THE fear of HIV/AIDS was such that at one time, those suffering from the disease (and even their families) were stigmatised and ostracised.
No one would even shake their hand or want to be in the same house, school, or workplace as them, forcing many patients to live out their lives in secrecy.
Those early years were a reflection of our poor understanding of the disease.
While HIV remains a threat globally, it is no longer a death sentence.
With effective treatment, individuals can lead normal lives, says Hospital Kuala Lumpur consultant infectious disease physician Dr Khairil Erwan Khalid.
However, this comes with certain conditions. Early diagnosis, timely initiation of treatment, strict adherence to the treatment regimen and managing risk-taking behaviours are all crucial for people living with HIV (PLHIV) to fully benefit from the treatment.
Dr Khairil says when someone with HIV is on effective anti-retroviral therapy and adheres to the regimen, their viral load is undetectable and thus they cannot transmit HIV to their sexual partners.
It's a concept related to HIV treatment and transmission, called U=U, which stands for "Undetectable = Untransmittable".
This is supported by extensive research and has been endorsed by major health organisations, he adds.
"U=U emphasises the effectiveness of modern HIV treatment and aims to reduce stigma around HIV by highlighting that people with an undetectable viral load can lead healthy lives and maintain sexual health without passing the virus to others."
In Malaysia, the landscape of HIV has changed over the last three decades, with the mode of transmission shifting from primarily drug users to sexual transmission.
This shift is significant and reflects a global trend, not just a Malaysian phenomenon, says Dr Khairil.
In Malaysia, the change was particularly dramatic, he adds due to the highly successful Harm Reduction Initiative, which includes the Needle Exchange Programme and Opioid Substitution Therapy.
These programmes were implemented nationwide and at a scale that effectively altered the trajectory of the epidemic within a decade.
"This success story highlights the importance of adopting substantial, evidence-based approaches guided by science to address the increasing sexual transmission of HIV."
Sexual transmission of HIV remains a threat, especially among young people in Malaysia.
Health Ministry data indicates that 214 students in public or private higher education institutions were infected with HIV in 2020. The numbers dropped to 186 in 2021 but picked up again in 2022 (221) and 2023 (224).
Malaysian AIDS Council (MAC) vice-president Dr Dinesh Mahalingam says firstly, we have young people — teenagers and those in their early twenties — who possess very poor knowledge of sexual and reproductive health (SRH) and HIV.
These individuals were either never formally educated on the subject or didn't receive enough information to form a proper understanding.
As a result, they are often unaware of preventive measures, leading to increased transmission of HIV and other sexually transmitted infections (STIs).
Secondly, there is a subset of young people who have acquired some knowledge about HIV, SRH, and safer sex practices. However, without proper guidance or formalised sexual education programmes, combined with the influx of inaccurate information from the Internet, social media, and peer discussions, they struggle to translate this knowledge into responsible behaviour that could protect them from HIV infection.
"This group represents the challenge of the information age — a new reality that we must confront. If we don't provide them with the accurate information they need, they will seek it elsewhere, often from unreliable sources," says Dr Dinesh.
This is why it's crucial for authorities to take control of the narrative around sexual health and HIV, he adds.
"Without a more convincing and holistic approach to sexual education, we risk losing the battle of information."
MAC is also emphasising the need to lower the age of consent for HIV and STI testing.
This recommendation is grounded in the alarming reality of current sexual behaviour and exposure among our youth where we are witnessing an increasing number of HIV cases being diagnosed at a younger age, says Dr Dinesh.
"The sooner we adapt our policies to reflect this situation, the better equipped we will be to combat the spread of HIV and other sexually transmitted infections among young people."
Early testing provides a significant advantage by enabling early diagnosis, which in turn allows for the prompt initiation of treatment.
This can dramatically improve health outcomes, reduce the likelihood of long-term complications, and decrease the chances of further transmission.
PROVIDING SUPPORT
DUREX Malaysia and the Malaysian AIDS Foundation have launched the Positive Living Programme. This dual initiative aims to provide comprehensive psychosocial support for newly diagnosed People Living with HIV (PLHIV) and promote sexual health awareness among young Malaysians.
Newly diagnosed PLHIV face significant psychological, social, medical and economic challenges. The initial shock of the diagnosis often leads to anxiety, depression, and concerns about stigma and discrimination.
These individuals may struggle with self-esteem and fear of ostracism by family, friends and the broader community, while workplace discrimination and healthcare stigma further complicate their situation.
The vulnerability of young people to unsafe sex practices and inadequate protection was highlighted in the recent Durex Global Sex Survey (GSS) 2024.
The survey, which covered 36 countries and included 29,500 respondents aged 18 and above, including Malaysia, highlighted a disconnect between sexual activity and responsible sexual practices.
It indicates that despite 70 per cent of Malaysians being sexually active, only 24 per cent have purchased condoms in the past year.
As many as two in five have had sex without protection against unplanned pregnancy, with a third having sex without protection against sexually transmitted infections.