Assoc. Prof. Dr. Mary Huang Soo Lee
Department of Nutrition and Health Sciences
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia
Serdang Selangor

Introduction

Malaysia, as a developing country is undergoing similar demographic changes as other countries in the region and despite declining fertility rates, due to previous high fertility is experiencing a population age structure characterized by what is often referred to as the result of “population momentum”. This increase in the number of young people is also accompanied by various social changes brought about by development. The availability of educational opportunities in the country and the availability of employment has indeed delayed the age of marriage thus exposing the young to behavior which if not addressed will threaten the quality of life we fight so hard to achieve. Among the threats, the spread of infectious diseases including HIV/AIDS which is also fueled by globalization and communication. Although HIV/AIDS has been around for more almost twenty years and despite the large investments in research and education the epidemic does seem to abate and in fact today we are aware that no country has been spared. Those of us Asia have been warned by the World Health Organization (WHO) that as we enter into this new millennium, the epicenter of the HIV/AIDS epidemic has shifted to Asia, home to the most and second most populous countries in the world (China and India).

Population of Young People in Malaysia

In Malaysia, young children aged zero to fourteen made up more than 40 percent of the total population (43.8% in 1957, 44.6% in 1970) partly due to the post war deliveries but this percentage started to decline in 1980 by more than three percentage points with every census (39.5% in 1980, 36.3% in 1991 and 33.3% in the year 2000). In the meantime, the proportion of 15 to 24 years old as a percentage of total population has remained at around one fifth of the total population (19.5% in 1970, 21% in 1980, 19.1% in 1991 and 2000). However despite the fact that the percentage distribution by age has declined slightly, total population of young Malaysians has increased. Figure 1 illustrates this point very clearly. In 1957, there were 2.7 million young people between below fifteen years and 1.13 million aged fifteen to twenty-four. Since then the number of children below fifteen has almost tripled to 7.8 million and those in the older age group of fifteen to twenty-four had similarly more than doubled to 4.5 million in 2000. Taken together, at the end of 2000 the population of young people numbered 12.3 million. The preparation of young people for adulthood is a long process, which begins at the time of birth. Compare to other periods of our lives, the adolescent years have been look upon as a unique period of growth accompanied by new challenges for the country in general and families in particular.

The HIV/AIDS Epidemic in Malaysia

Ever since the first case of an individual infected with the HIV was reported in 1986, the country has seen yearly increases in HIV positive individuals, those displaying AIDS as well as in the number of people who have died. Evident from Figure 2 is the increase in HIV infections from three in 1986 to 778 in 1990, 4,198 in 1995, 5,107 in 2000 and in 2002, 6,978 new infections were reported. Concurrently the number of AIDS cases increased from 1 in 1986 to 18 in 1990, 1,168 in 2000 and 1,193 in 2002 (Ministry of Health 2003). In fact in the year 2002 an average of 19 confirmed cases were reported daily. A breakdown of the data by age group (Figure 3) reveals that more that 80% of those infected are in the age range of 20 to 39 years, a time when young people are at the prime of their lives, an age cohort of individuals on whom the country depends for development. That this youthful segment of the Malaysian population should have to bear the brunt of the effects of the infection has far reaching consequences if nothing is done to arrest the speed at which the infection is growing.

Figure 3: Age Distribution of HIV Infected Individuals
(Source: Ministry of Health, 2002)

Between the end of 1991 and 2001 the number of young people infected has multiplied a few times. Figure 4 gives us a clearer picture of the exponential increase in the rate of infection among the young in Malaysia. This was especially so in the case of those aged twenty to twenty-nine where the increase in the number detected in the year increased by two and a half times from 806 in 1991 to 1955 ten years later. It can be assumed that the rate of infection detected in the 20-29 years age group were indeed of young people who were infected earlier, some perhaps in their adolescent years.

Proximity to the Golden Triangle has partly contributed to make the threat of drugs on Malaysia youthful population. Despite great efforts and resources spent on addressing the problems associated with drug abuse, results have not commensurate the efforts put in. Today with the advent of HIV/AIDS drugs only serve to fuel the infection in the country.

Impact of the HIV/AIDS Epidemic

In general the impact can be examined at the macro as well as the micro level. At the macro level the epidemic’s impact is felt mainly because it affects the very same population age group on whom the nation depends on for progress and development. However the impact can also be felt at the micro level that is at the family level, the very basic unit of our society.

Impact on the country

That developing countries have been disproportionately affected by the epidemic is an understatement. The devastating effects of the epidemic have in some countries crippled the already poor and depleted economies in such a manner that economic gains over a generation is lost to the epidemic. In some badly affected countries of Africa life expectancy has been reduced from more than sixty years to less than fifty years. Part of the reason is the fact that HIV affects the very same cohort of people on whom the country relies for economic development.

