children, those infected through blood donation or through work-related hazards; in otherwords, those who cannot be held responsible, i.e., blamed, for their exposure to HIV.Infected wives also appear to have easier access, and are perceived as such by othergroups, to financial aid. There is more public sympathy for these groups of PLHIV. Bethat as it may, stigmatization persists even for them – infected children may not beallowed to play with other children, wives may be blamed for their husband’s drugaddiction or their sexual infidelities, people may refuse to eat the food they cook orprepare, or sit beside them in the mosque, an infected wife may opt to move to anotherlocation with her children where no one knows of her HIV situation. These are the actualexperiences of the study participants; similar to others documented in other Asiancountries (APN+ 2004).From the community FGD, many participants verbalised the need to be sympathetic andto not discriminate PLHIV. However, at the same time, they also expressed caution ifthey had a neighbour who is positive, and if their children were to play with or be inschool with HIV-positive children. In other words, they were not cognizant that suchactions were stigmatizing. One participant admitted that the fear of contagion, fromcasual contact or from food that a PLHIV prepares, remains despite the informationdisseminated about ways of transmission. This fear of contagion persists even amongsome healthcare workers as <strong>this</strong> study shows. Again, the basis seems to be disbelief orlack of confidence in what is taught about HIV transmission.In fact, there were numerous cases of institutionalised stigmatization and discrimination,including using medical files of a different colour for HIV patients and segregation ofHIV-infected prison inmates, which identify them to others without their consent.Although routine testing of prison inmates and drug rehabilitation residents is notmandatory, there is no precedence of anyone refusing or allowed to refuse testing. Prisoninmates also say they received no pre- or post-test counselling. Some of the women sexworkers who had been in prison, said that their food trays were labelled with the words‘HIV”. While the segregation may have protected them in some way from otherprisoners, the greater problem they felt was that it led to more people outside prisonfinding out about their HIV status from fellow inmates, with negative consequences. Theabsence of counselling and active follow-up also means that HIV-infected releasedinmates are left to cope on their own, some with fatalism and apathy. Those who returnto drug use are not likely to change their behaviour.HIV POLICIES, PROGRAMME IMPLEMENTATION AND PLHIV PARTICIPATIONComparatively, women infected by their partners were the least aware of public policiesand programmes related to HIV/<strong>AIDS</strong> that could provide resources and support to HIVinfected persons in the country. However, a majority of respondents were insteadaggrieved by the stereotypical and fear-arousing HIV/<strong>AIDS</strong> awareness campaignsmounted by the Government. They lamented that such campaigns instilled fear in thesociety that HIV kills as well as blamed HIV-infected persons’ behaviour, deemedimmoral or deviant, for contracting the disease, namely, the constant association of HIVwith drug users and sex workers in particular. Instead, many of them expressed theGovernment should educate the public about HIV and <strong>AIDS</strong> in a factual manner withoutmoralizing people’s behaviours so that society can understand their challenges forpositive living. Specifically, several of the study participants pointed out the need toportray HIV-infected persons as trying to continue day to day living, going to work,134
working towards their future, who can contribute to society. Effective medication hasenabled PLHIV a longer lease of life but the stigma on HIV prevents them from living itas others in the community.Several respondents related their negative experiences of some of the HIV/<strong>AIDS</strong>programmes or practices pertaining to HIV/<strong>AIDS</strong>. These include indiscriminatedisclosure of HIV diagnosis and status in prisons and drug rehabilitation centres whereHIV testing is routinely conducted, often without pre-test, and sometimes without posttestcounselling. Some of them were greatly traumatised and humiliated by suchunethical and insensitive practices. Coercion to have the HIV test done at work placeswas also revealed. In addition, many were visibly upset with the current practice in publichospitals that deny a dignified death for HIV-infected persons. This hospital practice,whereby HIV-infected persons who die in hospitals are cleaned up, if relevant, and sealedin body bags, does not allow close family members to be involved or perform proper lastrites. Furthermore, transporting the body in sealed body bags reveals the HIV status ofthe deceased to others in the community and reinforces the fear of contagion and,consequently, the stigma of HIV for the surviving family.When asked about the extent of participation in HIV policies and programmeimplementation, those who were more empowered and articulate (some drug users andMSM) were very keen for PLHIV to be directly involved in policymaking relevant to allHIV infected persons. Several of these participants were already actively involved withvarious HIV-related NGOs in outreach to hospitals, prisons, and drug rehabilitationcentres. Drug users, in particular, expressed the need to create support groups and “aftercare”post-rehabilitation programmes to ensure they could cope and be integrated back tosociety. Others voiced the need for self-help, vocational and income-generatingprogrammes to enable positive living for HIV infected persons. It is pertinent to note,however, that some of the respondents pointed out that HIV infected persons themselvesneed to, first, be confident of their own HIV status in order that they can step out to beinvolved and participate in HIV policymaking and programmes towards positive living.That is, PLHIV need to be more visible to facilitate society’s acceptance but, at the sametime, it is recognised that ensuing negative repercussions discourage them from doing so,hence, a chicken and egg dilemma. As such, efforts to protect PLHIV from the negativeeffects