According to the 2018 UNAIDS report on Malaysia, from the estimated 87,000 people living with HIV (PLHIV), 39,018 patients are currently on antiretroviral therapy (ART).
This means that only 45% of HIV patients are currently covered by ART. These dismal statistics prove that there are many measures that should be implemented to improve our care and management of HIV/AIDS patients.
We need to figure out why there are patients who are still not covered by ART.
The problem is most likely multifactorial in nature: patients might be afraid or reluctant to get treatment for HIV/AIDS; access to treatment might be lacking in certain parts of Malaysia; and doctors might not be providing an environment that is supportive enough for patients to get the necessary care.
From the 2016 Global AIDS Response Progress Report released by the Ministry of Health, the key populations in Malaysia that are affected by HIV/AIDS are people who inject drugs (PWID), female sex workers (FSW), transgender people (TG), and men who have sex with men (MSM).
If initially the epidemic in Malaysia was due to PWID, over the years, the trend has shifted to be more due to sexual transmission.
It is crucial for healthcare practitioners to approach these key populations and be sensitive of their needs.
Doctors should also be non-judgmental and focus on the health issues that revolve around the patient’s sexual activity so that patients are willing to be honest and get tested for HIV.
If doctors start to act as moral arbiters, he or she will impose his or her values on to the patients’ and deter patients from coming forward to receive the necessary treatment.
As a society, we still attach stigma when it comes to HIV/AIDS and sexually transmitted infections (STIs), which prevent proper diagnosis and management of these patients.
From the 2014 Integrated Bio-Behavioral Surveillance (IBBS) study, only 13.4% to 39% of key populations (FSW, MSM, and TG) had received condoms with HIV-related information. It is obvious that we are still lacking when it comes to advice that we should impart to our patients.
Doctors might avoid talking about safe sexual practices, but they should know that their medical advice can save lives.
Furthermore, the IBBS survey in 2012 and 2014 shows an increased trend of alcohol and psychotropic drug use before sexual intercourse. These behaviours further complicate sexual practices and can prevent proper use of a condom during sexual intercourse.
Thus, doctors should take a thorough history from the patients and give comprehensive advice to them. Doctors should be part of the solution in the HIV/AIDS epidemic, instead of resorting to blaming the patients.
In a cross-sectional study by Kwee Choy Koh et al. (2017) involving 65 patients newly diagnosed with HIV, up to 56.9% of patients had presented with HIV-related conditions at a primary healthcare facility during the three years prior to diagnosis.
This shows that there are missed opportunities to detect, and consequently treat HIV earlier. Therefore, more training should be given to doctors in general and primary care physicians in particular, to ensure that we are more proficient when dealing not only with key populations but also with patients who have the risk to be infected with HIV/AIDS.
Keeping this in mind, the Malaysian AIDS Foundation (MAF) has teamed up with the Malaysian Society for HIV Medicine (MASHM) to create HIV Connect.
It is an online training platform that educates primary care physicians regarding diagnosis and treatment options of HIV/AIDS, pre- and post-exposure prophylaxis of HIV/AIDS, and STIs.
Dr Suresh Kumar Chidambaram, President of MASHM and Infectious Diseases Consultant at Hospital Sungai Buloh said of the programme: “Those successfully completing this online module will be invited for face-face to training. After this training, they will be provided the opportunity to do clinical attachments in the nearest infectious diseases clinic. This way they will be comprehensively trained in management of HIV and STI.
“Because we want to reach out to as many primary care physicians as possible, this platform is free of charge. We hope that this programme can fill in the gaps that may exist in the physicians’ knowledge of HIV/AIDS and STIs and also remind them of the sensitivities involved when it comes to sexual history taking and imparting advice related to sexual health.
“Collaboration with community-based organisations such as MAF will give doctors more holistic training that ensures the concerns of the PLHIV are incorporated in the training.”
Dr Suresh also believes that we should work toward “more PLHIV to be diagnosed and started on effective treatment. Unlike in Western countries, very little HIV treatment is currently being provided by general practitioners in Malaysia”.
In alignment with the Ministry of Health’s commitment to end AIDS by 2030, we hope that this programme will supplement the other programmes that are already in place. We hope that in addition to the government facilities, the private clinics will also step up so that patients will have more choices when it comes to getting and receiving the proper care. This programme is our way to empower primary care physicians – I hope they will take up this call.
The online program can be accessed through https://hivconnect.mashm.net/. If you have any enquiries, email HIVconnect@mac.org.my or call 03-40474312.