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Aids: Gov't Blasted for Bold Steps

Contributed by Anonymous on Sunday, October 30 @ 22:51:27 CST

Healthby Baradan Kuppusamy, Kuala Lumpur

Beneath the affluence, the sophistication and the Western trappings lies the soft underbelly of Malaysia's Islamic conservatism no sex education in schools, no holding hands, no kissing in parks, no visuals of condoms on television and, sometimes, even no cinemas.

So it came as a deep shock to many when the moderately Islamic government of Prime Minister Abdullah Badawi announced suddenly in June and without public discussions that the Health Ministry has approved a harm reduction programme, under which free condoms and needles would be distributed to 130,000 injecting drug users to curb an alarming rise in HIV/AIDS infections.

The previous government under Prime Minister Dr Mahathir Mohamad was in denial for many years, rejecting pleadings by human rights organisations, medical experts and the Malaysian Aids Council to begin such a scheme. The government always said it was immoral to give condoms and needles.

Authorities even stopped private groups distributing condoms and needles in the capital's Chow Kit area, whose narrow and garbage-strewn back lanes are a hothouse for drug injection and infection of the virus.

But officials say Abdullah, whose Islamic credentials better place him to placate and overcome opposition to the plan from Islamic clerics, was persuaded into starting the harm reduction scheme by alarming new statistics seen by the Health Ministry.

HIV infection ballooned from about 3,000 known cases in 1993 to over 64,000 by 2004. But United Nations medical experts say the true figure is usually five times that number in Malaysia's case about 300,000 people living with the virus.

A recent study among 326 inmates in 26 drug rehabilitation centres here showed that 65 percent were intravenous drugs users and that 77 percent were sexually active. But only 19 percent used condoms during sex.

With more recent data showing 75 percent of all HIV infection directly caused by needle sharing and unprotected sex among Malaysia's 600,000 drug addicts, experts say the harm reduction program is long overdue and might not stop an epidemic.

Even the U.N. World Health Organisation weighed, warning that with 15,000 children orphaned by AIDS, the country is staring at an HIV epidemic and must take drastic measures to contain the danger.

"It was only after studies were carried out that a finding was made that Malaysia was at the initial stage of an HIV epidemic," said WHO representative Hans Tieru.

"The government was persuaded by the alarming statistics and the success of similar (harm reduction) schemes in orthodox Islamic countries like Iran and Indonesia," a senior Health Ministry official involved in planning the scheme told IPS. "We have been in denial for at least two decades. we can't continue like this any longer."

Malaysia has been struggling to reduce the spread of HIV/AIDS, but activists say many of the steps taken were amateurish, ad hoc and seldom sustained.

Three states have introduced compulsory HIV tests for couples intending to marry, but such programmes, experts say, do not tackle the root causes of drug addiction and the virus' spread.

Now that the government has bitten the bullet and allocated the money, experts say they hope to see the first signs of a turnaround.

In October, the first batch of needles and condoms will be distributed to the targeted 130,000 injecting drug users and the sexually active among them.

"The programmme will cost about 150 million ringgit (39.5 million U.S. dollars) and we hope to see results within about five years," Health Minister Dr Chua Soi Lek told IPS. "If we do nothing some 300,000 Malaysians are in danger."

"We will give them needles so that they will not share needles," Chua added. "Morally, we're neutral. Actually, in medical reality, without condoms, HIV will spread."

"We have decided to take the bull by the horns. Many other countries, even Islamic countries, have similar programmes and scored major success against the virus," said the minister.

Despite the government's optimism, clergy of all faiths have voiced their opposition. Hindu, Christian and Buddhists argue the scheme is fundamentally immoral because free condoms and needles only encourage more illicit sex and drug usage.

Islamic clerics are fiercely opposed to the plan. Senior cleric Harusaani Zakaria, who is influential within government circles, has condemned it, saying it will encourage illicit sex. "HIV-infected persons should be held confined on an isolated and remote island and not endanger society with their infection," he famously said in May.

It is an opinion widely held among Islamic clerics, officialdom and ordinary Malaysians.

"This is a ridiculous scheme . it will simply encourage more free sex and more drug addiction among the people," says Mahfuz Omar, a key leader in the opposition Islamic PAS party.

He wants the government to tackle what he says is the root cause of drug addiction and HIV infection prostitution. "The government must close down all the massage parlours, karaoke lounges and social escort services that are all fronts for prostitution," said Omar.

Ruling party leaders want the plan watered down to provide free condoms only to married couples among drug addicts or to those who are HIV-positive.

But government officials strongly defend the programme.

"We have tried other measures but it has not worked, and countries which have implemented it have a significantly lower number of cases," Dr Ismail Merican, the top official at the Health Ministry, told reporters.

The convenor of the Malaysian Harm Reduction Working Group, Dr Adeeba Kamarulzaman, said the success of the harm reduction programme will depend on whether it includes enough community workers, training and a sufficient budget.

"We have to educate our society. Many developing countries have introduced the harm reduction programme," she said in an interview.

It is more than just needle exchange, added Kamarulzaman. "It is also about information, counselling, drug substitution therapy, and it's about helping and caring."

Malaysian Aids Council President Marina Mahathir strongly backs the programme, and wants the government to launch a campaign to educate the public about it. "While other countries have gained knowledge on how to deal effectively with HIV, we have only moved backwards," she said in her weekly article in a local newspaper last week.

"Political leadership is the single most important deciding factor in any successful HIV response. Every country that has managed to reduce its infection rates has been the ones where political leadership has been strong," added Mahathir, daughter of the former prime minister.

As an example she cited Uganda, which Mahathir said had reduced infections from 16 percent of all adults to six percent.

Senegal, a Muslim country, has maintained its infection rate at just 1.5 percent thanks to early education for its people and the distribution of 10 million free condoms, she added.

Even Iran, Mahathir wrote, allows a needle exchange programme and the distribution of condoms among prisoners. "Behind all this success is political will and the active support of the religious leaders," she added.

"Malaysia has a choice we can continue making superficial attempts or we can be bold. One day we will wake up to find we have a very serious epidemic on our hands," warned Mahathir. "Then there will be no one to blame but ourselves for our complacency." (END/IPSAP)



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