(Excerpts from Malaysia Country Statement at the 38th Session of the United Nations Commission on Population and Development, 4-8 April 2005, New York)
Malaysia has, within a relatively short period, succeeded not only in achieving growth but also in addressing more effectively the problems of poverty and economic imbalances. Today, poverty is predominantly a rural phenomenon with absolute poverty diminishing. The number of poor households in Malaysia has been considerably reduced from about 619.400 in 1990 to 267,900 in 2002. The incidence of poverty among Malaysians decreased from 17.1 per cent to 5.1 per cent during the same period. Rural poverty decreased from 34.9 per cent in 1995 to 11.4 per cent in 2002 while urban poverty decreased from 3.6 per cent to 20 per cent.
If the HIV epidemic persists and goes unchecked it will be detrimental to the achievement made by Malaysia in reducing poverty. There will be an increase in health and social expenditures of government and a decline in family income due to loss of productive family members resulting in an increase in the incidence of poverty. But this is a vicious cycle Those infected by HIV/AIDS are those who are poor and cannot afford to seek treatment. The best option in addressing this challenge is an effective health promotion strategy directed towards the high-risk groups, young people and those living in poverty.
The vast impact of the HIV epidemic on the demographic profile of the country such as population growth, distribution and structure, widowhood and increase in orphans among children and in reduction of the reproductive years resulting in lower fertility. There will be a reduction in the quality and quantity of labour; reduction in volume and use of savings. resulting in less investment, less productive employment, and lower incomes. All these may lead to greater increase in the incidence of poverty and this vicious cycle has to be addressed in view of the grave consequences of the HIV/AIDS epidemic.
Since the first case was reported in December 1986, there has been an increase in the number of HIV infections. Over the last four years (2000-2003), the average number of new HIV cases reported annually was more than 6,000 cases. By June 2004, the cumulative number of HIV infections was 60,621 with 8,840 cases of AIDS and 6.523 deaths. The main mode of transmission is intravenous drug use (75.5%), followed by heterosexual transmission (13.2%). The HIV infection rate is highest among young adults aged 20-39 years while the proportion of women infected with HIV is also increasing. More than 40 per cent of those infected with HIV are fishermen and odd job workers, the occupation sectors that are often associated with those living in poverty. There are indications that infections are moving out of the initial drug user group into the general population. Inadequate access to correct information, cultural and religious constraints, stigma, discrimination, silence, denial and ignorance are some of the factors contributing to the epidemic. Other factors such as mobility of the population and economic constraints also appear to be contributing to HIV vulnerability
In Malaysia, the HIV/AIDS prevention and control program was setup in 1987 with the establishment of HIV/AIDS coordination mechanism, under the responsibility of
the Ministry of Health. The principles of the Government’s national programme are based on the need to protect the health of the public whilst ensuring and respecting the rights of the individual, avoiding discrimination against infected persons and recognizing that information, education and communication are the key to HIV/AIDS prevention.
Over the last eight years Malaysia has initiated several programs to address the needs of adolescents and young people realizing that adolescent reproductive and sexual health is crucial in our efforts to control and prevent HIV/AIDS. In this regard, the Ministry of Women, Family and Community Development through its agency, the National Population and Family Development Board has implemented programs on health development and assertive training of adolescents. The Federation of Family Planning Associations, an NGO, has developed a modular training program specifically for adolescent reproductive health. The Malaysian AIDS Council, an umbrella organization of multiple NGOs has played an important role in advocacy, capacity building and coordinating activities addressing specific target groups. Community-based services are provided to outreach groups and people living with HIV/AIDS needing rehabilitative support, especially discharged inmates from rehabilitation centers and prisons.
The Government’s achievements in many areas of prevention and health care have been impressive. Health services in the hospital and primary health care systems are of a high standard, in particular in H!V management. Strong measures are in place to ensure blood supply safety. A range of treatment protocols and guidelines are in place. Access to antiretroviral therapy (ARV) is free, or heavily subsidised for selected groups. The Government has introduced compulsory licensing to increase access to affordable ARV drugs and is continuing to negotiate with the pharmaceutical industry on prices for essential treatment drugs
The major challenge for Malaysia is to increase the geographical coverage of HIV/AIDS-related services and their reach especially to vulnerable populations and those living in poverty.
Under the current development plan, the thrust of poverty eradication will be to re-orientate poverty eradication programmes to reduce the incidence of poverty to 0.5 per cent by the year 2005. Poverty eradication programmes will be more target-specific by addressing pockets of poverty, particularly in remote areas as well as among disadvantaged groups. Programmes will also be introduced to address the issue of urban poverty, particularly among those residing in the periphery of urban areas. Towards this end, programmes to provide social amenities, including housing, health and education, will continue as well as be upgraded to meet the needs and demands of these groups and improve their quality of life.
This poverty eradication programs will go hand-in-hand with our present programs for combatting HIV/AIDS which will be based on the National Strategic Plan on HIV/AIDS 2005-2009. This Plan provides a general framework for a nationally-driven, expanded and comprehensive HIV/AIDS response over the five–year period 2005 to 2009. Its purpose is to safeguard the health of all peoples in Malaysia in relation to HIV/AIDS. It provides the basis for coordinating the work of all partners with a view toward achieving the most effective and efficient use of available resources and ensuring rapid action and results-based management.
In adopting this National Strategic Plan for 2005 – 2009, the Government of Malaysia places on record its strong commitment to addressing HIV/AIDS as a development issue and to driving an expanded and comprehensive multi-sectoral response to the epidemic. Malaysia will continue to take an active role in regional cooperation on HIV/AIDS, and willing to share our experiences in implementing HIV/AIDS and poverty eradication programs with other countries, especially developing and south-south countries.
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