World wide, 23 mill workers 15-49 (the most productive segment of the labor force) carry the virus. In Malaysia for example 82% of those diagnosed with HIV/AIDS is in the age group of 20 to 39 years. In the urban areas they are needed to provide the labor for industries and in rural areas young people are also needed for food production. In fact the food security of some countries have been threatened due to the death of young people from the epidemic. Therefore HIV/AIDS cuts supply of labor for development. However before the infected succumb to the infection the deterioration of health slashes the income for many workers. Industries on the other hand face increased absenteeism thus increasing labor cost and at the same time valuable skills and experiences are lost to the nation.

At the same time countries are also burdened with the responsibility of higher health expenditures needed to treat the secondary infections that are associated with HIV/AIDS. More than that social needs of infected as well as affected families will have to catered for.

Impact on the Family

Basically HIV/AIDS can be looked upon as a huge problem with profound social and economic implications. As an epidemic, it affects the very basic unit of our community and country. Its association with behavior or lifestyles and therefore morality makes acceptance of individuals living with the virus, difficult. At the same time people living with HIV/AIDS (PWHAs) are also ashamed or afraid to reveal their status. The fact that a PWHA can continue to live a normal life for many years with no sign nor symptom makes revelation of their status to partners not urgent and his by itself endangers their partners. The lack of a cure nor vaccine further accentuates the fear (of contracting the virus despite having basic knowledge) in people having to come into contact with them. Under such circumstances testing to confirm HIV status is avoided because knowledge of their own status can also mean that they will or can be stigmatized and discriminated against. This becomes a vicious cycle in which the virus is then allowed to infect whoever does not take the necessary precautions.

At the family level persons living with HIV/AIDS (PWHAs) are faced with the dilemma on whether to reveal their status to his/her loved ones. To their spouses this is often perceived as a betrayal of trust. This is especially so in the case of those who were infected through unprotected sex (outside of the marriage and it could also have been before marriage) or the sharing of needles with an infected person. Beyond the initial stage of this feeling of betrayal, the spouse has to face the question of whether he/she has also been infected. Sometimes diagnoses are only made after a child borne to the couple is diagnosed with AIDS. In situations like this there is every possibility that by the time the virus is diagnosed in the infant, parents are already infected.

The absence of a cure for AIDS makes diagnosis a death sentence. The long illness itself weakens PWHAs labor inputs. Not only does the family experience a loss of income, they are also burdened with the need for money to be spent on the increasingly frequent infections experienced due to degeneration of the immune system. Antiretroviral therapy available to prolong the lives of PWHAs are costly and because it is a recurring expenditure the economic impact on families is long term. Wives often find themselves forced to work (sometimes without much skills nor education) in order to support their families. Children are forced out of school because of lack of money. Children are forced into child labor often into exploitive and extremely hazardous forms of work. In such situations young girls are especially vulnerable because they are sometimes forced into occupations, which exposes them to the infection. Therefore it is not surprising that families affected by HIV/AIDS can be push into poverty due to the inability to produce (and therefore earn an income) coupled with the increased need for medication for infected members.

Older parents who depend on their children for economic support suddenly find themselves without the economic security they thought they would have with children. More than that AIDS often leave grandparents solely responsible for the economic as well as psychosocial development of the grandchildren now that their children and their spouses have succumbed to the virus. At the same time women, as wives or mothers (who could also be infected) find themselves having to care for the infected because of cultural expectations due gender

While the impact of the epidemic differs in form and magnitude across families, communities and societies, one salient feature remains: the impact on a child’s life. Children of families whose parents who have AIDS find themselves having to face various forms of uncertainties in their lives. UNAIDS in conjunction with UNICEF and USAID brought out joint report “Children on the Brink 2002” highlighting the fact that it is estimated that by 2010 an estimated 106 million children under the age of 15 would have lost one or both parents and of this number 25 million of them due to HIV/AIDS alone. The same report estimated that in 1990 AIDS orphans made up 0.9% of all orphans of the world. This decrease to 0.5% in 1991 but by the year 2001 this same percentage had increased to 12.4%. It is estimated that by 2005 the proportion of AIDS orphans as a percentage of total orphans will further increase to 18.6% and escalating to 23.7% in 2010. Children impacted by HIV/AIDS risk exploitation, including physical and sexual abuse. Isolated from emotional connections with the family, some engage in risky sexual behavior. Those forced to live on the streets may turn to prostitution and crime as a means to survive. While most of these children were born free of HIV, they are highly vulnerable to infection (Children on the Brink, pg. 9). UNICEF in fact pointed out that from their study of AIDS orphans many of them were deprived of basic education.

Conclusion

HIV/AIDS is one epidemic that has transcended two millenniums. Asia is now depicted to be the new center of the infection, which has been shown to have devastated several if not most African countries in the last twenty years. The knowledge we have gained from the epidemic in Africa must surely be put into action in Asia before it is too late. With a large proportion of our population in the age group most vulnerable to the infection, concerted effort must be made to protect them. The time has come for action not procrastination. Collectively countries can hope for greater success at preventing the virus from destroying individuals, families, communities and countries.

References

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