Commentary: Stigma and shame hold Malaysians back from seeking help for STIs
Is a culture of shame about contracting sexually transmitted infections leading more Malaysians to find answers online? Dr Ilias Yee hits out at this problematic attitude.
KUALA LUMPUR: The Internet has increasingly become the place where Malaysians search for answers to their medical concerns at their fingertips.
In a study published in November, researchers from the University of San Diego found that a staggering 58 per cent of posts on a Reddit thread about sexually transmitted infections (STI) requested for public opinions or a “crowd diagnosis” of their symptoms.
Would that also be the case in Malaysia? You bet. Try typing in “STI forum Malaysia” on your search engine and you will be served with dozens of unregulated and unmonitored forums discussing how one can contract an STI, some of which have no medical basis.
Thankfully, some responses on a few local forums provide helpful suggestions, urging netizens to visit a certified clinic and discouraging verbal abuse that border on discrimination.
You might find it a surprising place to seek out answers to whether they might have an STI, but anecdotally, many Malaysians share that they search for home STI testing kits on online shopping platforms.
It is difficult to determine the veracity of these products despite personal reviews and the companies’ claims, but that does not stop Malaysians from buying them.
Such an approach could result in potential delays to diagnosis and treatment, increasing the risk of further spreading the disease. If such resistance to seeking diagnosis becomes more widespread, it could pose a public health concern.
WHY CROWD DIAGNOSIS IS PROBLEMATIC
Public forum sites allow users to ask questions anonymously and receive a variety of free and seemingly “legit” answers from the masses. However, this may give someone searching for answers misplaced confidence in the wisdom of crowds, as well as the notion that any health question can be tackled by harnessing the power of the Internet.
Given the sensitive nature of this topic, it is understandable that one would resort to online sources in hopes of a quick solution while remaining anonymous.
But such sentiments and secrecy could fuel an even larger tendency to self-diagnose and consume antibiotics or antiviral drugs that might not be necessary.
Notably, gonorrhoea infection is now resistant to most families of antibiotics, as a result of improper prescribing and misuse of antibiotics.
An incorrect diagnosis and mistreatment of an STI may not only lead to complications to a patient’s condition, but may also negatively impact public health.
THE STIGMA OF STDS IN MALAYSIA
The topic of STIs remains taboo in many societies, so it is not openly discussed. But what makes this subject even harder to talk about in Malaysia?
Almost half of the participants living with HIV claimed that they have been gossiped about over the past 12 months, according to a 2012 People Living with HIV Stigma Index carried out by the Positive Malaysian Treatment Access and Advocacy Group.
Almost one in six also say they have been excluded from social gatherings and religious activities, with more reporting being on the receiving end of verbal abuse or physical assault.
Research reveals disturbing attitudes about sex and STIs in Malaysia. Studies in 2017 suggest that while Malaysians’ awareness of HIV is high, it is less so for non-HIV STIs. Despite understanding the risks, many sexually active youths still engage in unprotected sex.
Moreover, sexual activity has become the leading cause of contracting HIV in Malaysia. Health Minister Dr Dzulkefly Ahmad highlighted in December 2018 that sexual transmission is responsible for 91 per cent of all reported HIV cases in 2017, compared to just 33 per cent in 2002.
Such statistics should encourage Malaysians to practise safer sex, yet they remain reluctant to do so. Perhaps some are unwilling to use contraception for fear of being judged or causing suspicion from their partners.
This mindset could have contributed to a 140 per cent increase in HIV transmission cases due to unprotected sexual intercourse from 2002 to 2017, according to the Malaysian Ministry of Health’s Country Report Progress 2018.
The high cost of diagnostic tests is an additional barrier to providing proper treatment to STIs. For example, the Nucleic Acid Amplification Test can detect common STIs such as gonorrhoea and chlamydia in the absence of symptoms.
However, it is an expensive test. Many cannot afford to pay out of pocket for it in private clinics, and likewise, it is not readily available in public clinics.
Since a significant proportion of gonorrhoea and chlamydia infections are asymptomatic, without diagnostic tests, many infections go undiagnosed. They only surface much later when complications begin to manifest.
OVERCOMING SHAME AND STIGMA
There should be more accessible options for professional consultation when it comes to STIs. They can come in the form of innovative online platforms that readily connect patients to doctors wherever they are, such as DoctorOnCall.
Such services guarantee patients experienced professionals who can advise them on proper treatment, while maintaining patient-doctor confidentiality.
Additionally, if the condition requires further investigation, a qualified doctor is in a better position to guide patients through suitable procedures, and can refer patients to a hospital or clinic equipped to conduct more complex tests.
Sex and sexual health have been taboo for too long and it’s time we embrace these topics with the right attitude. That includes being mature enough to acknowledge that sex is a part of life, and that a number of people contract STIs at some point of their lives.
Dr Ilias Yee is a Malaysian medical practitioner at the Community Health Care clinic, and has been championing issues related to sexual health, HIV and substance use disorders for over a decade. He is also a consultant on DoctorOnCall.