Breaking the Silence: Tackling the Challenges of HIV Testing in Malaysia

WORDS ASSOCIATE PROFESSOR LOW BIN SENG

FEATURED EXPERT ASSOCIATE PROFESSOR DR LOW BIN SENG School of Medicine Faculty of Health and Medical Sciences Taylor’s University

WHAT IS HIV AND WHY DOES IT MATTER?

• The human immunodeficiency virus (HIV) attacks the body’s immune system, leaving it vulnerable to infections and diseases.
• Without treatment, the infection can progress to acquired immunodeficiency syndrome (AIDS), a severe stage marked by opportunistic infections like tuberculosis and certain cancers.

HIV IN MALAYSIA

• In Malaysia, HIV remains a critical public health concern.
• 85,000 people, both adults and children, are currently living with the virus.
• 2,900 new infections were reported in 2023, according to the Joint United Nations Programme on HIV and AIDS (UNAIDS).
• These numbers underline the urgent need for improved prevention, testing, and treatment strategies.

HOW HIV SPREADS… AND HOW IT DOESN’T

HIV transmission occurs through body fluids, such as:

• Blood
• Breast milk
• Semen and vaginal secretions

Common means in which these body fluids, and hence the virus, are spread include unsafe medical practices and shared needles.

However, HIV cannot spread through casual contact such as sharing food and water or through kissing.

TREATMENT FOR HIV INFECTION

• To date, there is no cure.
• However, antiretroviral therapy (ART) allows individuals with HIV to live long and healthy lives.
• Starting ART early and sticking to the regimen is key to improving health outcomes and preventing transmission.

THE WINDOW PERIOD: A TESTING DILEMMA

• The window period refers to the time after HIV infection when the virus is present in the body but not detectable by certain tests.
• During this period, individuals may test negative but still be capable of transmitting the virus.

Testing methods vary in their ability to detect HIV during the window period.

• Antibody tests: Detect antibodies produced by the immune system (3 to 12 weeks after exposure).
• Antigen/antibody tests: Detect both antibodies and p24 antigens (2 to 6 weeks after exposure).
• Nucleic acid tests (NATs): Detect the virus itself (1 to 4 weeks after exposure).

Malaysia’s public clinics provide affordable testing options, but stigma and lack of awareness deter many high-risk individuals from seeking timely tests.

WHY THE WINDOW PERIOD MATTERS

• Missed diagnoses. False negatives may delay crucial interventions, allowing the virus to spread unknowingly.
• Mental toll. The uncertainty of one’s status can discourage testing, especially in conservative communities.
• Public health risks. Individuals unaware of their status may fail to take precautions, increasing transmission rates.
• Delayed treatment: Missed opportunities for early ART can worsen health outcomes.

STRATEGIES TO OVERCOME HIV TESTING CHALLENGES

Malaysia is making strides to improve HIV testing and prevention. Key strategies include:

• Public awareness campaigns. Educate people about the importance of regular testing and the window period to address false negatives.
• Combination testing. Use multiple testing methods to enhance early detection.
• Community screening. Reach out to high-risk groups, such as sex workers and people who inject drugs, through targeted health programmes.
• Pre-exposure prophylaxis (PrEP). Expand access to this preventative treatment for high-risk individuals.

A CALL TO ACTION

As the world marks World AIDS Day on December 1, Malaysia must double down on efforts to tackle the challenges of HIV detection and prevention.

By spreading awareness, expanding access to innovative testing methods, and reducing stigma, we can make meaningful progress toward a future free from HIV.