MALAYSIA has progressed in reducing HIV transmission rates, especially through programs that target injection drug users and sex workers.
But the shift toward sexual transmission among young people, especially gay men, brings new challenges that need different approaches.
In 2024, the country recorded 3,185 new HIV cases, with 64 per cent linked to homosexual or bisexual contact, while 32 per cent came from heterosexual contact, a contrast from the 1990s when injection drug use was the main culprit.
Sabah has Malaysia’s third highest HIV cases after Selangor and Kuala Lumpur with 344 new cases recorded in 2024.
“As long as there is sharing of bodily fluids, a person will be infected with HIV and the rates are higher in same-sex encounters,” Hospital Universiti Malaysia Sabah (HUMS) Associate Professor Dr Mohd Nazri Mohd Daud told the recent Red Ribbon Talk 2025.
“In the context of Lesbian Gay Bisexual Transgender (LGBT), because this sharing occurs through sexual relations, the ease of HIV entering the body is multiplied many times because it happens in an unnatural way,” said Dr Nazri who was among speakers at the open forum organised by Universiti Malaysia Sabah’s Faculty of Social Sciences and Humanities.
He said God created the female reproductive organs with cells that are resilient and do not easily get injured, compared to cells lining the rectum, which are easily damaged if there is rough penetration.
“When cells are easily damaged, HIV infection becomes easier. That is why the ease of HIV entering the body of those who engage in unnatural sex is much easier compared to those who have sex through normal means.
“Simply put, HIV spreads through the sharing of bodily fluids. Whether through sexual contact, contaminated blood, drug use through needles or from mother to child during pregnancy, thus whenever there is sharing of bodily fluids, the risk of HIV spreading goes up,” he said.
Dr Nazri pointed to several things happening at the same time that have led to more HIV cases among young people, especially within the LGBT community.
He said these are social and environmental factors, not something inherent to any group.
“One principle we all understand is the neurobiology of the brain. The prefrontal cortex, the part that helps a person tell right from wrong, good from bad, only matures starting at age 21 and continues until 25.
“During their teenage years, our young are not fully capable of making the right choices and so they get trapped in negative situations and social problems,” he said.
He said during the Covid period, with the digitalisation era and apps, there was a boom where everything became available with Artificial Intelligence and so on.
“This happened at the same time as the production of synthetic drugs. Designer drugs or new synthetic drugs that are more dangerous, more powerful than conventional drugs, also came out during this period when many tested positive for HIV,” he said.
He said synthetic drugs can be 10 to 50 times more powerful than normal drugs but would not show up in standard urine tests.
“The practice of ‘chem sex’ (using drugs during sexual activity) is more common among the LGBT community.
“When someone uses drugs, the sexual activity becomes more powerful, more aggressive, more forceful, leading to more injuries in the areas involved,” he said.
“Within the LGBT community, we find that the risk of someone facing emotional problems and depression happens more often compared to the general population.
“They (LGBT) use sexual activity as a form of self-medication, to treat feelings of emptiness and low mood.
“Those who feel spiritually and emotionally empty will use drugs to get rid of that loneliness, because drugs create a high that fills that void.
“Similarly with the LGBT community, we find they are more likely to use drugs in their relationships, so everything is connected. It is not just one factor causing HIV in the LGBT community but many factors coming together,” he said.
He said society’s rejection towards the LGBT community makes the problem worse.
“These are what I call marginalised groups, people who are isolated. But isolated by whom? By all of us. We are the ones who separate them. That is why they do not come to us (medical team) for treatment,” he said.
He said these creates a cycle where those who need medical and mental health help the most are the least likely to ask for it, because they are afraid of being judged and discriminated against.
“If you have friends among the LGBT community or those with HIV, help them, save them.
“The most important thing is to not marginalise people. Whether they have made mistakes or are facing difficulties, they are still human beings who deserve our help to return to a healthy, normal life. That is what we should all work towards,” he said.
The medical community has put in place rules that balance public health needs with personal privacy.
“When couples go for HIV screening before marriage, the positive or negative result is not revealed to the religious affairs department,” Dr Nazri said, adding that it only states that the candidate has undergone HIV testing.
“If a test comes back positive, that person is referred to a family medicine specialist for counselling. We do not have the authority to say whether they can or cannot marry.
“We provide options through counselling because we understand that medically, if HIV is controlled and there is no virus in the body, they would not transmit the disease to their partner,” he said.
He said medical professionals ask for permission before sharing results with religious authorities.
“We ask the client, ‘May we inform the religious department that your test is positive for counselling purposes from the religious perspective?’ If they say no, we would not inform them. That is sufficient to allow them to marry,” he said, adding that is the protocol.
