1,000 crosses put up by World Concern, USA, in support of World AIDS Day (© Andrew Conn / sxc.hu)
STARTING from 2009, Muslim couples intending to marry must undergo mandatory screening for the Human Immunodeficiency Virus (HIV). We don’t know how this became official, but it now is, with the cabinet’s approval.
Deputy Prime Minister Datuk Seri Najib Razak said the measure was the government’s response to the increase in HIV infections among women, who are more vulnerable than men. Najib also said that according to the United Nations Programme on HIV/AIDS (UNAIDS), although Malaysia has a concentrated HIV epidemic, we are recognised as having “high political will”.
Political rhetoric aside, the fact is mandatory HIV testing is flawed.
It is, for example, curious how the deputy prime minister appeals to UNAIDS’s authority to legitimise the programme, but does not tell us what else UNAIDS recommends.
Most pointedly, UNAIDS does not support mandatory testing. Instead, it recommends for all testing to conform to the “Three Cs”: involved informed consent, confidentiality, and pre- and post-test counselling.
In fact, the Malaysian AIDS Council (MAC) and the Malaysian Positive Network (myPlus) both go one step further, saying that mandatory testing actually does more harm than good. These AIDS organisations also call on the government to adhere to international human rights standards. An individual’s right to privacy, individual security, and personal autonomy must not be compromised.
Even the Malaysian Family Physicians, in its official journal, carries a commentary warning against confidentiality breaches. The commentary also questions the cost-effectiveness of mandatory testing. It concludes that mandatory testing does not guarantee a sustainable reduction in HIV transmissions.
That is only logical. After all, just because a person tests negative (for HIV) before marriage doesn’t mean that he or she will not expose himself or herself to HIV down the line. Having unprotected sex with another partner can, and in some cases will, happen no matter what a person’s test results say before marriage. How useful then is it to enforce one-off testing in the first place?
Stigma and discrimination
Furthermore, the larger environment in Malaysia stigmatises and discriminates against communities most vulnerable to HIV — sex workers, drug users, gays, bisexuals, and transsexuals.
According to MAC and myPlus, the only way around this is to ensure that the “Three Cs” are part of a larger comprehensive package that promotes HIV prevention, treatment, care, and support. Imposing mandatory testing even before such stigma and discrimination is addressed will only discourage individuals from testing, for fear of subsequent persecution.
(© Sebastian Czapnik / Dreamstime.com)
On the other hand, giving mandatory testing a veneer of moral righteousness will give those who do screen a false sense of security. If we do not arm the public with full and frank information about HIV, what’s to stop an uninformed person from thinking, “I am safe and don’t have to do this again?” It is precisely this “I am safe” mentality that causes rising infection rates in the first place.
Cloaked in secrecy
There is a history to controversial suggestions by the authorities on dealing with HIV. On 8 Oct 2008, Islamic Development Department (Jakim) director-general Datuk Wan Mohamad Sheikh Abdul Aziz said all state religious authorities had agreed to enforce mandatory HIV testing. Apparently, they all agreed in a meeting in July 2008.
What public consultation and research the authorities embarked on to arrive at this decision was never revealed. And why such testing should be put under the purview of the religious authorities and not the Health Ministry was never discussed.
The 8 Oct Jakim announcement was therefore slammed by various AIDS advocacy and service organisations in a 1 Dec joint statement on World AIDS Day. MAC president, Prof Dr Adeeba Kamarulzaman, called the announcement “alarming”.
(© Irineu I Degasperi / sxc.hu)
In 2005, then Health Minister Datuk Seri Dr Chua Soi Lek drew the ire of various Islamic groups, including PAS, for suggesting distribution of condoms, needle exchanges and methadone treatment for drug users, in order to address rising HIV infections. Chua was accused of legitimising immoral behaviour and violating Islamic laws.
In 2001, Johor was the first state to introduce mandatory testing via its religious affairs department. This was done without public consultation. There was also no disclosure of any comprehensive studies by the state authorities which caused them to arrive at this decision. Yet, since then, Kelantan, Negeri Sembilan, Sabah, Sarawak, and Selangor have followed Johor’s lead.
It is ironic that the only time the Malaysian government actually tried to implement something conforming to international best practices and human rights standards, it was shot down by a group of religious moralists.
The irony continues. It is the Islamic groups that are now acclaiming the deputy premier the most for his announcement on mandatory testing, a measure that is clearly flawed by international standards. Muslim Consumer Association secretary-general Datuk Dr Ma’amor Osman is even suggesting extending mandatory testing to non-Muslim couples.
Katagender parodying the whip invoked on women senators to pass the Islamic Family Law Bill in 2006
(pic courtesy of Ezrena Marwan)
This demonstrates that the power struggle is not solely within the domain of the HIV discourse. It is also embedded in the larger matrix of Islamisation in Malaysia, and the accompanying warnings not to question policies and laws inspired by certain interpretations of Islam.
The power struggle is not just limited to discourses within the country. In 2001, Malaysia led a bloc at the UN to deny a general assembly resolution that would protect the dignity and rights of lesbians, gays, bisexuals and transsexuals.
Nevertheless, it is disingenuous to blame Muslims or Islam for regressive approaches to HIV. The world’s most progressive HIV harm reduction programme has been implemented in none other than the Islamic Republic of Iran, a regime seen by many as fundamentalist Islamist.
(© Jan Roger Johannesen / sxc.hu)
Because of regular consultations with conservative ayatollahs, Iranian activists have managed to give clean syringes and needles to heroin users, and distribute condoms to sex workers. Government clinics nationwide offer free counselling, testing and treatment. Tehran has even allowed condoms and needles to be available in its prisons — acknowledging tacitly that the more humane solution is to protect inmates from HIV rather than judging their sexual activities and drug-taking.
The way forward
Malaysia still sees alarming rates of violence against women, including marital rape and domestic violence. There is still widespread stigma against sexual minorities — the October 2008 fatwa banning tomboys is but a recent example. Condom use is nearly impossible to promote in the mass media.
Also, the class dimension of HIV infections has scarcely been addressed. The most economically vulnerable do not have the means to access counselling, testing and treatment.
Meanwhile, Malaysians who question decisions by the Islamic authorities are also routinely warned, threatened, and harassed. The government even uses “insulting Islam” as an excuse to detain citizens without trial under the Internal Security Act.
Having said this, it is so easy for opponents of mandatory testing to lose the moral high ground. After all, an ordinary citizen would ask, isn’t mandatory testing only logical and good for the couples involved?
The answer, unfortunately, is a resounding no. In Malaysia’s environment, rife with stigma, discrimination, and impunity, it is a mistake of catastrophic proportions to impose mandatory testing for HIV. The better solution would be to educate the public — fully, frankly, and without discrimination — on the facts of HIV transmission and the many ways to prevent and treat it.