Dr Adeeba Kamarulzaman
I refer to the article titled “No room for a secular Malaysia” by Dr Rafidah Hanim on May 18 in FMT.
Whilst I do not wish to enter into the long-standing debate on whether Malaysia was built on the concept of a modern, progressive, democratic and secular nation with Islam’s constitutional position as the country’s official religion, I do wish to discuss the erroneous assertions put forward by the writer regarding LGBT and the HIV epidemic in a secular Malaysia.
One can in fact reason that HIV, as all other health matters, is a good argument for secularism where policies should be based on evidence and not driven by religious and ideological beliefs.
The writer has rightly pointed out that there has been a rise in HIV infection amongst men who have sex with men and transgenders in Malaysia.
The reason for the increase in infection despite there being effective HIV prevention and treatment programmes available show that there are specific challenges and barriers faced by these individuals.
Local research has shown that there exists high levels of depression, anxiety and substance misuse because of the stigma faced by these individuals that result in fear and delays in seeking specific treatment and interventions to prevent HIV infection.
A culture of intolerance and persecution of LGBT and fear of being judged by the medical community and society in general and a deep sense of self-stigma deter many from coming forward for HIV testing and treatment. As a result, HIV infection goes undetected and untreated and subsequently transmitted.
In contrast, in societies that are more open and less judgemental and more accepting of sexual diversities and minorities, the concept of ending AIDS is becoming a reality.
In San Francisco for example, where a large community of men who have sex with men exist, comprehensive, strategic and sustained implementation of scientific knowledge combined with political commitment and civil society engagement provides an opportunity for this city to end AIDS by 2030.
Secondly, the writer pointed out that data from UNAIDS have shown that in the Middle East and North Africa (MENA), where most Muslim countries are located, and where the majority uphold criminal law with regard to homosexuality, there were an estimated 230,000 people living with HIV which gives an adult HIV prevalence of 0.1%.
Indeed, overall the HIV prevalence in Muslim majority countries is lower than that of non-Muslim countries.
Adherence to Islamic codes and practices such as prohibition of sex outside marriage and a delay in sexual debut no doubt contributes to this lower prevalence. Furthermore, male circumcision has been scientifically proven to effectively prevent HIV transmission.
However despite the existence of these harsh laws, the MENA region still recorded approximately 18,000 new HIV infections in 2016 and is one of the only regions to witness a rise in new HIV infections and AIDS-related deaths due to poor access to antiretroviral treatment.
Closer to home, Kelantan has also consistently recorded one of the highest levels of HIV prevalence in the country. In other words having laws that criminalise sexual behaviour does not necessarily guarantee that a state or country will be free of HIV.
Thirdly, in the early 2000s Malaysia witnessed an escalation of the HIV epidemic as a result of injecting drug use.
Despite scientific evidence that showed that these infections could be prevented by providing treatment with methadone for opiate addiction and the use of clean needles and syringes to prevent HIV transmission, these strategies were for decades resoundingly rejected on the basis that they were against Islamic teachings.
Thousands of Malay Muslim men became infected and died as a result. Many more went on to infect their spouses who unknowingly gave birth to HIV infected infants.
Fortunately, enlightened political, medical and religious leadership subsequently agreed that saving lives was paramount and the harm reduction programme was eventually approved and implemented nationwide.
Today, more than a decade later, the number of new infections amongst people who inject drugs have been halved and research shows that approximately 14,000 new HIV infections have possibly been averted and RM40 million saved in health costs in the period between 2006 and 2013 as a result of this programme.
Many advances have occurred in the world of HIV in the last three decades, chief amongst them is the availability of treatment that does not only allow an HIV infected individual to live a normal life but also prevents onward transmission.
Central to the global goal of ending the AIDS epidemic is ensuring that as many people as possible know their HIV status and receive treatment as soon as possible.
There is no doubt that adherence to the basic teachings of Islam such as prohibition of relationships outside of marriage will protect an individual from infection. However the HIV epidemic also thrives in a culture that judges and discriminates.
Instituting religious laws towards gays, bisexuals and transgenders will only further deepen the stigma towards these individuals, deter them from coming forward for essential prevention and treatment services and paradoxically worsen rather than reduce the rate of the HIV epidemic.
HIV is a public health issue that is best dealt by implementing evidence-based programmes and interventions as has been demonstrated with Malaysia’s own successful harm reduction programme.
As a society we will need to learn to differentiate personal from public sins. The practice of Islam that emphasises human dignity and compassion will be far more effective in complementing and supporting scientifically proven efforts in getting those at risk to seek health services than the criminalisation of sexual behaviour that is being sought by the writer.
Continued punishment and criminalisation of personal sins will not help us achieve the global goal of ending AIDS. Ultimately public health policies must be rooted in evidence and science and not on religious and ideological beliefs.
Dr Adeeba Kamarulzaman is Dean of the Faculty of Medicine, University of Malaya, Chairman of the Malaysian AIDS Foundation, and member of G25.
The views expressed are those of the author and do not necessarily reflect those of FMT.