Hazlin Hassan
The Straits Times
The number of women with HIV infections in Malaysia has soared.
The rise has added urgency to calls for the government to make HIV screening compulsory for Muslims before they get married.
Deputy Prime Minister Najib Razak announced the move to make human immunodeficiency virus (HIV) screening mandatory after chairing a meeting of the Cabinet Committee on Aids yesterday.
'Next year, we will make it mandatory for all states to impose the HIV screening as part of the pre-marital course,' he told reporters.
Some states, including Kelantan, Negeri Sembilan, Sabah, Sarawak and Selangor, have already made it mandatory for Muslim couples to undergo HIV screening before they get married.
This latest move comes as fresh statistics reveal that the number of women infected with HIV is rising sharply.
The number of women infected through normal sexual intercourse rose from 5.02 per cent in 1997 to 16.3 per cent last year.
Back in 2006, the Malaysian health authorities had already detected a rise in the number of women infected with HIV/Aids.
According to the Malaysian Aids Council, the country's leading Aids non-governmental organisation, the majority of them were housewives.
It said that among women infected then, 1,628 were housewives while only 406 were sex workers.
As of June this year, the total number of housewives infected was 2,565, compared with 525 cases of infections among sex workers, according to Ministry of Health figures.
Many of these new infections were among married monogamous women, indicating that they acquired the virus from their husbands.
HIV infections among housewives were highest in Kedah, Terengganu and Kelantan, with each recording more than 200 cases, according to the New Straits Times.
Among the male cases, the majority of them were drug users. They comprised some 59,000 of the total 83,527 HIV cases in the country.
Aids researchers said this likely indicates that men who were infected via contaminated needles were transmitting the disease to their partners.
Left untreated, HIV causes Aids, which can lead to death.
While the number of women infected is rising sharply, the overall HIV infection rate in Malaysia has dropped by nearly half over the past five years, Datuk Seri Najib pointed out yesterday.
This year, there were 3,452 new HIV cases, compared with 6,756 in 2003, thanks to a national programme to stem infections, he said.
The government's goal is to reduce the figure to 11 cases per 100,000 population by 2015 compared with 12.8 cases now, he added.
But the move to make HIV screenings mandatory was condemned yesterday by the Malaysian Aids Council, which called it 'alarming'.
Council president Adeeba Kamarulzaman said in a statement that it was crucial that each person who receives a positive HIV test result also receives counselling and treatment.
She warned that women, in particular, 'due to their lower status in society, are more likely than men to be vulnerable to discrimination, violence, abandonment and ostracism, if they are found to be infected with HIV'.
The statement also warned that a policy of mandatory screening 'may drive those infected with HIV underground and not achieve its purported goal of protecting public health'.
However, most ordinary Muslims who have yet to tie the knot have welcomed the move.
Anis Abdullah, who is single and in her 30s, said that the test is not a big deal to her.
'If I'm going to be sleeping with someone, I'd really like to know that he's safe and I wouldn't be offended if he asked me to take the test either.
'It's because of this day and age we're in. It's very easy to tell yourself 'no sex before marriage', but it's not always that easy,' she told The Straits Times.
Lavinia Rahman, 38, said: 'I wouldn't want to feel 'cheated' if I were to discover my significant other is HIV- positive after we are married, regardless of how he got it.'
Study finds virus can reach immune cells in just 4 hours
TUESDAY, Dec. 16 (HealthDay News) -- A new route of male-to-female transmission of HIV -- in which the virus can travel through healthy genital skin to reach immune cells in just four hours -- has been identified by U.S. researchers.
It's long been believed that the normal lining of the vaginal tract was an effective barrier to HIV during sexual intercourse, because the large HIV virus couldn't penetrate the tissue. But the Northwestern University Feinberg School of Medicine researchers found that HIV can penetrate normal, healthy genital tissue to a depth where it can get to immune cells and infect them.
The researchers labeled HIV viruses with photo-activated fluorescent tags and were able to track the viruses as they penetrated the outermost lining of the female genital tract (the squamous epithelium) in female human tissue obtained through hysterectomy and in animal models.
