Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.

1. Do we understand
each others?
Dr Ruby Bazeer @ Dr Rubz
Executive Director of PAMT

2. How to break the wall?
HCW vs Community (KAP)

3. Fear?
Lack of knowledge?
Less empathy?

4. • “A woman went to (a) hospital for treatment and they
found out she was HIV positive. The doctor respected her
confidentiality, but one of the nurses lived in her
neighbourhood and told on her. It became a horrible
situation for the woman.”
• “Unfortunately, the most problematic area is that a lot of
ongoing stigma and discrimination is in the hospitals and
clinics,” As it is, even when patients know their rights,
many are reluctant to challenge it because that would mean
they have to reveal their status,says Professor Dr Adeeba
Kamarulzaman, director of the Centre of Excellence on
Research in AIDS (CERiA) and the head of University
Malaya Medical Centre Infectious Diseases Department.

5. • Dr Beyrer, who was in Malaysia recently for the Lancet Series
Symposium for HIV in People Who Use Drugs, describes the lack
of human rights considerations in responses to HIV that still exist
today as some sort of tug-of-war between human rights principles
and political will.-
http://www.thestar.com.my/Lifestyle/Health/2011/01/09/Human-
rights-in-HIV/
• “Mainly, it’s because human rights principles, such as universal
access to prevention, treatment, and care, and non-discrimination
in that care, have so often clashed with strongly held social and
legal constraints at country level.
• “So, we see countries agreeing to universal access, but then
politicians want to deny that access to people whose behaviours
are seen as unworthy, illegal, or stigmatised. This includes drug
users in many countries, people who sell sex, men who have sex
with men, transgenders, prisoners, migrants, and the poor.

6. • Consent- verbal or written
• Skip questions/procedure
• Poor counseling-Poor
information/explanation- window period
• Late result- Negative not informed
• Poor follow up especially during
confirmatory test result
• HCW Less empathy –reveal the positive
result
• Confidentiality –not 100%
• Informing the partner/family – not duty of
HCW
• Different doctors - tx
• KPI (quantity – more work)
• Using name (TG)
• Not enabling environment-
Prakahwin together with VCT
• Long procedure- too many rooms
• Prejudice (All LGBT has HIV)
• Time concern (Busy)
• Assumption (KAP knows
everything)
• Misconception – What is
LGBT?SW? Sex activity?
• SOGIE- Sexual preference, MSM, TG,
FSW
• Poor history- pt not honest
• Wrong wording –’ pelacur’
ASK YOURSELF – HOW TO IMPROVE
HCW
Poor rapport

7. KAP
• Fear
• Not ready
• Poor knowledge
• Prejudice (All HCW are
discriminative)
• Time concern (KAP are not morning
glory)
• Assumption/Phobia (Everyone is
watching them)
• Misconception – Counselor vs
Trained Post basic
• Misunderstanding (questionnaire)
• Not being honest –
Scared,don’t trust HCW
• Not cooperative
• Shame
• Ignorance - Poor follow up
• MIA/Defaulted - resistance
• Previous bad experience
• Curiosity – not sure to ask or
not
• Defensive mechanism
• suicidal/depression
Not demanding but rights to access universal service

8. Communication
• Learn their street language
• Use lame man words
• Repeat words and keep asking them “ada faham? Ada
soalan?apa yang tak faham?”
• Tone – very important.
• Eye contact, smiles
• PRIVACY!

11. Universal health access
KAP = HIV/STI
• SRHR
• Primary care – DM, HTN, RA, Gout, CA,
• Mamography
• Hormone therapy
• Contraception
• TB
• Hep C
• Hep B vaccine
• Mental health – suicidal thoughts, depression, GID

12. KLINIK ANGGERIK
COMMUNITY SENSITIVE CLINIC
• Pilot project with KK Cheras Kuala Lumpur
• SOGIE training with 8 staffs from KK Cheras;
MO,Counselor,MA,Nurse,Pharmacist,Registra
• Enabling environment – target zero discrimination, zero stigma
• One special room – not unit! – Klinik Anggerik
• Not just VST/VDRL but it is total health care including breast examination,
papsmear,genital examination, bp, hormonal,dietary, referral for mamography
with LPPKN and Hep B vaccine with Family Planning NGO
• Special day – special time (Tuesday 2pm-5pm)
• Due to demand, changed to Monday- Friday 9am-5pm but usually clients prefer
after 2pm
• No name calling, ORW will be guiding
• Work closely with NGO (they refer us for any SOGIE question/case, legal/policy,
shelter, peer support)
• Due to good rapport, different NGO uses the facilities (PLHIV peer support
group starts)
• Now many clients request to go and many went second follow up.

15. If you can’t break the wall,
“90:90:90 – It is a dream…” – Dr Shari’i
A dream doesn't become reality through magic; it takes sweat, determination and hard work.
-Colin Powell
just jump over or go underneath… be innovative

16. Thank you