Experts warn of shift in HIV transmission from injections to sex

Public health experts say new trends have emerged in the spread of HIV despite a drop in infection rates and AIDS-related deaths in the country, including a large number of male patients and a shift in mode of transmission.

Speaking at a recent webinar, Dr Nurliza Ibrahim from the health ministry said statistics from the National Registration Department for 2002 to 2021 showed that 85.5% of the 67,880 people living with HIV in 2021 were men.

“Between 2006 and 2021, 90% of new HIV infections were among men,” she said.

“Figures also show that 63% of HIV cases in 2021 were attributed to men who have sex with men.”

Dr Raja Iskandar Raja Azwa from the Malaysian AIDS Council meanwhile said that the transmission of HIV had shifted over the past three decades or so, from infection through injections to sexual transmission.

He said rapid development and migration to urban areas had exposed more people to the risk of HIV infection. Nevertheless, he added, public health strategies had remained unchanged.

He called for a shift from the focus on condoms as the main HIV prevention strategy to the use of pre-exposure prophylaxis or PrEP medication.

“PrEP is a preventative medication that lowers the risk of getting HIV from sex by up to 99% when taken correctly,” he said.

“But it is not a huge game changer today despite being in the public since 2015 at least.”

Raja Iskandar also said that PrEP treatment should be made more widely available at the community level, and urged the government to take the pragmatic step of subsidising it for those in the low-income group.

Dr Anita Suleiman from the health ministry’s disease control division meanwhile said there was a lack of large-scale intervention studies on public willingness to take PrEP pills.

“We have to understand, before the ministry can come out with a policy, it must have strong data-based evidence,” she said.

Adding that plans for wide-scale studies on PrEP were underway, she said other initiatives and programmes to reduce HIV infection were also ongoing, especially to help those from the low-income bracket get better access to healthcare.

Consequently, she said, there had been a 70% drop in the number of new HIV cases from 2002 to 2021.