The findings were expected to be presented Dec. 16 at the American Society for Cell Biology annual meeting, in San Francisco.
"This is an unexpected and important result. We have a new understanding of how HIV can invade the female genital tract," principal investigator Thomas Hope, a professor of cell and molecular biology, said in a university news release.
"Until now, science has really had no idea about the details of how sexual transmission of HIV actually works. The mechanism was all very murky," Hope said.
These findings, if confirmed in future studies, could help in the development of new microbicides and vaccines to protect women against HIV.
"We urgently need new prevention strategies or therapeutics to block the entry of HIV through a woman's genital skin," said Hope. While condoms are 100 percent effective in blocking HIV, "people don't always use them for cultural and other reasons."
Women account for 26 percent of all new HIV cases in the United States, according to the U.S. Centers for Disease Control and Prevention. Based on its most recent analysis of 2005 data, the CDC estimated that there were 56,300 new HIV infections that year, and 31 percent were due to high-risk heterosexual contact. More than half of the new cases of HIV infection worldwide are in women.
More information
The U.S. Food and Drug Administration has more aboutwomen and HIV.
AUCKLAND: Southland grandmother Jan Waddell has one wish she wants to die from old age and not the HIV retrovirus she got from a contaminated needle in Australia six years ago.
Until then the former nurse wants people to deal with their ignorance, learn about women with HIV, and get rid of their negative reaction and discrimination.
Mrs Waddell (59), who with her husband runs a small lifestyle block with alpacas, goats, sheep and chickens at Mataura, is one of the public faces of a campaign by Auckland HIV and Aids support group, Positive Women.
The campaign, launched in Auckland yesterday, wants to overcome the common but misguided impression that women with HIV are different and should be feared and avoided.
‘‘We are no different to anybody else and that’s the message we want to get across,’’ said Mrs Waddell.
She contracted HIV in Australia in 2002 in a one-in-amillion chance, when she pricked her thumb with a contaminated needle as she put it into a ‘‘sharps’’ container, which is used for sharp instruments and syringes.
She was confirmed as having HIV, or the human immunodeficiency virus, about three months later.
Without treatment, HIV can lead to Aids (acquired immune deficiency syndrome) and death. With modern treatment, HIV patients can live a long life, some without side effects from the drugs they must take.
Jane Bruning, Positive Women national co-ordinator, who first learned she had HIV 20 years ago, said HIV did not automatically lead to Aids.
‘‘Nowadays, there are such good medications and people are living 20, 30 years and more, so it is possible you may not die from HIV although you will have to take medications for most of your life.’’
She said HIV was not restricted to the gay community and recently the number of heterosexual people with HIV, particularly women, was growing.
By 2006, the number of women with HIV had passed the number of gay men with the disease.
For Mrs Waddell, living with HIV had been an emotional challenge but she coped with a lot of support from her family and friends.
She believes she will probably live out her life without contracting Aids, particularly with the huge advances in HIV medicines.
However, with the medicines come the side effects.
‘‘I have had so many side effects. In the last six years, I have been on four different combos because of side effects.
‘‘I have had muscle wasting, fatigue, nausea. I have had problems with my liver, kidney stones, insomnia, a whole lot of things.
‘‘I am doing pretty well at the moment and the top of my wish list is that old age will get me before Aids does.
‘‘The realities are pretty good.’’
She said modern medications were giving a quantity of life and a better quality of life was just around the corner.
‘‘It is not the death sentence it once was.’’
HIV also came with another side effect which Mrs Waddell and her husband decided on jointly: sex is no longer part of their life because HIV can be passed on through sexual contact.
‘‘My husband and I decided at the very early stages we would absolutely abstain from everything. We were quite comfortable with that in our married life and still are and that has never been a problem for us.’’
She concedes doing without sex could be a big issue for some couples where one had been diagnosed as HIV positive.
‘‘There is always that worry that something will go wrong the condom will fail.’’
