Transgenders and Men Who Have Sex With Men (MSM) are most vulnerable when it comes to HIV/AIDS protection, according to Pink Triangle members, Manis and Along.
According to data provided by the Malaysian Aids Council (MAC) in 2013, there are 85,332 people living with HIV in Malaysia with around 9 new cases per day.
And while there were 3,393 new HIV infections reported in 2013, this number does not reflect the vast majority of silent and underground transgenders and gays who choose not to reveal themselves for treatments.
According to the new figures by the Malaysian Aids Council, sexual transmission of HIV superseded Injecting Drug Users (IDUs) beginning 2010 and has been rising year on year.
This is a worrying trend, as unlike injected drug users transmission which requires a deliberate act by the individual to inject themselves, sexual intercourse happens more rampantly, between heterosexual and homosexual partners and the probability of transmission increases when individuals do not practice safe sex or disclose information about their previous sex partners.
Raymond Tai, the Marketing and Communications Director of Pink Triangle Foundation (PT), an NGO providing HIV/AIDS education, prevention, and support programmes, maintains that the population figure of LGBT in Malaysia is less than 10 percent of the total population and they are vulnerable because they are not receiving information to protect themselves.
Most have gone ‘underground’ and treated as criminals under Malaysian law – even when they are wearing female’s clothing. This is where the Pink Triangle Foundation is trying to reach and offer help, anonymously, he shared with Malaysian Digest.
“Transgenders and Men Who Have Sex With Men (MSMs) self-stigmatize themselves because the government has laws against them. This makes it difficult for them to be linked to the public health service. And without access to medical care and the fact that they keep to themselves, awareness and prevention of HIV/AIDS is lacking amongst them”.
“Healthcare professionals should also adhere to the Ministry of Health’s policy of no discrimination, interference of personal beliefs and prejudice when it comes to medical attention,” says Raymond.
When Malaysian society at large pretends that they do not exist, how do we address the increase in HIV transmission through sexual intercourse, putting all Malaysians at risk, including heterosexuals, homosexuals and minors?
Manis Chen, a ‘transwoman’ who is part of the Pink Triangle Foundation, in charge of reaching out to the transgender community, shared her story with Malaysian Digest. She believes that it is important that the government acknowledges the existence of the transgender so that the census can reflect their demographics and also recognize an important issue that withholds them from seeking medical attention.
“How can the government address our needs if they don’t even accept who we are? My existence is not being acknowledged. You see the census? It says heterosexuals have the highest risk of transmitting HIV. But I am a woman, in a man’s body – and they classify me as a man. This is why the information is skewed.”
“Society don’t have issues of me being a transwoman, unless I dress sexily, or flirt outrageously, then I am creating problems in society but if most of us blend in and mingle freely with everyone then it shouldn’t really be an issue” quotes Manis.
“A transperson needs HRT (hormone replacement therapy); our needs are different from the normal man and woman. In Malaysia we don’t have HRT yet, but I hope one day we will have it.” Manis highlighted on the special needs of transgenders.
She says that the lack of professional doctors who know about both HRT and its combination with HIV treatments are discouraging to transgenders. HIV positive people need to take HAART (highly active antiretroviral therapy that helps prevent the virus from causing further damage) but the combined effects with hormone therapy is not well-known.
“So about this new medication where do I go to address my concern and fears? Because I am a transgender and it’s complicated. They can address the side effect of HAART, but not of my HRT”.
The Malaysian government does not recognize transgenders, and because of their unique needs to have hormone replacement therapy, a therapy that is not recognized in Malaysia, if they do acquire HIV then it is difficult for them to get medical advice that can look into these two problems.
“I have to take female hormones because I want to be a woman. I already am mentally – and that is where gender is located. Gender is not located in-between your legs…Even transmale, those who are female and become male have to take testosterone. They have beards and the butt will shrink – some do a mastectomy and remove their breasts. … nobody monitors what we take and what the side effects are from taking these pills…same goes with the HIV medication process”.
Transgender and HIV positive
Malaysian Digest asked Manis how HIV Positive transgenders are coping in our society.
“A lot of them are down. First you don’t know if you should continue with your hormone pills. You don’t think your body can endure all these medications and you worry about the side effects. You cry on my shoulder, they cry on my shoulder. We can just give emotional comfort”.
“Some stop taking their female hormones and revert back to their masculine (or feminine) old self. It’s not who they are but due to lack of empowerment, knowledge, and information they cannot proceed with their life as a transgender”.
For Manis even walking into hospitals and clinics pose a problem.
“When I produce my IC my name will be Ali Bin Abu (male birth name), yet I am like this (female looking). When they call me Encik Ali, I present myself and they say “Is this you? Because the name here says Ali Bin Abu, and male.”
