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Because of the points raised already, there occur significant tensions amongst differing stakeholder teams. As an example, because there is collaboration with those managing HIV and through the NGO community with both MOH and spiritual leaders, there was consensus that is general religious leader’s engagement serves to transform them.

“Ustaad [religious leader]. They said LGBT [lesbian, gay, bisexual, transgender] these are generally disease; these are generally psychological illness…..’…’ for me personally to achieve success, we can’t include using them …’…’They won’t do just about anything for people. They still say Haram. they nevertheless state Haram” (PLHIV)

There was distrust among the transgender community and spiritual leaders, in addition to using the MOH. Further tensions arise because of money dilemmas plus the rationale of resources, particularly with regards to teams that work with MSM communities. Tensions arise because of uncertainty over whom holds influence and power, when it comes to formulating policy, as illustrated with premarital HIV testing test for married people. Nonetheless, further tensions are made because the basic populace hold a silent impact within their power to lobby the us government.

“once you tell the typical population…oh you may be wasting cash providing needles….that variety of attitude sometimes happens for them it is really distract to the programme also”….’…’ sometimes the problem is raised in parliament…you understand they raise these style of problems MAC (Malaysian Aids Council) is needles that are giving (PLHIV)

Whilst further discontent is due to the perception that the government has been dismissive of both the advice, and economic requirements of some NGOs, particularly in marginal teams, such as for instance MSM.

“….as an NGO, you had been to inform the us government, the federal government wouldn’t event look at you, wouldn’t also pay attention to you, however for instance you have got UN agencies carrying it out, they simply take another type of view of it …you know, they are going to listen” (PLHIV)

Actions you need to take

All stakeholders are dedicated to preventing HIV, but have differing stances as to how this will be well achieved, with spiritual leaders thinking that the way that is best of preventing HIV would be to come back to Islamic training, associated with sexual intercourse.

“Abstinence is the greatest, okay… They usually have to prevent Zinah [illicit intimate activity]. Whatever becomes hurdles in the front, abstinence continues to be the very best. So that the training to provide the condoms, or other kinds is certainly not ok…we have to offer the understanding programme, utilizing the Islamic provisions” (spiritual frontrunner)

Nonetheless, those coping with HIV and Non-governmental organisations consider it needed for a more practical, less moralistic damage decrease technique to be integrated.

“. really we now have free condom campaign but our…our individuals in Malaysia can’t accept the campaign because…they state we have been Malaysian nations, Muslim countries…” (PLHIV)

In the exact middle of both of these poles, reside the stance associated with the Ministry of wellness who will be within the hard place when trying to manage a concentrated HIV epidemic as public health doctors.

“We are rather peaceful in regards to the behavior but really, i will say that…as long we don’t agree with this behaviour as we are Muslim. But we have been attempting to be expert inside our work here…we will be looking at the transmission part…we are putting on various hats” (MOH Officer).

Whilst simultaneously being forced to get together again the individual part of navigating methods being basically considered un-Islamic, are uncomfortable with, but usually feel these are typically earnestly be involved in that sin by relationship ‘Suhaba’.

“There is not any intercourse outside wedding. Therefore if anyone really wants to state that just how condom is permissible, Qur’an estimate permissible outside wedding in Islam, I discover that difficult to ingest because as a concept, there’s no sex outside wedding in Islam, how could you flex one thing, fold by words…in words or whatever…how can we say one thing is…you know, how could you wish to avoid a thing that just isn’t right?” (MOH official)

Conversation

Those who work in solution distribution and policy manufacturers have actually on event differing viewpoints, for instance, the stakeholders through the spiritual group basically genuinely believe that the sole long term means of reducing the prevalence of HIV is by, “going back again to Islam” a phrase heard usually. This can include the advertising of abstinence of sexual intercourse until wedding & most definitely will not condone or endorse safer intimate practices away from marriage, such as for example condom circulation as this is within opposition for their belief that is central system.

A different viewpoint is taken that endeavours to be more public health focussed, however it must be taken into consideration that they themselves hold their own Islamic perspectives and are subject to being questioned by other groups, including religious leaders and individual tax paying Malaysian Muslims within the Ministry of Health.

Islam impacts not only health policy and energy but in addition the procedure as well as the way by which policies are implemented and also this is obvious within the technique that the premarital HIV testing test arrived to existence, that will be nevertheless essential for Muslim maried people and never non-Muslims. There are particular tactics useful to just and crudely ‘get things done’ as expressed by a true number of individuals. This either meant that activities of particular programmes, such as for instance inside the NGO community advocating for marginal teams such as for instance preventing HIV amongst males who possess intercourse with guys had either to be performed “silently” or at the very least to not overtly promote their work, otherwise it may jeopardise other stakeholders as well as financing.

In these instances, it really is observed just how crucial language is and exactly how it’s utilized to neutralise and placate stakeholders, by focussing on wellness as opposed to liberties, and emphasis regarding the term favoured by the Ministry of wellness, “prevention of disease”. A few of the language in usage shows stakeholder that is existing, stigma and discrimination and suggests ethical and spiritual judgement such as for instance expressions like ‘prostitution’ or ‘sodomy’ and steering far from such terms to options such as for example ‘sex worker’ and rectal intercourse may be required to shift concentrate and alter the paradigm to an even more general public health centred one.

Additionally it is well worth mentioning that although Malaysia’s prevalent population consists of Muslims, numerous that are coping with HIV, or susceptible to HIV illness might not be Muslim; yet, additionally they are impacted by Islamic religious opinions on HIV prevention policies and another can ask whether their demands are met. Nonetheless, maybe this discrepancy could possibly be viewed as a secured item and a means of circumventing the principles, by reiterating the declaration it is maybe not just Muslims who’re afflicted with HIV but non-Muslims of other spiritual denominations and that as an element of Malaysia being a multicultural, multi-ethnic and multi-religious culture the government and health policies such as Non-Muslims should be catered for too.

The issues described are not exclusive to Malaysia, but many Muslim countries which are also forced to formulate strategies to cope with an increase in the cases of HIV in many ways. Many predominantly Muslim majority nations such as Iran [17] plus the center East and North Africa area [18] have had to acknowledge focused HIV epidemics that are confined to high-risk teams, such as for example males who possess intercourse with guys, and IVDU when it comes to Iran. Hasnain [19], in her analysis of ways to HIV harm decrease defines just how it really is practice that is often common of makers in Muslim nations to respond with a “propagation of Muslim ideals”, specifically avoidance of intimate methods beyond your confines of wedding, the main stance of Islamic religious systems in Malaysia.

Limitations

Firstly, there was clearly trouble in gaining use of the individuals become interviewed because of the sensitiveness regarding the research subject. This dilemma ended up being addressed by getting approval through the stakeholders and NGO participation to recruit feasible participants for interviews from inside the risk that is high.