Protection of PLHIV’s Rights Between Political Will, Stigma, and Dogma in Southeast Asia
On August 8th, ASEAN celebrated its anniversary. There are still many problems facing this region, including more problems of human rights violations, ranging from Rohingya refugees who were expelled from their own country, environmental issues that violate the agrarian rights of the community and damage the environment with very broad and permanent impacts, intimidation and terror against human rights activists, sexual violence, or intolerance, to violations of the rights of People Live with HIV (PLHIV).
According to UNAIDS data, around 3.5 million people are living with HIV in the Southeast Asia region. More than 99% of PLHIV in ASEAN reside in five countries: Indonesia, Malaysia, Vietnam, Myanmar, and Thailand. Since 2010, the region has made progress in combating the epidemic, with successful condom programs in most countries.
Between 2010 and 2015, AIDS-related deaths and new HIV infections have decreased in all high-burden countries except Indonesia and Malaysia. Both countries have rarely experienced declines in HIV cases, and these regions are far from achieving the target of being 90% HIV-free by 2020 and ending AIDS by 2030. These two countries, which have the world’s largest Muslim populations, face significant moral barriers in reaching key populations of PLHIV and providing fair access to services for PLHIV from ISPs.
According to the 2018 gender justice assessment in Indonesia, the religious moral views of health workers in several areas remain a barrier to providing equitable health services to groups. Stigma and discrimination in health services also continue to hinder key populations, especially MSM and transgender, from accessing services. Research also highlights the severe impact of discriminatory practices on PLHIV. With 20% of key population cases and 10% of cases at primary health services experiencing high rates of loss to follow-up, it’s clear that stigma and discrimination are significant barriers. Health service providers’ refusal to treat PLHIV in general clinics exacerbates these issues, isolating individuals and undermining their health outcomes.
The 2020 External Study of the Health Sector’s Response to HIV and AIDS in Indonesia (WHO, 2020) highlighted that the incidence and prevalence of HIV among MSM and trans women remain high in most regions. While in Malaysia in the last decade, sexual transmission became the main mode of transmission, and MSM is expected to become the main key population in Malaysia in year 2030 as projected using the Asian Epidemic Model (AEM) 2022 Global AIDS Monitoring, Country Progress Report. Despite improvements in life expectancy, social justice for PLHIV key populations in ASEAN region, including MSM, transgender, and sex workers remains inadequate.
While legal and policy frameworks are insufficient in addressing social justice issues for PLHIV. Local laws and local/regional AIDS commissions fail to mitigate stigma, discrimination, and violence effectively. In Indonesia, the discrimination reflected in the new penal code (KUHP) that exacerbates discrimination by potentially criminalizing LGBT individuals, sex workers, and women, which hinders HIV response efforts. Additionally, there has been no transformation in the working methods and perspectives of health workers, as biased moral views remain an obstacle to achieving the specific goal of reducing discrimination against PLHIV.
All in all, discrimination in health services, and stigma from law, government and religious figures, combined with a lack of protective laws, perpetuates social injustice and barriers for PLHIV to access service. Therefore, addressing stigma and discrimination in service provision through participation of religious figures to transform the perspective of health service providers is essential to improving access to and quality in HIV services.
Various interfaith meetings have been held by religious leaders from various influential institutions in each country in the Southeast Asian region, but they have not discussed much about the rights of PLHIV. In the future, so that meetings of religious leaders are not just lip service, there must be courage for influential religious leaders to mobilize religious organizations to voice the importance of various health services that can be accessed by PLHIV.
قَالَ رَسُولُ اللهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ: “مَنْ عَادَ مَرِيضًا أَوْ زَارَ أَخًا لَهُ فِي اللهِ، نَادَاهُ مُنَادٍ: أَنْ طِبْتَ، وَطَابَ مَمْشَاكَ، وَتَبَوَّأْتَ مِنَ الْجَنَّةِ مَنْزِلًا”.
(رواه الترمذي وقال: حديث حسن، وفي بعض النسخ غريب).
I heard Messenger of Allah (ﷺ) saying, “Whosoever visits an ailing person or a brother of his to seek the Pleasure of Allah, an announcer (angel) calls out: ‘May you be happy, may your walking be blessed, and may you be awarded a dignified position in Jannah”. [At- Tirmidhi, who categorized it as Hadith Hasan].
Basically, every religion has arguments from holy books that support protection for PLHIV, as above; it’s just the political will of religious leaders in the Southeast Asian region in using religious arguments that support PLHIV services or, on the other hand, turning their backs on the humanitarian message in holy books.