“Some nurses address me as Kakak (sister) and puts my gender as female, but they are being tied by the Ministry of Health’s Standard Operating Procedures that you have to call them based on their IC name. Their hands are tied.”
Only in a few rare court cases do judges order the National Registration Department to facilitate the person’s identity needs. But a caveat exists – you are only allowed to do so, if you have done a sex change operation.
“So that means that I have to remove my penis, and not all trans want to do the sex change due to money, religious reasons, or fear of surgery”, recounts Manis.
Some transgenders suffer in silence and many fall through the cracks of our society. Aleesha Farhana was a transwoman who went to court to change her gender from male to female. Although born as a male, she identifies herself as a woman and the IC change would help a local university to place her in the female hostel.
Despite doing a sex change operation, Aleesha failed to change her IC details, and under unknown circumstances died soon after. The trans community believes that she committed suicide due to depression. These are some of the struggles that transgenders face.
“We already are stigmatised for who we are, and if we were to have HIV – just imagine how much more shame people would make us feel?”
Another subgroup of this marginalized community of ‘hidden’ people is ‘Men Who Have Sex With Other Men’ (MSM). Along (nickname for elder brother) is a MSM living with HIV. Born in 1982 from Perlis but growing up in Selangor, Along was diagnosed with HIV, and then AIDS, around February 2011 onwards.
“I had just left my work as a club lounge escort….something like a male GRO. Starting from October to December, I started to feel like something was not going well, I started coughing first, my body started getting weaker and thinner, and I had used up all my medical leaves already. Finally I had to quit my job and they referred me to Hospital Sungai Buluh (HSB) Infectious Disease Unit. The same day I visited the Hospital, was also the same day I was put into the ward.”
Along was found to be HIV positive.
He encourages other MSM to seek out treatment.
A Legal Dilemma
Along also shared the unchartered territory that transgenders tread on every time they deal with medical and law enforcement authorities.
“The thing about us MSM is that, we are afraid. Whenever it comes to testing us for HIV – we freak out. And there is the fear of being stigmatised. Because eventually, we will have to admit that we might have had sexual relations with other men”.
The nurses and doctor surely would ask: “You have sex with someone ke? Sape?”
“The Infectious Disease Act of 1988, clause 12, states that if you display any of the diseases you cannot spread it to anyone. These include HIV and tuberculosis, where they will put you into an isolation booth and on medication for 6 months.
“A MSM friend of mine contracted HIV from another partner without knowing it. He thought of doing a police report, but the police informed him that they cannot arrest the HIV positive partner if they didn’t arrest him as well, because being a homosexual in Malaysia is a crime as well. The police asked: “Are you sure you want to reveal your sexuality to us police, because we think you’re gay. In the end, they just told me to not do anything, as there was nothing I could do.”
Along also shared his own experience that, “when I was 19 years old I was raped by an unknown assailant, and it left me in pain and feeling helpless. I couldn’t even lodge a police report because I do not know how he looked like.”
Manis briefly elaborated the wide range of people who are grouped into this marginalized community, ranging from macho gays, butch lesbians, ‘sissies’ gays, femmes, trannies/shemales as well as transwoman and transmales.
A separate feature story can be written on this topic on its own. Gender, Manis says, is a concept that is fluid and cannot be dictated by what is between ‘your legs’.
While it is understandable that as a Muslim nation Malaysia prohibits transgender and homosexual people, as a civilized society, we have a responsibility to take care of the needs of all citizens, irrespective of their gender preferences.
Pretending that this community does not exist is counter-productive as the risk of HIV infection through sexual intercourse in Malaysia will climb higher without proper education, rehabilitation and monitoring.
Reaching out to this community to provide much needed education is a priority.
“I would also want to clarify that HIV positive people can still have sex with others, as long as they use lubricants and condoms (oral and penetration)”, says Along. “HIV is transmitted through only three ways – from mother to child, sharing of drug needles, and unprotected sex”.
Speaking of unprotected sex, MSM men have a tendency of not wearing condoms properly, Along commented. “When they are on heat, they grab on any condoms…and use any lubricants available. Cooking oil for example, or vaseline, will rub on the condom and cause a breakage”.
Along also recommends that MSM’s and transgenders approach Pink Triangle for screening tests where they offer anonymous testing and counselling for HIV and sexually transmitted infections, and support and care for people living with HIV.
“We can help anyone who believes they might be at risk. It’s just a simple test, and if you turn out to be positive, we will help you with the hospital procedures”.
Along now has to take medication for the rest of his life to keep the HIV from spreading. He still has a partner (who is also HIV positive) and tries to live life to the fullest.
He leaves us with a final advice, “It is much better to know now than to live in ignorance and suffer from it. Don’t wait, do your screening test now”.
– Malaysian Digest