Ahad, 13 Disember 2009

HIV In Sarawak: Challenges Are Abound (BERNAMA)

By Melati Mohd Ariff

KUALA LUMPUR, Dec 10 (Bernama) -- Her voice was tinged with sheer frustration as she spoke of her works advocating HIV and AIDS prevention programmes in her native state of Sarawak.

Her frustrations were not due to the workload but the extreme challenges she and her team from Sarawak Aids Concern Society (SACS) had to struggle against in carrying out their advocacy works.

One of the challenges, she said was to reach a significant proportion of the people still living in the rural and remote areas including places like Baram in Miri, Belaga and Kapit near Sibu and Limbang.

To prove her point, she had on the big screen the map of Sarawak to which she described as "sparsely populated with a huge land mass the size of West Malaysia minus Melaka."


If trains and highways are the norms for transportations in West Malaysia, in the interior of Sarawak, rivers and their tributaries are the equivalent.

Tar sealed roads are a rarity in the interior and more often the roads are just loose stones or plain dirt roads, popularly known by the locals as timber tracks.

"These roads are subject to being damaged easily by weather and heavy use and as a result, often become dangerous and impassable," Rahmah Wahap-Nicholls, SACS's programme manager told participants of a roundtable discussion on HIV and AIDS held by the United Nations Theme Group on HIV in Kuala Lumpur recently.

According to this gutsy 57-year old retired nurse, even though river transport is the lifeline of the people living in the interior of Sarawak, it too has significant limitation.

She explained not only is the cost extremely high, at certain time of the year, the rivers can either be too low or dry at places and at the extreme end, it may swell with fast flowing rapids.

Still she said some parts of Sarawak are only accessible by air and the cost to get to some remote places can be higher than a return flight for a Kuala Lumpur-London trip.


Despite the relatively low accumulative figures of HIV and AIDS cases in Sarawak as compared to other states, Rahmah said the number is steadily rising year on year.

Up to 2009, she said the reported cumulative figures are slightly over 1,000.

"The worrying trend is that more and more housewives are getting infected. For the first six months of 2009, 57 per cent of new cases are housewives. As the main mode of transmission is heterosexual sex, focus on this group needs to be scaled up," she said, adding that the husbands of the infected women did not want to get themselves tested, saying that the virus is not from them.

Rahmah also pointed out her concern on HIV infection among the young population of Sarawak between the ages of 20 to 39 years.

The problem, she said, was not so much of injecting themselves with drugs but instead indulging in free sex.

Even students are prone to experimenting amongst themselves.

"Many students said they do not have other entertainment except to entertain each other. The teachers told us this even. We received many requests from schools right in the interior of Sarawak to implement HIV prevention programmes and it is not possible to reach these schools within a day or two.

"They asked us to give talks to their students and we cannot immediately response for the obvious reason, namely manpower and funds. By the time we got to the school, when the students are in form five or six, the teachers would tell us it is almost too late," said a frustrated Rahmah.


Another thing that worrying Rahmah and her colleagues is that the deadly virus has even managed to find its way deep in the interior of the State.

HIV, she explained has not only affected those living in towns and cities where easy access to treatments and drugs are available but also in the interior rural areas where journey to the nearest district hospital may take a day or two by timber tracks and boats.

If the arduous journeys are in itself not an obstacle, she said, the cost of getting to the nearest hospital is. Many living in the interior are farmers and have irregular income.

According to Rahmah, for people in this kind of situation, the prospect of spending a large sum of money on transport to collect their medications is simply not an option, since this would mean spending the family's daily living expenses on cost of travel.

"We are talking about maybe around RM80 from one end of the river to another. Who wants to go there even if the service is free? Sadly this is often the scenario that we come across during our travels," she sighed.


Based on SACS experiences whilst implementing its programmes throughout the state, particularly in the interior, Rahmah said knowledge and awareness of HIV and AIDS is generally very poor.

