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Figure 1: % cumulative HIV cases by year and mode of transmission100%80%Percent60%40%UnknownMother-infantOrgan RecepientBlood RecepientHetrosexualHomo/BisexualInjecting Drug Users20%0%1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003YearAs shown in Figure 1, the majority of infections are related to IDU. As testing,diagnoses and reporting improve over time, the proportion of infections classified underunknown causation has narrowed. Over the same period, the proportion of infectionsclassified as heterosexual has risen, particularly after 1995 when the Ministry of Health,as the lead agency in the country’s prevention and control strategy, expanded itsscreening programme, including through government antenatal clinics, prisons and drugrehabilitation centres.In fact, heterosexual transmission contributes a significant proportion of infectionsamong Chinese Malaysians, in contrast to Malay and Indian Malaysians for whom IDUtransmission predominates by far. Heterosexual transmission is also prominent in certainlocations, e.g., Sabah.With regards to the preponderance of IDU in Malaysia, it is recognised that this situationis partly due to reporting bias. Substance abusers are routinely tested for HIV when theyopt for treatment and rehabilitation or when they enter the criminal justice system.Although the direct route of disease transmission among this group is most likely throughcontaminated needles or other objects involved with injecting drugs, it is recognised thatunprotected sex may also be a risk factor. Furthermore, most of the substance abusers areheterosexual and risk infecting women partners and offspring. Other issues pertinent tosubstance dependence and the ensuing life circumstances, hamper prevention efforts,such as, fear of criminal prosecution, marginalisation, apathy and poverty. Hence, thisgroup remains a priority in controlling the HIV epidemic.The rise in diagnosed infections via heterosexual transmission raises concerns forwomen. While HIV cases have continued to be overwhelmingly male, the percentage ofwomen has increased from 1.4% in 1990 to nearly seven percent (3,781 cases) in 2003.In terms of AIDS, the number of women diagnosed increased from two in 1991 to 700 in2003, representing about eight percent of all AIDS cases. Again, increased detection hasfollowed expanded HIV testing among women through mandatory testing in antenatalcare. The unequivocal difference between infections among men and women in Malaysia15