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Malaysia’s HIV response has been shaped by decades of community advocacy, public health work, and dedicated people on the ground. What are the challenges that still lie ahead? To mark this year’s World AIDS Day, on this episode of #ConsiderThis Melisa Idris speaks with Dr Nur Afiqah Mohd Salleh, Vice President of the Malaysian AIDS Council. She’s also a Senior Lecturer at the Department of Social and Preventive Medicine of Universiti Malaya’s Faculty of Medicine.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:14where we want you to consider and only consider what you know of the news of the day. Malaysia's
00:19HIV response has been shaped by decades of community advocacy, public health work and
00:26dedicated people on the ground, including the good folks at the Malaysian AIDS Council.
00:32Now to mark this year's World AIDS Day, we begin tonight's program with a short documentary
00:38reflecting on the progress we've made so far. And later, I'll speak with Malaysian AIDS Council
00:46Vice President Dr. Noor Afika Mohamed Saleh about where we are in Malaysia's HIV response journey
00:53and the work that still lies ahead.
01:04In Malaysia, the HIV response has always been about people, the men, women and families
01:11who face stigma, isolation and fear. For two decades, global support gave them more than
01:16medicine. It gave them hope, a chance to be seen and a strength to rebuild their lives.
01:22Rather than having parallel programs that are funded internationally, we have been able
01:31to integrate and incorporate programs but are led and the services are provided by the NGOs,
01:40working hand-in-hand with clinics at the state level and of course at the federal level.
01:49With Global Fund support, NGOs reached the streets, the clinics opened their doors wider and communities
01:55at the margins finally had access to prevention, treatment and dignity.
01:59They have used Global Fund financing to largely finance prevention, community outreach and
02:07community services for the HIV response.
02:11These voices, once hidden, are now at the heart of Malaysia's response. And the journey
02:15ahead is about making sure no one is left behind.
02:18I applaud Malaysia for being a leader in this area.
02:22The numbers matter, but behind every statistic is a story like Ridwan's, a reminder of why this
02:27fight is worth it.
02:37Ridwan knows the struggle firsthand. Once a patient himself, today he is a community health worker
02:48in Kuala Lumpur. His mission, to turn his journey into hope for others.
02:53I work as a community health worker under PT Foundation. It is a partner of Malaysian East Council
02:58and also Yerasan East Malaysia. So we are doing our wish for the key affected population
03:05to do the testing on the ground and then to bring our client to the clinic for further testing
03:13or any prevention method that we can give to our client. When you got the treatment undetectable
03:21viral load, you don't transmit it to other people. You will have the opportunity to have
03:26a family. But along the way, Alhamdulillah, after a few years, I already stable on treatment.
03:33He already got his partner, get married and get a son already. I think more, already
03:42have two children. Yes, that's what a very memorable formula. So what made me stay in this
03:51place because maybe I can help people to give some hope and to assist their resilient journey.
04:00But not everyone's journey is easy.
04:03I have a few clients that because when they have this experience, they are away from their family
04:14because their family did not know about their status, then because they have shame, they
04:19are not going back to their family. I have some client that involves something like using
04:24substance. After we have supported them and then they have them to listen, they get their life
04:34changes, going better. And then some of them, even though some of them go get a new job and
04:41then have stopped on their substance use, and then some of them even go to Umrah.
04:47For Reduan, these moments, patients starting families, others finding the courage to reconnect
04:53others are symbols of hope, proof that Malaysia's HIV response is working.
05:00Communities are the backbone of public health responses for non-communicable diseases, communicable
05:05diseases, including HIV. Because they can deliver prevention, harm reduction and testing in the
05:11case of HIV, the treatment literacy and adherence support. They are able to reach the key populations
05:17that often find it hard to access mainstream systems or in some places are excluded.
05:23It also requires a rights-based approach and designing inclusive and collaborative dialogues
05:28to ensure nobody is left behind.
05:31And that's where prevention, including PrEP, changes what's possible.