For Mrs Waddell and her husband it was a personal choice but it also depended on the strength of their relationship and how understanding the partner was.
It could put a huge stress on relationships but for Mrs Waddell and her husband, it meant a stronger relationship.
‘‘We talked about it. There are other things that are more important to him.’’
She said her husband understood what HIV was and had been supportive and understanding.
Her advice to other couples facing an HIV crisis was to be honest with each other.
‘‘You have to sit down and talk to each other and be totally honest. You have to say if you are going to miss this sex then we have to make a decision.
‘‘But I think it would be very hard for them.’’
She also urged people to get all the support they could from friends and family and any specialist groups such as Positive Women, where they could talk freely and not worry about any stigma.
She said there was not enough education to overcome the ‘‘fear of the unknown’’ among people who did not know enough about HIV or Aids.
She said people did not want to come near her or touch her for fear of catching HIV.
Many also felt it was a disease restricted to the homosexual community.
‘‘There are so many people out there who still believe it is called the gay plague and it is just ridiculous people can be thinking like that in this day or age.’’
She said being part of a campaign which had never been undertaken in New Zealand, was a wonderful experience.
Labels: Campaign, HIV/AIDS, Interesting
Beijing, February 20: China will come up with a special HIV/AIDS prevention policy this year to combat the rising incidence of the infection in the gay population of the country, the ministry of health said here Wednesday.
The policy will incorporate detailed HIV/AIDS prevention measures for gays, including extending the use of condoms, according to the ministry's work plan for disease prevention and control in 2008.
China has decided to intensify its AIDS intervention campaign on gays by carrying out AIDS prevention training among the gay population nationwide as well as conducting consultation, HIV/AIDS tests, venereal disease treatment in some areas, the ministry said.
According to an appraisal report jointly prepared by the Ministry of Health, the World Health Organization (WHO) and UNAIDS, among the 700,000 people living with HIV/AIDS in China by the end of 2007, 40.6 percent contracted the virus through heterosexual transmission, 11.1 percent through same sex intercourse.
'Sex has become the main channel of contracting the HIV virus,' the report said.
China's health department estimated that the country has 5 million to 10 million gays. Most of them are in middle and large cities in China.
According to recent research on gays, prevalence of HIV/AIDS among this group in China is getting serious with the infection rate reaching 2.5 percent to 6.5 percent.
The Chinese government will expand its coverage of replacement therapy for drug addicts, using methadone, a synthesised narcotic, and continue to improve its policy of offering AIDS patients various free services, such as counselling, testing, anti-viral medicine and education for orphans of AIDS patients, the ministry said.
Clinics providing the therapy have been built in 503 communities in 23 provinces, autonomous regions and municipalities, figures from the Chinese Center for Disease Control and Prevention (CDC) showed.
HIV/AIDS policies and programmes disregard the sexual needs of people living with the virus, claim a number of HIV-positive women who attended the third Africa Conference on Sexual Health and Rights -- held this week in Nigeria.
The initiatives focus on prevention and treatment, they add, ignoring the fact that people living with HIV/AIDS who are conducting normal lives still want to experience sexual pleasure, and have children.
"The epidemic has evolved. HIV-infected people are not dying; we are living and we are having sex," noted Beatrice Were, an activist in Uganda for the Global AIDS Alliance, a non-profit based in Washington.
She said health care providers and others are shocked when they discover that a person living with HIV/AIDS is either interested in or having sex, viewing this as irresponsible -- even though condoms have been shown to be highly effective in preventing transmission of the HI virus, and re-infection of a person who has already tested positive.
"We are looked upon as patients who need to be pitied, patients who must be told what to do -- and this includes to abstain from sex, and not to fall pregnant," added Were, who has been HIV-positive for 16 years. "We are treated with bias, even though we are capable of enjoying sexual pleasure without passing on the disease."
Furthermore, noted Belinda Tima -- board co-chair of the International Community of Women Living with HIV/AIDS (ICW), a charity headquartered in London -- sexual pleasure need not be limited to penetrative sex, but can take a variety of forms.
