HIV: When understanding fails to translate to action

MALAYSIA is witnessing a worrying rise in HIV infections among young adults despite unprecedented access to information, with experts warning dating apps, stigma and silent transmission are fuelling the country's new wave of cases.

Malaysia's 2024 HIV & AIDS report recorded 3,185 new infections primarily through sexual transmission, with the fastest growth seen in adults aged 20–39.

This upward trend is consistent with national surveillance over recent years. New HIV cases rose from 2,760 in 2022 to 3,220 in 2023, while the estimated number of people living with HIV increased from 81,942 to 85,283 during the same period.

Gender trends revealed the most striking shift, where the epidemic remained overwhelmingly male, with the male-to-female ratio growing from 7.5:1 in 2022 to 8.8:1 in 2023 and in 2024 9.4:1.

Rising infections among men particularly those in higher-risk sexual networks aligned with projections that men who have sex with men (MSM) will become the primary population driving new infections by 2030.

Public health experts say this trend reflects a widening and dangerous gap between HIV awareness and real-world behaviour.

Former Health Ministry Disease Control Director and Harm Reduction Action Network president Dr Anita Suleiman said the rise in HIV cases among men in higher-risk sexual networks was expected, noting Malaysia’s MSM has grown significantly.

“In 2018, we estimated about 220,000 MSM in the country and the actual number is likely higher today,” she said, adding that risks remain high because about one-third of MSM living with HIV remain undiagnosed or untreated and inconsistent use of condoms or pre-exposure prophylaxis (PrEP) continues to drive transmission.

Dr Anita also warned that the recent raids on men-only saunas and spas may worsen the situation by fuelling stigma and pushing communities further underground.

Beyond enforcement issues, she said modern relationship patterns among the young were also shaping the landscape of risk.

Dr Anita said dating apps have quietly reshaped how young people form sexual relationships, making it easier to meet partners quickly and increasing the likelihood of more frequent and riskier encounters.

Without regular testing, honest safety discussions or consistent protection, it elevated the chances of HIV and sexual diseases transmission, she said, emphasising that the apps themselves were not the problem but the behaviours they enable.

Meanwhile, Malaysian AIDS Council (MAC) Executive Director Jasmin Jalil echoed the concerns, noting that dating apps and social media increased the speed, anonymity and opportunities for casual or multiple partners - a known HIV risk factor.

“Technology can be used for harm or for good, which is why MAC is intensifying our digital outreach, offering discretion, anonymity and round-the-clock access,” he said.

He pointed to MAC’s ProtectNow digital outreach and TestNow online HIV testing service as examples of how digital platforms can reach people who have never visited clinics or drop-in centres, becoming key gateways for HIV education, prevention and treatment for those reluctant to seek help.

Low awareness, high stigma - A dangerous combination

Commenting on whether Malaysians still lack awareness of HIV risks, the experts stressed that the issue goes beyond “not knowing” and instead driven by misinformation, silence and false confidence.

Dr Anita said particularly troubling data from a 2023 survey saw only 11 per cent of Malaysians aged 15 to 24 had adequate HIV prevention knowledge, highlighting the urgent need for targeted education.

Jasmin noted that while awareness campaigns have reached wider audiences, real understanding remains uneven, with many Malaysians still viewing HIV as an “other people” problem - a false sense of security, especially risky for the youths.

He said emotional and social pressures often override what young people already know, creating a gap between awareness and actual behaviour.

“Information alone isn’t enough. Decisions in real life are influenced by emotions, peer pressure, alcohol or drug use and relationship dynamics. That’s why practical guidance is just as important as knowledge.”

Jasmin also highlighted the cultural barriers that prevent meaningful conversations at home.

“Sex is still a taboo subject in many Malaysian families. So instead of learning from responsible adults, young people often turn to peers, pornography or social media and that leads to half-truths and risky behaviour.”

From a religious and cultural perspective, he said society must adopt a compassionate and realistic approach.

“We do not encourage risky behaviour, but we have a duty to protect life and health. That means being honest about how HIV spreads and giving our youth the tools to protect themselves and their partners," he said.

The experts said Malaysia must normalise HIV testing by making routine screening for sexually active individuals as common as regular health check-ups, while also strengthening comprehensive, non-judgemental sex education delivered jointly by schools, parents and religious leaders.