05:36PrEP is a medication that effectively to prevent HIV up to 99% for if you take it daily.
05:43PrEP, or pre-exposure prophylaxis, is changing lives. In Malaysia, its rollout began with Global Fund support,
05:50national leadership and the work of community programs like Reduan's.
05:56With access to the Global Fund, we were able to implement more differentiated services to cater for other key populations.
06:11So that's number one. And number two, we were also able to scale nationally, which was always a struggle when it was purely domestic funding.
06:22So from the perspective of the Global Fund, I mean, Malaysia was obviously responding to their own epidemic in their own time and way before the Global Fund came in as a partner.
06:33What the Global Fund has seen Malaysia do is a consistent, evidence-driven response since their very first days.
06:42They had a CCM before we had CCMs.
06:46They had a coordinated response across sectors from the very beginning, signed up for the Sustainability Development Goals,
06:55when that was the goals that the Global Community had put together. And they've really partnered with the Global Fund since then to both respond to the changes in the epidemic,
07:07but also respond to the way the world has responded to these epidemics.
07:12We already fund almost everything ourselves. That means like 95% of that are our funding. So the transition will be smooth and natural.
07:23HIV prevalence among people who inject drugs has declined from 22% in 2009 to 7.5% in 2022. This success stems largely from publicly funded harm reductions program.
07:43Since 2003, we've been working with 20 NGOs through the Malaysian Ads Council and we have spent 8 million yearly with strong accountability.
07:57It ensures support which committees directly.
08:00Ending HIV is not government's burden alone. Corporates are playing their part, making the transition sustainable.
08:08Yayasan Saim Darby is one of them. Their investments prove that HIV response is not just charity, but a shared responsibility.
08:16Our support for MAF and MEC in the course of HIV and AIDS for prevention, treatment and care for HIV and AIDS is way past charity.
08:29It's not only charity, but it is our shared responsibility coming in together.
08:36In Sarawak, commitment goes further. It's the first state to directly fund HIV programs. This tripartite effort, government, NGOs and corporates shows how local leadership strengthens national progress.
08:51Sarawak is showing a real leadership. We applaud the Sarawak state governments for side and willingness to take ownership of this issue.
09:01Sarawak has faced unique challenges that require even a greater level of interventions.
09:07From vast geographical barriers to the cultural and linguistic diversity of the AIDS people.
09:14So, in Sarawak, we are very fortunate that everyone comes together.
09:18From the Malaysian AIDS Foundation, from Sarawak government, from Sunway Group and Tan Sri Jeffrey Chia,
09:24as well as Yayasan Saim Darby and Yayasan Petronas, as well as all the various NGOs in the local area.
09:33And each playing their role, do their part.
09:43From Ridwan's patients rebuilding their lives, to national leadership, corporate partners and Sarawak's bold commitment,
09:49Malaysia's HIV response is no longer donor driven.
09:52It is nationally owned, community powered and shared across society.
09:58Ending HIV by 2030 is possible.
10:01The story of Malaysia shows us how.
10:04The video we just saw captures only some of the people and partnerships that are behind Malaysia's HIV response.
10:29Joining me now to help us understand the work that continues every day, and also the challenges that lie ahead,
10:37is Dr. Noor Afika Muhammad Saleh, the Vice President of the Malaysian AIDS Council.
10:42She's also Senior Lecturer at the Department of Social and Preventive Medicine at University Malaya's Faculty of Medicine.
10:50Dr. Ika, welcome back to the show. It's so good of you to join me.
10:53So that was such an interesting video. And in it, I think that there was some mention of Malaysia's transition,
11:00or Malaysia's process of transitioning away from donor funding to sustain our HIV AIDS response.
11:08I'm curious to understand why this transition is happening.
11:11Why is this shift taking place? And why is it important?
11:14What does it mean for the work that the MAC does, for instance?
11:20Thank you, Melissa, for inviting us today.