Misconceptions abound, she said, it was alarming to realise how truly lacking and inadequate previous attempts had been to educate the rural population on HIV and AIDS.

"After almost 30 years of this epidemic, some are still asking whether the virus is still around or it is killing people. There was also fear to get tested because if they know they are infected and they have to get the drugs, how are they going to assess it?

"Might as well they did not know or they just accept it after all they say they are going to die anyway? This is then one of our biggest challenges, to embark on spreading knowledge on HIV and AIDS and prevent transmission through sustainable programmes to the rural population of Sarawak.

"As one of the very few NGOs dedicating itself to fighting HIV and AIDS in Sarawak, SACS is facing other challenges. The current low figures of HIV and AIDS cases tend not to warrant attention," said Rahmah.

She expressed disappointment and dismal that HIV and AIDS is a low priority area and the recession inevitably has impacted funding.

"Whilst HIV and AIDS projects in many states in Peninsular Malaysia enjoy support from their state governments, we at SACS has yet to be the recipient of a similar privilege," she explained.


Besides the challenge to obtain enough funds for SACS programmes, Rahmah also touched on yet a significant risk factor in the spread of HIV in Sarawak, namely the presence of a large migrant workforce in many parts of the state.

According to her, the mushrooming of plantations at a very fast rate in Sarawak has resulted in the state to be increasingly dependent on cheap foreign labour.

Sarawak's timber industries, she added also employ large numbers of workers from neigbouring country.

Rahmah said timber camps are located deep in the interior where access to the workforce is subject to agreement and cooperation from these companies.

"For instance, there are timber camps all around Belaga and Kapit and plantations in large areas in Miri. They are not accessible easily to members of the public. There are also timber camps that you are not even aware of their existence and the only way to get to those places is by timber tracks constructed by the companies in addition to journeys by air and boats," she explained.

SACS, according to her has had a measure of success in reaching the target group but this has not been without difficulties.

"Many companies are suspicious of the motives of NGOs operating in Sarawak and unfortunately for us, this has meant initially at least we have difficulty in getting permission to enter or do awareness programme in their premises,"she explained, adding that many of the workers at the timber camps came from Kalimantan and the number is massive.


Despite the uphill task she is facing, Rahmah is not giving up, clinging firm on the old adage "When the going gets tough, the tough gets going."

"I must be honest and admit that many a time when we are faced with the impossible, the human spirit does get a battering and it is the deep commitment to this cause that reminds us that doing nothing or turning away is not an option,"she told Bernama.

Besides her teammates from SACS, Rahmah also has the undivided support from her husband, Colin Khalid Nicholls and her three adult children. Colin, she said also provided technical support for SACS and looking after its website,

Rahmah's almost 26 years experience of working as a trained nurse in the UK where she met her husband who was also a trained nurse provided her with the much needed strength to persevere in her HIV and AIDS advocacy works.

During her sojourn in the UK, she has also spent some years as a volunteer counselor with a charity in Kent, supporting and counseling survivors of childhood sexual abuse.

The couple returned to Sarawak in mid 2006 following a self-imposed retirement and eventually got involved as volunteers in SACS through some mutual friends who had been volunteering with the Society, formed on May 19, 1998.

"It was only on deeper involvement with the SACS that I got to find out the enormity of the tasks ahead. The society was in need of direction, having spent the previous seven years only implementing ad hoc programmes in Kuching, leaving the rest of Sarawak uncovered.

"Laying the foundation of expansion becomes my priority in 2007. This was a very challenging period primarily due to extreme shortage of funds available for the society to start the enormous task ahead of us, " Rahmah told Bernama.

In 2008, Rahmah said she set herself a task of expanding SACS's services to other parts of Sarawak, namely to reach out to the indigenous people living in the interior.

"In parts we have managed to achieve this but the more meaningful consequences of that must be the increasing capacity of the society to do more work all over the state in the form of grassroots involvement with programmes targeting their own community.

"Mobilising people to take ownership of the responsibility for their own community is certainly one I am very proud of," said Rahmah.


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