ORANG ASLI VILLAGE


A HOTBED FOR A FEARFUL DISEASE

By Audrey Edwards

Sunday Star
August 16, 2009

The death of 40 residents of an Orang Asli village of 700 from HIV/AIDS has prompted the authorities to step up efforts to educate them on the dangers of the disease.

THE road leading to this Orang Asli village in Johor is dotted with shops selling second-hand items including furniture, electrical products, carpets and decorative items.

Once in the village itself, infrastructure such as a religious school and brick houses loom into view.

Located some 45 minutes from a bustling town, the Orang Asli who live here are definitely close enough to modern living.

It is also the location which has the highest number of HIV/AIDS cases tracked among Orang Asli, so far.

Although a proper record is not available, the number of HIV cases among Orang Asli nationwide currently stands at between 70 and 80.

Previously, HIV/AIDS in the community was traced only when the Orang Asli fell sick and visited healthcare establishments where they were subsequently tested.

Of this number, about 50 come from this particular kampung.

This village which has a population of about 700 has seen 40 deaths related to the virus.

Giving an overview of the situation in Malaysia, Misra Nisran Asra Ramlan, Department of Orang Asli Affairs deputy director-general, says the increase in the number of HIV/AIDS cases in recent years is due mainly to two factors – drug abuse and unprotected sex.

There are also cases of MSM (men who have sex with men).

"It is not serious yet but we have seen a slow increase in the past five years," he adds.

Previously, the Orang Asli community was isolated and there was no direct communication with mainstream communities or development.

But times have changed and the modern lifestyle that has crept into the Orang Asli community has brought with it some negative impacts.

Awareness programme

The department, he says, has now embarked on a programme with the Malaysian AIDS Council (MAC) and Health Ministry to track the exact number of HIV/AIDS cases among the Orang Asli.

The programme is also designed to create awareness about the disease and also organise health checks and other related activities.

Two other villages slated for visits are in Rompin, Pahang and Carey Island, Selangor.

"This is a very new programme. Before this, we looked at diseases like leprosy, malaria and tuberculosis," Misra says.

MAC was asked to come in because their activities were able to attract people, especially the younger crowd, he explains.

When HIV screening is done, the people are informed about it as part of the procedure and anyone who is tested positive is referred for counselling and treatment, he adds.

The department is allocating about RM50,000 for the programme.

The tok batin (village head) is one irate man as he recounts how those infected in his village refuse to listen to words of advice.

"You scold, but they don't listen," he says.

He also says it was difficult for his people to get access to treatment.

"Those who get the medication sometimes don't take it," he sighs.

The tok batin, who is 63 years old, also resents the "outsiders" who, he says, enter his village and end up using the women freely.

Drug use has also crept into his community.

"You come in here, you have to show some respect," he states.

His take on the spread of HIV/AIDS in his community is that the outsiders bring it with them to the village or that his people get it when they move out to the cities and towns to seek a better life.

The UNAIDS Report to the UN Permanent Forum on Indigenous Issues for the fifth session of the forum, in 2006, found that very few countries have reliable national surveillance data to indicate the "true level" of HIV infection among indigenous peoples.

One key factor affecting the impact of the epidemic on indigenous populations is the peoples' relationship to land. This is when they are no longer allowed to live on the land, from where they draw their cultural identity, and are forced to abandon their traditional living.

This affects them in many ways, including how the HIV/AIDS epidemic may be experienced in their communities.

While some live on reservations or enclaves, the extent to which they are able to retain their traditional lifestyles is limited.

Poverty, unemployment, imprisonment, alcohol and drug use (including injecting) may be more common in some settings.

Coupled with geographical isolation, the community has limited access to mainstream educational, healthcare and public health facilities.

"Each of the factors gives rise to a heightened risk of HIV," the report says.

It also notes that those who migrate to urban areas have a similar range of problems.

Other factors include poverty, geographical isolation, different demographics and disproportionate impact on young people, consequences of marginalisation, different understanding of health and medicine, low levels of participation in policy-making processes, and increased burden of healthcare already existing in the communities.

For the young indigenous people, the report states that they face particular issues of partial integration into mainstream society, disconnection from their traditional culture and dislocation from land.

It adds that HIV and sexual and reproductive health programmes need to be able to target these young people with acceptable and appropriate messages and support.

"That is complicated by their multiple identities as indigenous young people and as members of broader societies," it adds.

"Some cultural practices that put young people at increased risk also need to be addressed, because some issues are difficult to acknowledge and discuss openly."

MAC executive director Bakhtiar Talhah says the pilot project with the department was aimed mainly at understanding the problem among the Orang Asli.

It is not easy to gain access into the Orang Asli community and the support of the tok batin is vital, he says.

The Orang Asli, he stresses, "tick all the right boxes" when it comes to spreading the virus.

"It is the right recipe. And it is the same in communities like fishing villages. They are all on the fringes of society. They do not have the same level of access to things like job opportunities and knowledge.

"It has nothing to do with whether the Orang Asli act or look differently. They just don't have the same socio-economic standing as the average Malaysian."

In the past, there were only sporadic studies about HIV/AIDS among the Orang Asli and there was no way to gauge the overall picture, he says.

"The prevalence is higher than normal," he emphasises.

On the recent programme, Bakhtiar says it shows that a government agency and non-governmental organisation can work well together.

The department is able to bring their health workers and facilities to provide services like dental checks while the MAC engages the people with a more friendly approach that includes karaoke competitions, make-up lessons and youth-to-youth sessions, he says.

"Now, it is more targeted at getting the younger men out to attend the programme."

Bakthiar agrees that access to treatment will be difficult and will hinder efforts to combat the spread of HIV.

"We worry that when they come to know they are HIV-positive, they will not seek treatment out of fear or ignorance," he says.

They are also worried that treatment might come too late because of a late diagnosis.