11:24So the transition from international donor support like a Global Fund has been taking shape over the past several years.
11:33And we know that for more than a decade, the Global Fund has provided around RM30 million in support.
11:39So that's roughly 3 to 4 million annually to strengthen prevention efforts among key populations.
11:47And what we're seeing over the years, our economy has strengthened and we've moved into upper middle income status.
11:53So we naturally began losing eligibility for certain forms of donor financing.
11:59And over the past three years, the government has been developing sustainability plans to kind of manage the transition from international support so that we can continue delivering HIV services.
12:11So it's a gradual process. And this shift was not sudden.
12:15But what has changed is really the speed of the transition.
12:20So right now, global public health funding is really stretched.
12:24And we know that, you know, big institutions like Global Fund, UNA, SNWHO, they're dealing with tighter budgets.
12:31They're dealing with shifting priorities.
12:33And also, there's a lot of geopolitical uncertainty around that.
12:37And even the United States, which has always been the biggest contributor to global health, is also scaling back.
12:44And because of that, we're also seeing these other donor countries that are starting to do the same thing.
12:50And analysts would argue that we're entering this new phase for global HIV financing,
12:56one where the old model of large scale multilateral funding needs to be rethought.
13:05And because all of these pressures, what we're seeing is faster and deeper funding cuts around the world.
13:11And donors are now focusing their support on, you know, on only the most undeserved countries.
13:20And what it means for us, for Malaysia and many middle-income countries,
13:25this would mean that we need to step up with more domestic resources far sooner than expected.
13:31What does that mean as domestic funding sources?
13:35Would that mean the private sector would have a role in supporting the national response to HIV AIDS?
13:43Yes, that's right.
13:44It means that the Minister of Health are the domestic resources, the private companies as well.
13:50Okay, so talk to me a little bit about that.
13:52How do you go about convincing or working with the private sector, with corporations,
13:58to support the Malaysian response to the epidemic?
14:03I'm just wondering because I can only imagine this could be a great part of their CSR.
14:09But how do you go about convincing them, particularly when there are many other competing demands for the same resources?
14:19Right. So I think the key is positioning.
14:24We know that with treatment widely available and AIDS-related deaths are declining,
14:31many would assume that the crisis has passed.
14:34But with this perception, we often overlook a critical truth,
14:38which is nearly 1,000 Malaysians are still dying from AIDS-related illnesses each year.
14:44And what we're seeing over the news is also alarming.
14:46We're seeing new infections among young people, and these continue to rise.
14:51So for corporate partners, MAC and also the Malaysian Next Foundation,
14:55we emphasise a very simple message that the epidemic is not over,
15:00and the gains that we've made are very fragile.
15:03And we need to have sustained investment to avoid reversal.
15:07So Malaysia's strength lies in our structured science-driven national HIV strategy.
15:13And each national strategic plan is long-term, it's evidence-based,
15:18and it's anchored in public health logic.
15:20And these are qualities that appear to be appealing to corporations that kind of seek measurable and also credible impact.
15:28And this very clarity has been the key reason why Malaysian companies such as Yaya San Darby, Petronas, and also Sunway Group,
15:39these companies have stepped forward as long-term, highly committed partners.
15:45And their involvement has created a uniquely Malaysian tri-sector ecosystem where, you know,
15:52we've got the government, we've got the civil society, and we've got the corporates,
15:56we're all collaborating in a very coordinated but non-duplicative way.
16:01I love hearing that the kind of big GLCs have really stepped up and come and really helped in their response,
16:10and fills that gap of funding as we're seeing international donors pull out of the ecosystem.
16:18Can I ask you, Dr Ika, amidst this transition, are there any areas that you are concerned about that might face funding gaps?
16:28I'm just wondering, you mentioned the sustainability of the programmes,
16:33so to ensure the sustainability of the programmes, are there any risks to that sustainability that comes from this transition?
16:40Okay, so to better understand where the vulnerabilities are, I think we need to step back a bit
16:46and look at how Malaysia funds its HIV response.
