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

DECEMBER 3 — 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 family that is anchored by a mother and a father, I was rather curious about the 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 a groom. Such was the equation of relationship in a child’s mind whose vocabularies 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 used by people in general to derogate others. Kids who picked it up from the adults, threw these words to each other in the school compound as a way to cancel the person that they were not happy with. 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, and; 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 account 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, a flock of people jumped at the opportunity to share the statistics to validatetheir homophobic campaign with the use of hashtag #saynotolgbt. While they were fixated on the last pie chart that showed 57 per cent of HIV infections in 2018 were among men who had sex with men (MSM) they also conveniently ignored that 37 per cent of the cases were from heterosexual people. In fact, the pie chart for the year 2010 clearly illustrated that homosexual people only accounted for 8 per cent of the cases as opposed to 40 per cent from heterosexuals. No one seemed to be concerned about the 800 per cent 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 utterly unethical and inhumane – is seriously flawed. Lesbians (the L in the LGBTQ) in particular, have 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?

In the same manner, 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 healthcare professional in the public sector – that regardless of their personal belief, they never deny care for this community, many of them are complicit in stigmatising these people as social outcasts. Instead of promoting empathy and inclusivity which are all so important for collective public health interventions, they use their career and professional experiences 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 LGBTQ+”. To them, what they say does not contravene the oath that they take under the Declaration of Geneva (i.e Hippocratic Oath) that, among others 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 only 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 LGBTQ community or in short, homophobia.

According to Avert, negative attitudes towards people who identify with LGBTQ community are strongly related with HIV epidemic worldwide. Demonization of LGBTQ 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” (Loh, 2018). This year, 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 myself, 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.

I for one am not an expert in Islamic Studies. But I do know one thing for sure; Allah’s Mercy always prevails 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 LGBTQ people to live a dignified life without sacrificing one bit of my own faith.

In fact, this has been shown time and time again by minority Muslims who live in the West. Take Representative Ilhan Omar in the United States for example. We all cheered in pride when she took her oath on the Quran - one of the first two Muslim congresswoman to do so in the United States. Yet, we conveniently look past her fight for the LGBTQ rights. To name a few, she had rallied against gay conversion therapy and introduced a legislation that would sanction Brunei for the country’s homophobic laws. In Mexico, a local Muslim friend was appalled by the homophobic campaign spearheaded by Muslims in Malaysia.

Changing the conversations to change the communities

This year, the theme for the World AIDS Day is “Communities Make the Difference”. I believe it is time that we as a community make a difference by changing the tones and vocabularies of our conversations with respect to HIV and communities at risk such as the LGBTQ people, 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 (Zainal & Chung, 2019). 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 and catering to their needs instead of obsessing over their sexuality or gender identity – which is very counter-productive.

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 clients especially the LGBTQ people. Bad experiences with health care staff (even on social media) may lead to them hiding important information about themselves or abandoning medical care at all. 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.

* Aisha Adam is a former pharmacist with the MOH. She did her Master’s in Public Health at the University of Melbourne. Currently, she is learning Spanish and theater in Mexico City.

** This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail.

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