HIV/AIDS: A call for self-reflection and empathy

LETTER | As a child, like many other Malay Muslim kids, I heard the story of Prophet Luth where Allah punished the whole village because the men were romantically interested in men instead of women. There was a mention of sodomy, but I could not care less to ask the adults what that meant. 

Living in a traditional family, I was rather curious about same-sex attraction. Why would anyone be attracted to their own gender? You cannot have a family with them. All I knew about marriage back then was that there must be a bride and  groom. Such was the equation of a relationship in a child’s mind whose vocabulary had yet to expand to homosexuality (heterosexuality even), bisexuality, gender queer, transgender and intersex.

Growing up, words like "pondan" (transvestite), "mak nyah" (transwoman) and "gay" were derogatory terms. Kids who picked it up from adults, threw these words around in school as an insult. Even when these terms were not used to derogate others, these people were hardly portrayed in a positive light. 

Sure, we were amused by the character Sam (played by the young Imuda) in the sitcom "2+1" and we laughed at all the queer characters of "Jangan Ketawa". But once all the laughter subsided, we were always warned not to become like "them" or Allah will not be pleased with us. 

Only when I was older did I learn that these actors faced strong criticisms for their effeminate characters; some were even penalised for cross-dressing. It is hard to fathom the duality of our treatment toward these people; on one hand, you enjoy their talent and all the beauty they bring to life, but on the other you dehumanise them by not recognising their contributions and place in society. 

The only images that we allow to represent them are that of problems and diseases.

Reductio ad absurdum

A few days before the World AIDS Day, the Ministry of Health (MoH) via its official Facebook released an infographic on the changing landscape of HIV infection. I am not sure why, but it has since been removed from the public’s view. 

However, during the short period that it was available online, people jumped at the opportunity to share statistics to validate their homophobic campaign with the use of hashtag #saynotolgbt. 

While they were fixated on the last pie chart that showed 57 percent of HIV infections in 2018 were among men who had sex with men (MSM), they also conveniently ignored that 37 percent of the cases were from heterosexuals. In fact, the pie chart for the year 2010 clearly illustrated that homosexuals only accounted for 8 percent of the cases as opposed to 40 percent from heterosexuals. 

No one seemed to be concerned about the 800 percent increase in cases among heterosexuals from the year 1990 to 2010 the same way they were alarmed by the 7-fold increase in cases among homosexuals from the year 2010 to 2018. 

What is more troubling is how the misuse of such statistics to invalidate the whole LGBTQ community – on top of being unethical and inhumane - is seriously flawed. 

Lesbians, in particular, have a significantly lower risk of contracting HIV compared to heterosexuals. So where is the logic of this campaign against the whole community under the pretext of HIV prevention?

Cognitive dissonance is commonplace amongst health professionals in Malaysia when it comes to dealing with the LGBTQ community. Though it is true - based on my own experience as a public healthcare professional - that regardless of their personal belief, they never deny care to this community, many of them are complicit in stigmatising them as social outcasts. 

Instead of promoting empathy and inclusivity which are all so important for collective public health interventions, they use their career to list all the problems faced by the community only to (mis)conclude with “you will not have all these problems if you are not LGBT”. 

To them, what they say does not seem to contravene the Hippocratic Oath they took that says: I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient (World Medical Association, 2017). 

Homophobia vs Public Health

Part of the National Strategic Plan for Ending AIDS (Nspea) 2016-2030 is to reduce stigma and discrimination against people living with HIV (Plhiv). 

The MoH has done a commendable job in assessing and reporting the stigma and discrimination faced by Plhiv. If people read the Country Progress Report on HIV/AIDS, they would know that the low rates of HIV testing and anti-retroviral therapy (ART) were found to be associated with the burden of shame and guilt carried by most of the key population (Sector HIV/STI/Hepatitis C of Disease Control Division, 2018). 