16:50For treatment, including the purchase of HIV medicines, the antiretroviral therapy and other healthcare system costs,
16:57around 95% of the national HIV budget is already being funded domestically,
17:03so that's roughly around RM80 million a year.
17:07And Malaysia has been providing free HIV treatment for more than a decade.
17:11So another key pillar is the social contracting mechanism,
17:16where the Minister of Health funds civil society organisations,
17:19including the Malaysian AIDS Council, to deliver targeted prevention services.
17:23And this model has matured over time.
17:26We start with MAC-led outreach and then we integrate it with clinic kesihatan, our primary healthcare clinics,
17:33and now through the nationwide depreciated HIV services for key populations platform.
17:39Now, losing global fund support is definitely significant,
17:44but Malaysia isn't going into this transition unprepared.
17:47We've got sustainability plans that have been developed and tested,
17:51and the Ministry of Health has increased depreciated health services for key population funding
17:56from RM7 million to RM8 million for 2025,
18:00and to ensure that our frontline programmes continue without disruption.
18:05But still, HIV is very sensitive for funding shocks and gains that we've seen over the years can reverse quickly,
18:14without a sustained investment and political commitment.
18:17So what it also means that the way forward lies in strengthening our domestic partnerships across federal,
18:24our state, and also private sectors.
18:27We want to diversify funding to kind of reduce vulnerability and keeping Malaysia's HIV response on a sustainable path.
18:36Yeah. Umi, we saw some of those funding shocks with the pandemic when money was being diverted to other public health responses.
18:44So talk to me a little bit about the progress that we've made.
18:48So Malaysia should be so proud.
18:50We've made massive strides in reducing the prevalence of HIV AIDS among key populations.
18:57But I saw a news report earlier this year that there had been a rise in the number of HIV infections amongst tertiary students.
19:06Can you talk a little bit more about that, Dr. Ika,
19:08and what strategies are in place to make sure that there is improved HIV prevention and care for this group in particular?
19:15Right. So the main challenge that I feel we need to acknowledge is that there's this gap between the realities that young people face and the kind of information they actually receive.
19:28So Malaysian youth are encountering sexual content way earlier, right, through digital media, through their peers, through online platforms.
19:39But access to accurate, non-judgmental information is still very much limited by our norms and also institutional barriers.
19:50And we recognize this. Yeah. So for this very reason, Malaysian Youth Council has shifted towards the youth-led autonomy focus model,
19:59specifically through the KAMI model, which is the Kelab Kesihatan Anak Muda IPT, KAMI.
20:04So we empower university students to become peer educators, to become campus advocates, to deliver accurate information,
20:12and then to link their peers to services such as testing, treatment, prep, and mental health support.
20:18So I think for me, these peer-led models are really encouraging because young people would trust and relate to their own networks.
20:27And the goal is not only to educate, but we want to build trust. We want to reduce fear.
20:32We want to create a safe space where conversations about sexual health can actually take place.
20:37And these are all critical factors for sustained behaviour change.
20:41Right. Talk to me about incorporating some of those values into a scaling prep, scaling prep, making it more accessible.
20:51And well, maybe you can tell us a little bit more about prep. We heard about it in the video, but you can tell us more about efforts on that front,
20:58especially for areas that are, I guess, geographically diverse, that there's more cultural barriers in place.
21:07So, uh, prep is a pre-exposure prophylaxis. So, uh, a lot of people would eat prep because they're engaged in high-risk sexual behaviour.
21:15So it's a very effective tool to prevent people from getting HIV in the first place.
21:20So we've got the prep-gov initiative. So that's a collaboration between MOH, Malaysian East Council, Malaysians Foundation, and the Global Fund.
21:29And the uptake has expanded rapidly with around 10,000 Malaysians now using prep.
21:35And we've also got private clinics that are responding to, um, to rising demand, helping people to expand, assess.
21:42Um, and we are currently pursuing a dual channel strategy.