of disclosure, such as loss of employment, must be enforced. Avenues for suchprotection in critical areas, such as healthcare and workplace settings, are alreadyavailable in the form of the Patient’s Charter (MMA 1995) and the Code of Practice forthe Prevention and Management of HIV/<strong>AIDS</strong> in the Work-Place(MOH/DOSH/MAC/UN<strong>AIDS</strong> 2001). What remain lacking are implementation and/orenforcement.IMPACT ON THE COMMUNITYFrom the FGDs with communities, it was learnt that Malaysian society, both urban andrural, has heard of the terms “HIV” and “<strong>AIDS</strong>”. However, their knowledge oftransmission is flawed and arises from inaccurate media propagation. “Free sex”,“multiple sex partners”, sex with sex workers and abuse of drugs through the use ofinjections, all morally unacceptable by our standards to a large extent, influence howsociety feel about the ways the virus spreads. Attention to the presence of the virus inblood contributes to the fear of any contact with the blood and saliva of an infectedperson (through play, work or food/drink). Although the participants are aware that135
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Table of ContentsPROJECT TEAM 5ACKN
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Information received at the time of
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AcknowledgementsThis research is fu
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The main findings from the qualitat
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school or work, transport costs for
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is that the large majority of women
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In fact, special surveys conducted
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ObjectivesThe specific objectives o
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have been rejected by their immedia
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eport) that his/her healthcare (or
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CommunityKnowledge/awareness of HIV
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Framework of analysisA descriptive
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urban and a rural community. In all
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medication, the physical health com
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husbands working in other places wh
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(“And then, this doctor, he/she v
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their food. Nurses and their attend
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“Because we take drugs….no time
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The same claim to 100% condom use w
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in asking them to use condoms, even
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“Normally…..normally, memang ma
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(“But I continued using at that t
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“Buat pada permulaannya, saya mem
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However, not all experiences with d
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yang amat sangat. Tak pernah I rasa
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long term fears and anxieties. The
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“The first time I heard from the
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handset, I too, have handset. Some
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have been turning to God since and
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felt I’m indecent. But, at one ti
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would certainly want to continue wo
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(Transgender, 53 yrs, Upper seconda
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“Sometimes I didn’t get enough
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positively portray people living wi
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“After my diagnosis...I’ll pay
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not know or might not want to be bo
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(UNAIDS 2005).(UNAIDS 2000):The fac
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“…bawak saya pergi hospital. An
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erpindah ke tempat lain makin lama.
- Page 84 and 85: pada HIV itu, dia nampak penagih. S
- Page 86 and 87: (Male, 49yrs, University education,
- Page 88 and 89: However this association with the n
- Page 90 and 91: “…..depends on who is the perso
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- Page 100 and 101: Table 2aDistribution of Respondents
- Page 102 and 103: female sex workers (seven out of 13
- Page 104 and 105: NO. OF LIVING PARENTSNobody 7 1 1 2
- Page 106 and 107: tested in drug rehabilitation cente
- Page 108 and 109: GroupsDUHetero-SexuallyInfectedMenT
- Page 110 and 111: y the Ministry of Health (74.2%) or
- Page 113 and 114: Child CareYes, often 0 0 0 1 0 1 0
- Page 115 and 116: GroupsDUHetero-SexuallyInfectedMenT
- Page 117 and 118: Figure 5: Percentage of Respondents
- Page 119 and 120: GroupsTable 12aEmotional Problems E
- Page 121 and 122: Stigmatization and how it has affec
- Page 123 and 124: GroupsTable 15How They Cope With Th
- Page 125 and 126: Table 18Percentage Of Respondents W
- Page 127 and 128: esponsible for their families. As m
- Page 129 and 130: In this study, it took more effort
- Page 131 and 132: eing transgender and sex worker whe
- Page 133: denies them social and economic opp
- Page 137 and 138: ReferencesAidsmeds.com (2006). Curr
- Page 139 and 140: Sen G, George A, Ostlin P (2002). E
- Page 141 and 142: Annex II: FGD Guide for PLHIV Group
- Page 143 and 144: ♦ Spouse: marital/sexual relation
- Page 145 and 146: I. Attitudes and Perceptions relate
- Page 147 and 148: I. HIV/AIDS Knowledge‣ What did y
- Page 149 and 150: Annex V: Rapid Needs Assessment Que
- Page 151 and 152: Types of support or responsibilityM
- Page 153 and 154: Please tick (√)one onlyIf yes,ple
- Page 155 and 156: more help would be useful for you i
- Page 157 and 158: Annex VI: Ethics Approval Letter157