KUALA LUMPUR, May 3 – Sexual health is still not adequately discussed in Malaysia where issues such as compromised consent, low level of awareness, sensitivities, and bureaucracy can prevent people with sexually transmitted infections (STIs) from seeking the treatment they need, said experts during a roundtable discussion on Positive Sexual and Psychosocial Health last March 27.
“When we talk about sexual health in totality, the reason many people don’t seek help or provision for sexual health issues is because the element of consent is always compromised,” said Dr Kamal Kenny, chairman of the Federation of Reproductive Health Associations, Malaysia (FRHAM).
As a result, many people shy away from getting the help they need. FRHAM works with marginalised people such as the LGBT community and the Rohingya committee, explained Dr Kamal, and many people from such communities are reluctant to come forward.
“In many cases that we have seen at FRHAM, when we do a study and reach out to the community, they say they do not want to get treatment from the klinik kesihatan because they find in many cases, the confidentiality element is compromised.
“So that hampers them from getting treatment,” Dr Kamal said, adding that they would rather seek treatment at a private clinic and for those not able to afford it, they end up going without treatment.
Education and awareness on sexual health for all stakeholders can help address this matter, but according to Dr Kamal, the bureaucracy is not in favour of bringing the subject out into the open.
Swept Under The Carpet
“For the longest period of time, we have been advocating comprehensive sexuality education. The biggest challenges and stumbling blocks that we face is that there are many agencies that feel this issue should not be spoken about in the public domain because of the sensitivity of the subject.”
“How are we going to reach out to people seeking help if we sweep something so crucial like this under the carpet?” he said. “We have gone into schools where we have been prepped by the schools to not share images that are supposedly sexually taboo.
“It’s very difficult to talk about something of this nature and not touch on the taboo. We are talking about sexual education, so how do you talk to a child about menstruation, masturbation, and not talk about the crux of these issues?”
If sexual health issues are not addressed, they present an enormous burden of morbidity and mortality for the country, Dr Kaarthig Ganesamoorthy director of DTap Clinic said, adding that STIs affect reproductive and child health.
“And this has a direct impact on the nation through stigmatisation, infertility, cancers, pregnancy related complications, and an increased HIV risk.”
Low Level Of Sexual Health Awareness
To underscore the importance of raising awareness about sexual health, Dr Kaarthig cited a recent study about knowledge on STIs among students in public higher education institutions in Melaka.
The respondents who participated in the study yielded a mean knowledge score of 24.1 over 38.
According to the study, HIV was the most known STI while gonorrhoea, trichomoniasis, and chlamydial infections were among the least known STIs.
The study also found that oral intercourse was the least known sexual activity that could transmit STIs.
Furthermore, over 90 per cent of the respondents were unaware that a person infected with STIs could be symptom free. “That’s the state of how much we as Malaysians know,” said Dr Kaarthig.
He added that the Malaysian population is barrel shaped with the most number of people in the barrel being in the 20 to 40-year-old age range.
“If we have those people who are in their prime in terms of contributing to the nation, but these people are also in their prime picking up a STI, then they are going to be inefficient.
“So, the more we talk about it, the more we get this information to that particular layer of people, things will ultimately turn out for the better.”
Medical Professionals Must Be Non-Judgemental
Knowledge and awareness can not only improve people’s understanding of sexual health, it can also help combat stigmatisation. On this front, health care professionals in particular, play a significant role.
“I think health stakeholders have to play a very important part by saying that sexual health is just like any other health issue, just like any other disease, therefore people with the condition should be treated,” Dr Kamal said.
It should not be difficult for medical professionals to avoid stigmatisation as they were taught in medical school not to judge or bring their own perspective to a case, said Dr Kaarthig.
“It’s important to understand what we are looking at. It’s important to understand cultural beliefs, religious beliefs, and social norms. If someone comes up to you and they tell you that they identify as something other than you know them to be, we need to take it as that, knowing what we know about the current situation. Take it at face value.”
The PT Foundation, a community-based organisation which provides sexual health services to marginalised people, aims to eradicate stigma and discrimination by empowering the community to lead its own clinic.
“If we want to change the narrative in the sexual health landscape, we cannot do it by not being inclusive,” said Ramesh Vadiveloo, community health care manager of the PT Foundation. “We start right with our staff.”
He explained that the clinic hires transgenders, women, and people living with HIV. “So, that’s how we make it inclusive, and also in the services that we provide.”
Initially, the PT Foundation worked predominantly with men who have sex with men (MSM), according to Ramesh, but the NGO now offers its services to other key populations affected by HIV AIDS, including people who inject drugs, female sex workers, the transgender community, and people who are already living with HIV.
Additionally, its range of services has expanded. ”Now, we’re going in the direction of providing more services for the transgender community, which includes hormone replacement therapy. For women, we are looking into HPV DNA testing.”
Adolescents A Crucial Target Demographic
While the PT Foundation also has an outreach programme, Ramesh said the NGO has been met with resistance when approaching higher education institutions to conduct its educational and awareness programmes.
“Forty eight per cent of new infection cases in 2021 are from the age of 13 to 29 years-old. That’s almost half of the new cases. So, if we don’t approach colleges and universities to talk about safe sex and sexual health, this number is going to get bigger and bigger,” he said.
“But colleges and universities are not allowing us to talk about safe sex and sexual health. That’s our biggest problem — the policies of the colleges and universities.”
People in that age group are a crucial target demographic so it’s counterintuitive not to reach out to them, said Dr Kaarthig.
“It is the adolescents who are willing to look for information, who are experiencing and challenging themselves through the hurdles of adulthood and reproductive health. But at the same time, they don’t let you go speak at the universities!”
Addressing this problem requires a policy and mindset change, he said, adding that there is also a need to explore the best way of connecting with the people who would be most receptive to their message.
“How to get them to understand what it is we’re trying to tell them and make the change so it’s not something that carries on.”