21:47One is through clinic kesihatan. So that's the primary health care clinic.
21:51We want to reach out to low income and high need individuals.
21:54And second through private, uh, GPs, private clinics, which can scale faster because of the flexibility and also proximity.
22:04But again, you know, with prep, there's always misconceptions.
22:08Some would critique that it's equivalent to promiscuity, but evidence is showing the opposite.
22:18Um, prep users engage more frequently with healthcare providers.
22:21That's what we want, right? We want people to engage more with healthcare providers.
22:24We want them to be able to receive regular counseling.
22:27And most importantly, we want them to adopt, um, safer behaviors.
22:31So Mac continues to emphasize on these, uh, data driven realities to both committees and also, um, stakeholders.
22:39Right.
22:40So having said that Dr. Ika, what do you still see as, um, Malaysia's, the challenges that Malaysia faces,
22:48or the biggest gaps that Malaysia still faces in wanting to achieve our, our, our goal of ending, um, the HIV AIDS epidemic by 2030.
22:59That's not long to go. It's five more years.
23:01So yeah, we've got the tools, right? We've got PrEP, um, we've got HIV medication, but I think a lot of the remaining barriers would be, uh, more social, structural, and political.
23:17And you're right. We're moving towards, um, to 2030. So that's our end game, right?
23:21We want to eliminate, uh, HIV by then. But what we urgently need to address is this, um, persistent stigma and misinformation, especially around sexuality and key populations.
23:36Addressing, um, addressing, um, rising infections among youth and university students that are driven by information gaps.
23:43So we need to fill in those gaps, um, structural barriers, enforcement environments that kind of deter people from seeking services.
23:53Um, sustainable financing as, uh, donor support diminishes and domestic investment, state government, uh, support becomes, uh, central.
24:05I believe that we can still achieve the 2030 target, but only through sustained political will, diversified, uh, financing and social environments that allow people to seek care without fear.
24:18And the progress today shows what is possible and the gaps that remain is a critical reminder for us to, to, to, to, to show us that the mission is far from complete.
24:28Right. Just, just before I let you go, Dr. Ika, I had, um, been following or reading up on, um,
24:34the new breakthrough, um, prophylactic, uh, that the new breakthrough prep.
24:39Um, I'm not going to pronounce it because I I'm scared I might get it wrong.
24:42Is it Lenacapavir? Is that right?
24:44So, okay. So that's, that's been hailed as a breakthrough in reducing HIV, um, the risk of exposure to HIV.
24:53Talk to me a little bit about that. Is that going to be a game changer in the way, um, governments respond to HIV in AIDS?
25:00Yeah. So, um, you're right. It's a game changer. Uh, it represents a transformative leap where,
25:07you know, it's a, it's a twice yearly injectable that dramatically reduces HIV risk.
25:12Meaning that people would only need to use it two times a year. Um, so every six months, a quick injection, that's it.
25:19But in Malaysia, um, we're pretty much limited for, for just one reason, which is the cost.
25:25So at this moment, we don't have, uh, Lenacapavir in, in the country and because of the costs itself.
25:32So current pricing places, um, Lenacapavir far beyond the reach of national programs and, um, most individuals.
25:40So until affordability improves, its rollout will remain minimal.
25:45But that said, it still holds long-term promise.
25:48It signals the direction of, um, HIV innovation and underscores the importance of, of planning for sustainable access.
25:56For Malaysia, this means closely monitoring, um, global developments, um, exploring pricing solutions,
26:05and also preparing this health system itself.
26:08So that once affordability improves, the country can quickly adopt and scale this potentially life-changing intervention.
26:15That is good news. I'm, that's so heartening to end on that note.
26:19Dr. Ika, thank you so much for being on the show today.
26:22That was Dr. Noor Afika Mohamed Saleh wrapping up this episode of Consider This.
26:28I'm Melissa Idris signing off for the evening.
26:30Thank you so much for watching and good night.
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