KUALA LUMPUR, Malaysia: At 33, relishing her safety and freedom after escaping from an abusive relationship, Ita* was ready to start afresh in 2006 when she received news that rocked her universe: she was HIV positive. Fear mixed with apprehension flooded her thoughts and she was gripped with visions of a dark future. Would her now second husband marry her? Was her child infected? Whats and ifs swirled in her mind for days. Ita felt trapped in a situation with which she wasn’t ready to cope.
Paying the price
Ita had trusted her husband, but this led to a life of high risks. What seemed like an opportunity to earn 500 dollars in a single night soon became a regular gig. “I became a prostitute at 21. All I did was to listen to him (referring to her first husband, who was her pimp). My daily earnings went straight into his hands,” describes Ita, who is from Malaysia, but spent most of her time in a neighbouring country. This was a deal brokered by her then husband who ran a mill of sex workers at at time when street based sex workers were at very high risks for acquiring sexually transmitted infections including HIV due to low use of condoms.
After six years abroad, she returned to Malaysia and shortly after had a child. Life soon became complicated. On days she was not out selling sex, she had to endure physical abuse at home from her husband. He had several partners at the time and Ita was very uncomfortable with the arrangement. Mentioning divorce would simply lead to more physical abuse. But when she finally divorced him, she wondered whether she may have contracted any infectious diseases from him or her former clients, and whether they could have been passed to her child.
“Thank god my child is free of HIV – I’m just so relieved.” Ita and her baby are also free of syphilis.
To ensure every child is born free of HIV and syphilis, Malaysia has been working for decades to improve access to prevention and care for all mothers. The country today became certified by the World Health Organization (WHO) as having eliminated mother-to-child transmission of HIV and syphilis, making it only the second country in Asia to achieve this milestone, after Thailand.
The journey that started in 1998 has come a long way. Integrating services for the prevention of mother-to-child transmission into a Maternal and Child Health programme renowned for its high quality and accessibility, including vulnerable populations, was the best starting point. But Dr Noor Hisham Abdullah, Director General of Malaysia’s Ministry of Health, acknowledges that new services such as this come with their share of challenges.
“We needed to ensure mothers with HIV adhered to life-long treatment. But most critical of all, we and our partners in the community had to ensure our patients did not feel stigmatized. We needed to break down that wall while building trust,” explains Dr Hisham.
Stigma
When scientists discovered the virus that causes AIDS in 1983, stigma and HIV were inseparable. Not only did the language in reports on HIV and AIDS seem disturbingly apocalyptic, stigma and discrimination were—and still are—an affront to human rights, often placing the lives of those living with the virus in danger.
Besides losing two jobs after her employers discovered she had been a sex worker, Ita remains fearful that her parents and siblings will disown her once they know she has HIV. She often grapples with the thought of even starting that conversation with her children, some old enough to know she was a former sex worker.
“People need to know that no one is born destined to work in the sex industry, no matter what people tell you, especially those you trust and look up to. Looking after yourself—especially in the sex industry—is very important. Medical check-ups are a must,” says Ita.
In 2008, Ita had a child with her second husband and in her words, “Thank God, that child is also HIV free.”
Mother-to-child transmission
Twenty five years ago, most new HIV infections in Malaysia were among people who injected drugs, but in more recent years, trends have shifted towards sexual transmission. In 2000, 16% of babies born to HIV positive women were infected. By 2016, with access to free HIV and syphilis testing and treatment, as well as monitoring and surveillance systems in place, the mother-to-child transmission rate had fallen to less than 2% for HIV and to less than 50 congenital syphilis cases for every 100 000 livebirths. According to WHO criteria, a reduction to or below these levels is considered as elimination of the public health problem.
WHO, UNAIDS and other partners continue to work closely with the Malaysian Ministry of Health to further strengthen reporting, monitoring and surveillance, and ensure that non-government healthcare provision is also accessible to groups of the population that may have been under-served. They also continue to advocate for services to be rolled out in a manner that supports human rights, gender equality, and strong community engagement.