The first HIV/AIDS case in Malaysia made its debut in 1986. Since then, HIV/AIDS has become one of the country's most serious health and development challenges. [1] As of 2020, the Ministry of Health estimated that 87 per cent of an estimated 92,063 people living with HIV (PLHIV) in Malaysia were aware of their status, 58 per cent of reported PLHIV received antiretroviral therapy, and 85 per cent of those on antiretroviral treatment became virally suppressed. Despite making positive progress, Malaysia still fell short of meeting the global 2020 HIV goals of 90-90-90, with a scorecard of 87-58-85. [2]
Malaysia is ranked seventh highest in adult prevalence of HIV/AIDS in Asia after Thailand, Papua New Guinea, Burma, Cambodia, Vietnam and Indonesia with a 0.45% prevalence rate. [3] According to the United Nations, Malaysia is one of the ten countries which together accounted for over 95% of all new HIV infections in the region of Asia-Pacific in 2016. [4]
In 2020, Malaysia recorded an incidence rate of 8.5 cases per 100,000 population, a 70 percent drop from 28.5 cases per 100,000 people in 2002. [5]
Malaysian HIV/AIDS cases have been reported since 1986 by the Ministry of Health. Since then, the national surveillance system had reported a cumulative of 105,189 HIV cases, 21,384 AIDS and 17,096 deaths related to HIV/AIDS giving total reported PLHIV of 88,093 cases or 96% of estimated PLHIV. [6]
Males still make up the majority of HIV cases (89%), but the number of women with positive status of HIV has been increasing. This is shown by the decreasing trend of male:female ratio of 10:1 in 2002 to 4:1 in 2014. [7] 42% of HIV transmission by age group occurred in 30–39 bracket. [7]
Between January and June 2014, 1,676 cases of HIV and 598 cases of AIDS with 402 deaths were recorded. [8] Out of this new infection, 79.7% are men.
In 2013, heterosexuals transmission recorded the highest (51%), followed by Injecting Drug User (22%) and Homo/Bisexual transmission (22%). The scenario shifted gradually whereby in 2016, the means of transmission of new HIV cases were highest among Homo/Bisexual (46%), followed by Heterosexual (39%), Injecting Drug User (11%), Others (4%) and Mother-to-Child (1%). [9]
In October 2018, Malaysia becomes the first country in the Western Pacific region to eliminate mother-to-child transmission of both HIV and syphilis, officially validated by the World Health Organization (WHO). [10]
HIV transmission by risk factor in 2016
(% of 3,397 new infections) [9]
HIV transmission by age group in 2016
(% of 3,397 new infections) [9]
Disease | Incidence Rate | Mortality Rate |
---|---|---|
HIV | 10.73 | 0.53 |
AIDS | 3.86 | 2.34 |
The HIV epidemic in Malaysia is concentrated in these key populations; [7]
Sex worker accounts for 0.6% of total reported cases thus far. However, the number of cases reported among sex workers are grossly under reported. [1] In 2014, Integrated Bio-Behavioral Surveillance (IBBS) in female sex workers shows an increase of sex workers living with HIV to 7.3% from 4.2% in 2012. [6]
An IBBS done in 2009 found HIV prevalence among the group at 9.3%, and was decreased to 4.8% in 2012. [6] However, in 2014, the IBBS shows an increase of HIV prevalence to 5.6%. [6]
At the beginning of the epidemic, injecting drug user (PWID) accounted for 70–80% of all new reported cases. This has started to decline since 2004. In 2011, PWID accounts for 39% of new reported cases. [1] In 2014, 16.3% of the PWID are reported living with HIV. [6]
IBBS conducted in 2012 shows 7.1% of MSMs is living with HIV. In 2014, the figure has increased to 8.9%. [6]
In 2001, the Department of Occupational Safety and Health developed a non-compulsory ‘Code of Practice on Prevention and Management of HIV and AIDS' which supports the creation of a non-judgemental and non-discriminatory work environment. [12]
During the 2011 Nineteenth ASEAN Summit, Malaysia together with other ASEAN nations, adopted the "ASEAN Declaration of Commitment: Getting To Zero New HIV Infections, Zero Discrimination, Zero AIDS-Related Deaths, Bali, Indonesia, 17 November 2011" to reaffirm their commitment in working towards realizing an ASEAN community with Zero HIV Infections, Zero Discrimination and Zero AIDS-related Deaths. [13]
On 13 October 2017, the then-Ministry of Human Resources Minister, Datuk Seri Dr Richard Riot Jaem announced that the government wants to draft a new regulation in an effort to eliminate discrimination against people living with HIV or AIDS at the workplace. The ministry plans to legislate the HIV and AIDS in Workplace Policy by 2020. [14] In October 2018, it is reported that the Malaysian AIDS Council (MAC) is currently working with the Ministry of Human Resources on a policy to ensure that people with HIV/AIDS including those receiving treatment are not discriminated when it comes to employment. [15]
Mandatory pre-marital HIV screening for Muslim couples was made mandatory by the Religious Department of State Government in nine states, beginning in November 2001 in Johor, followed by Perak, Perlis, Kelantan, Terengganu, Kedah, Pahang, Selangor, and possibly Melaka. Beginning January 2009, Muslim couples in the entire country are required to submit to premarital HIV testing. [16]
In 2018, the Ministry of Women, Family and Community Development mulls to make HIV testing mandatory for non-Muslim couples seeking marriage as well. [17] The proposal is strongly opposed by NGOs such as the Malaysian AIDS Council and the Sarawak AIDS Concern Society (SACS) citing the stance of World Health Organization (WHO) and UNAIDS that do not support compulsory screening of individuals for HIV. [18]
The first line of highly active antiretroviral therapy is provided for free in Malaysia by the Ministry of Health since 2006. [19] By the end of 2020, 58 per cent of reported PLHIV received antiretroviral therapy, and 85 per cent of those on antiretroviral treatment became virally suppressed. [2]
In September 2018, "HIV Connect", a self–paced, online learning platform that is designed for primary care physicians and other healthcare practitioners in Malaysia was launched. The online learning platform is a joint effort between the Malaysian AIDS Foundation (MAF) and the Malaysian Society for HIV Medicine (MASHM) to educate doctors regarding care and management of HIV/AIDS patients. [20]
The global pandemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.
Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.
Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year – in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.
With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.
UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.
The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.
The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.
Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.
Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.
HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).
Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.
Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.
With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.
Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
Founded in 1999, Alliance India is a non-governmental organisation operating in partnership with civil society, government and communities to support sustained responses to HIV in India that protect rights and improve health. Complementing the Indian national programme, we build capacity, provide technical support and advocate to strengthen the delivery of effective, innovative, community-based HIV programmes to vulnerable populations: sex workers, men who have sex with men (MSM), transgender people, hijras, people who inject drugs (PWID), and people living with HIV.
The registration of HIV cases in Armenia started in 1988. In 2010, HIV prevalence was estimated at 0.2% among adults aged 15 to 49. Overall, as of 31 July 2019, 3,583 HIV cases had been registered in the country among citizens of Armenia with 429 new cases of HIV infection registered in 2018.
Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in three high-risk groups, which is important when deciding how to approach intervention and prevention.