Lengthy Covid-19 Epidemic Threatens Malaysia’s HIV Programmes: Expert

Dr Adeeba Kamarulzaman raises possible reductions in government funding for HIV patients as a prolonged Covid-19 epidemic would affect the economy.

KUALA LUMPUR, July 1 — A prolonged Covid-19 epidemic in Malaysia could lead to budget cuts and manpower shortages for HIV/ AIDS programmes, said HIV expert Dr Adeeba Kamarulzaman.

The infectious disease physician at Universiti Malaya and former dean of the public university’s faculty of medicine noted that the Ministry of Health (MOH) did not reduce its yearly financial budget for HIV patients during the testing Covid-19 climate.

Nevertheless, Dr Adeeba also shared the possibility of funding reductions by the government in handling HIV patients if the Covid-19 epidemic continued as this would impact the economy.

“Maintaining existing programmes can be continued, but in terms of either implementing new programmes or expanding in a major way, critical programmes for instance, we are going to find challenges,” Dr Adeeba said at a roundtable session organised by the International Aids Society last June 4.

“Obviously, new programmes will require a new budget, expansion of programmes will require a new budget.

“Although HIV programmes did not see a larger policy impact on the national level, it has micro-level effects — on an individual or district level as there is a lack of testing for HIV.”

Next, Dr Adeeba also pointed out manpower constraints in health care facilities to handle HIV care when the country is battling new heights of Covid-19 cases. Although Covid-19 infections nationwide have declined slowly over the past few weeks, the intensive care units in many hospitals, such as Sungai Buloh Hospital in Selangor, are full of Covid-19 patients.

“Those of us who are working in the Covid-19 response are the same people who are working in HIV response, particularly on the clinical side. Let me tell you, I think all of us are getting exhausted as the days go on.”

Dr Adeeba also pointed out that the initial lockdown has impacted the HIV screening process as patients faced challenges to go to hospitals.

“The HIV patients coming forward for HIV testing, it is not just the logistics, the clinics were shut. You can’t travel outside of your immediate zones and areas. But also I think people were genuinely afraid to come forward to be tested, so we saw a decline in HIV testing.”

However, Dr Adeeba commended the efforts of community organisations who continuously found ways to reach HIV patients consistently and the quick adaptation of telemedicine in health care facilities generally in Malaysia.

According to Dr Wong Chen Seong, a consultant infectious diseases physician at the National Centre for Infectious Diseases (NCID) in Singapore, HIV testing in the country saw a decline last year compared to 2019.

“Compared to 2019, the number of HIV tests done nationally have dropped by about 30 per cent. The number of new diagnoses reported to the registry have dropped by about 20 per cent,” Dr Wong said.

Dr Wong said that a total of 8,800 HIV patients have been identified in Singapore since the beginning of the AIDS epidemic and as of now, approximately 6,800 patients are still alive.

He noted that in Singapore, HIV care is still fairly centralised in specialist centres and the country is working to establish a model where there’s more community-based care.

“But as it stands, and when 2020 came around, we were still very specialist-centred. Many of the hospitals and infectious disease centers were also where Covid-19 was, focused and centred.”

Dr Wong also mentioned that the quality of HIV care is being affected, although Singapore has pivoted telehealth care in its health care facilities during the Covid-19 pandemic.

“I tell my patients, I will start this journey with you and hopefully, I’ll walk the entire journey with you. Yet, I haven’t seen some of my patients for close to a year and a half, short of a phone call or a text message and so on.”

Dr Nittaya Phanuphak, the executive director at the Institute of HIV Research and Innovation in Bangkok, Thailand, also highlighted the challenges in vaccinating HIV patients against Covid-19 in the country.

She noted that Thailand does not have sufficient coronavirus vaccine supply, which has made the vaccination process harder in the midst of vaccine hesitancy among its people.

“It’s also vaccine hesitancy in general, and then vaccine hesitancy among certain populations, like among people living with HIV, among transgender women who are taking gender-affirming hormones, people who use to inject drugs, for example, that I think we have worked quite hard over the past few weeks, hoping that we will have enough vaccines to start the actual rollout.”

“When a huge Covid wave comes in, it’s like an overstretch to cater as health care providers now must also keep providing HIV and sexual health services.”

Dr Nittaya also said that the Covid-19 pandemic still poses stigma and discrimination towards HIV patients, whose rights are being violated during this time.

“In April, we may say that 100 per cent of our time is actually not doing much on HIV and sexual health service, but more on Covid-19.

“But now, we are getting into a more settled way of balancing our Covid-19 situation and HIV and sexual health work. So it is now maybe like 70 per cent and 30 per cent.”

In a nutshell, the Asean health care specialists echoed the need to establish a model of continual care for HIV patients during this prolonged Covid-19 pandemic, including improvements in health care infrastructure.

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