number of people living with HIV who were on anti-retroviral treatments had increased to 66 per cent in 2021, compared to 28 per cent in 2015.  Speaking at a World AIDS Day event last week Dr Norhayati said the government would be making PrEP more available in the coming year.

“The concept of U=U or Undetectable = Untransmittable is an important concept and proven to be effective in curbing HIV infection. PLHIV who take antiretroviral drugs according to the prescription, can live like normal individuals because the virus is undetectable and untransmittable,” she said.

OIP Staff

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