TREAT Asia Site Profile: University of Malaya Medical Center, Kuala Lumpur, Malaysia

Dr. Adeeba Kamarulzaman

June 2003— Compared with many countries in Southeast Asia, Malaysia has a relatively low prevalence of HIV/AIDS. UNAIDS estimates that only 0.4 percent of the adult population is infected with HIV and that a total of approximately 42,000 people in Malaysia are living with HIV/AIDS (2001). But there are indications that infection rates are rising, especially among injection drug users (IDUs) and female sex workers in urban areas. With few medical professionals trained to treat the disease, the country is ill-prepared to thwart a growing epidemic.

The University of Malaya Medical Center’s infectious disease unit is the premier referral service for HIV/AIDS patients in Kuala Lumpur and is a participating site in TREAT Asia. The site’s principal investigator for TREAT Asia, Dr. Adeeba Kamarulzaman, is one of the country’s top health experts on HIV/AIDS.

Dr. Adeeba estimates that there are only about 10 doctors throughout Malaysia who have significant experience treating HIV/AIDS. Her unit has three physicians on staff to treat all cases of infectious disease, including HIV/AIDS, tuberculosis, typhoid, malaria, and dengue fever. The unit runs HIV/AIDS-specific programs three days per week that currently serve about 300 patients—mostly men in their mid-30s expressing symptoms of AIDS-related disease, like tuberculosis.

Dr. Adeeba attributes Malaysia’s shortage of HIV/AIDS experts to the fact that the country’s physicians tend to shy away from specializing in infectious diseases, opting instead for more lucrative fields such as dermatology and ophthalmology. A high level of stigma associated with HIV/AIDS persists throughout the country. Malaysia is heavily Muslim and Malaysian society traditionally condemns many activities that can lead to transmission of HIV, including intravenous drug use, premarital, extramarital and homosexual sex, and sexual relations with sex workers.

The demographics of HIV patients attending Dr. Adeeba’s unit are not typical of the population at large. While injection drug users represent the majority of HIV/AIDS cases in Malaysia, Dr. Adeeba estimates that only 15 to 20 percent of patients who come to her unit are IDUs. A few of her patients are men who have sex with men, but most contracted HIV through heterosexual sex.

Antiretroviral drugs, such as AZT and DDI, are available through the government for approximately $50 per month. Yet this is beyond the reach of most people, even those attending the University of Malaya center, whose incomes tend to be higher than average. In areas such as the northeastern provinces of Western Malaysia, where injection drug use is prevalent and infection rates are high, low incomes prevent many from seeking treatment and care, let alone purchasing anti-HIV drugs.

As one of the few facilities in the country that offers HIV/AIDS services, the University of Malaya’s infectious disease unit provides a unique platform for researchers and health experts to collect patient information on an ongoing basis. As part of the TREAT Asia HIV/AIDS Observational Database (TAHOD), the unit will start to compile anonymous patient data. It is hoped that the insight gained through this endeavor will help the country develop effective national data collection practices and ultimately, effective AIDS prevention and treatment strategies.