Even the staunchest advocate of condom use cannot claim that the prophylactics are completely effective, however. Is there perhaps a sense among health workers that even the small risk of someone contracting the virus during protected sex with an HIV-positive person is too great?
"Condoms are not 100 percent safe -- we refer to it as 'safer sex' -- but the risk of infection in minimal," responded Anne Ntombela, the ICW's programme director for South Africa. "If you understand the nature of HIV and how it is transmitted you will know that it is not as easy as people think. It needs exposure for a sufficient period of time under the right conditions, and it needs an exit and entry point," she added, in reference to cuts, sores and the like.
The larger issue at play is a moral one, Ntombela said. "Health care workers try to force their moral values on other people, but in reality people will not stop having sex. They would be better served if they were told how to have safer sex, rather than not to engage in sex at all."
In addition, countries should create "...an environment that supports access to services. We need prevention tools like female condoms...and we need more co-operative research on living with HIV and AIDS, and policies and programmes that take cognisance of this."
Pregnancy prevention
Concerns about the sexual activity of HIV-positive people extend to the matter of pregnancy.
HIV-positive women may pass on the virus to children during pregnancy, labour or while breastfeeding. ARVs can reduce the risk of transmission to under two percent, according to AVERT, a global charity that helps combat the pandemic. However, research has indicated persistent fears about mother-to-child transmission of HIV, and that mothers who are HIV-positive could die -- leaving behind orphans who may receive insufficient care.
"When I chose to have a baby 15 months ago people demanded to know why I took the risk of infecting my child. There was a 98 percent probability of not infecting my baby -- but people...demanded to know why I took that two percent risk," said Rolake Odetoyinbo, executive director of Positive Action for Positive Treatment, a non-governmental group in Nigeria. She has lived with HIV/AIDS for a decade.
A number of delegates at the conference claimed that certain clinics administer contraceptive injections when providing AIDS treatment to women, without receiving the consent of these women or counseling them. There are also reports of health workers acting judgmentally towards HIV-positive women in search of reproductive health care, and even denying them assistance. Indications are that women with the virus may be pressed into having an abortion where this option is available, or into being sterilised.
But even in the face of these difficulties, an array of factors prompt women living with HIV/AIDS to become pregnant or remain so, notes a 2002 report by Ipas, 'Reproductive choice and women living with HIV/AIDS'. Ipas is an international organisation for the advancement of women's sexual and reproductive rights.
It states that "...often younger women appear to be most motivated by a desire for motherhood and the idea that having a child will give them more hope. In a few cases, personal convictions that abortion is wrong may prevent them from seeking terminations, so that they end up having children 'by default'."
Social expectations as concerns family size, the stigma surrounding childlessness and unsuccessful attempts to terminate pregnancy also play a role. In addition, childbearing can be seen as "...a means of obtaining or ensuring economic support from partners".
Noted the ICW's Ntombela, diagnosed with HIV 17 years ago, "All pregnancy is risky. Telling an HIV-infected woman not to have a child is the same as telling all women not to have a child in case it is born with a defect, in case it has Down's syndrome."
"There are worse complications than HIV for a child HIV-infected children can experience a healthy life style -- it's not like 10 years ago."
Restrictive abortion laws
Another issue that came under discussion at the Third Africa Conference on Sexual Health and Rights, held Feb. 4-7 in the Nigerian capital of Abuja, was the failure of most nations on the continent to ensure legal and safe voluntary abortions.
Several speakers at the biennial meeting called for the liberalisation of abortion laws in Africa. "Annually there are 5.5 million unsafe abortions performed in Africa, resulting in 36,000 unnecessary deaths," said Elizabeth Maguire, president of Ipas.
The conference was organised by various groups, including Ipas and the World Health Organisation, under the theme 'Sexuality, Poverty and Accountability in Africa'. About 400 people from 32 countries were present at the event.
Labels: Africa, Health, HIV/AIDS, World News
