NEED FOR MORE AWARENESS ON HIV/AIDS (First of a three-part feature)

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 exhange 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