What is missing in the discussion though, is how much stigmatisation of Plhiv is closely related with stigmatisation of the LGBT community, or in short, homophobia.

According to Avert, negative attitudes towards people who identify as LGBT are strongly related with the HIV epidemic worldwide. The demonisation of the LGBT community only prevents people at-risk from seeking protection, testing and other healthcare services. 

Worse, it has led to scores of hate crimes often targeted at gay men who are almost exclusively seen as the ‘vectors’ of HIV (Avert, 2019). In Malaysia, homophobia had at least taken the lives of two transgender women since December last year (Ghoshal, 2019). 

Amidst the hostility, the deputy minister of health emphasised that “HIV/AIDS is not about homosexual issue but unprotected sex.” This year, a similar message was echoed by the Malaysian AIDS Council (MAC) president Bakhtiar Talhah in response to higher infection rates among MSM, which is not unique to Malaysia.

LGBTQ rights and Muslims

As a Muslim, I am aware of the commonly accepted jurisdiction against same-sex marriage in Islam. Relationships and marriage, just like all other aspects of a Muslim’s life, are supposed to be part of ibadah (worship to Allah). For that reason, we are bound by the do’s and don’ts outlined in the Quran, Hadith and scholarly jurisdictions. That said, the knowledge of Islam is enormous and diverse in opinions.

Say: "Truly, my prayer and my service of sacrifice, my life and my death, are (all) for Allah, the Cherisher of the Worlds” (Al-An’am: 162)

I am not an expert in Islamic Studies, but I do know Allah’s mercy always prevails over His wrath. Regardless of what has been propagated over generations about the Prophetic tales, I believe Allah never writes off an entire community for eternity. 

That would contradict with His own names as Ar-Rahman (The Most Merciful), Ar-Rahim (The Bestower of Mercy), As-Salam (The Giver of Peace), Al-Ghaffar (The All-Forgiving) and Al-Wadood (The Most Loving). For me, it is completely possible to recognise the rights of the LGBT to live a dignified life without sacrificing my own faith.

In fact, this has been shown again and again by minority Muslims who live in the West. Take US representative Ilhan Omar for example. We all cheered in pride when she took her oath on the Quran - one of the first two Muslim congressperson to do so in the US. Yet, we conveniently look past her fight for LGBT rights. To name a few, she had rallied against gay conversion therapy and introduced legislation that would sanction Brunei for its homophobic laws. 

In Mexico, a local Muslim friend was appalled by the homophobic campaign spearheaded by Muslims in Malaysia. The following is a screenshot of our conversation (with English translation) on the topic.

 

Changing the conversations to change the communities

This year's World AIDS Day theme is “Communities Make the Difference”. I believe it is time we do just that by changing the tone and vocabulary of our conversations with respect to HIV and the communities at risk such as the LGBT, sex workers and intravenous drug users to be more dignified and humanised. 

As the MAC president said, we should look at HIV as a health issue instead of a moral problem. 

Marginalisation and criminalisation of key populations are only forcing them to live on the fringes of society, making access to healthcare and treatment more difficult. 

All this only runs counter to our own Nspea goals. By shifting our focus to public health, we would be more concerned about the well-being of the community instead of obsessing over their sexuality or gender identity.

Above all, healthcare workers should be equipped with sensitivity training that would guide them in recognising prejudicial attitudes as well as providing inclusive and respectful environment for all, especially the LGBT. 

Bad experiences with health care staff (even on social media) may lead to them hiding important information about themselves or abandoning medical care all together. 

Qualitative studies that take on the perspectives of the target populations should also be conducted to explore the real reasons behind the poor uptake of safe sex by the MSM without any bias so that effective interventions can be implemented.

Let’s not leave anyone behind.

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AISHA ADAM is a former pharmacist with the Health Ministry. She did her Master’s in Public Health with the University of Melbourne, and is now learning Spanish and theatre in Mexico City. 

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.