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KUALA LUMPUR (Reuters) - Strict laws and conservative attitudes are making the fight against HIV/AIDS harder in predominately Muslim Malaysia as they drive high-risk groups deeper underground.
Soliciting and sodomy are outlawed and there are heavy penalties for illegal drug use.
While lobbying from activists has won government support for HIV/AIDS prevention programs, distributing condoms and clean needles, implementation is far from easy.
Celine Ng, who runs a program distributing clean needles to drug addicts, knows that only too well.
Each day, her colleagues, many of them former drug addicts, lie in wait in abandoned buildings, on the fringes of jungles and dumpsites, where they give out clean needles to addicts in exchange for used ones.
Asked what her biggest challenge was, Ng answered instantly: "The police. They wait outside and (then conduct raids) and they say we are informers.
"Even my staff encounter problems with them. We have the endorsement of the narcotics (authorities) and we give needles, not drugs. So if they catch our clients with drugs, we can't stop them, but you can't catch those with just needles."
For homosexuals and sex workers, laws make it difficult to distribute condoms in gay venues because they are often used as evidence of the offence in court.
Anal and oral sex, even between consenting adults, is regarded as a "heinous crime" and is punishable by up to 20 years in prison. While prostitution is not illegal, soliciting is punishable by up to 10 years in prison.
Drug trafficking carries a mandatory death sentence.
"They (people in high risk groups) are driven underground, so you can't reach them," said Adeeba Kamarulzaman, president of the government-backed Malaysian AIDS Council.
"We have (our) outreach workers getting arrested. They (authorities) raid and catch everyone, we are forever trying to bail out our outreach workers from the lockup, which is a major headache on a day-to-day basis," she said.
Injecting drug users in Malaysia make up the largest risk group for HIV/AIDS, or 65 percent of the 4,549 new infections in 2007. The country had 80,938 people living with HIV/AIDS at the end of 2007, with 13,635 of them suffering full-blown AIDS.
But sources familiar with the HIV/AIDS situation in this country of 26 million people say the problem may be graver than the figures suggest.
"Infections are going up but surveillance is very poor in Malaysia," said Raymond Tai of the Pink Triangle (PT) Foundation, which runs drop-in centers for major risk groups like sex workers, drug addicts and transsexuals in Kuala Lumpur.
"Many young gay men only know of their illness for the first time when they are warded with AIDS. How long have they been positive, how long have they been infectious? It is critical."
He said one in four men who have sex with men is HIV positive in Bangkok and there was a rising trend in Hong Kong.
"Those who came in for HIV testing and identified themselves as men who have sex with men, 10 percent tested positive. This is very high and consistent with what is happening in the region," he said.
The 10 percent figure came from tests conducted by PT Foundation between mid 2006 and end 2007.
What's worrying is the disease is moving away from high-risk groups to women in general.
"These (high risk) groups don't exist in isolation, drug users have wives, drug users patronize sex workers, they buy sex, they sell sex," said Kamarulzaman.
Concerned groups are trying to push out HIV/AIDS prevention messages, difficult in an environment where advertisements are under tight state control.
Condom ads are not allowed on national television, except in certain contexts such as promoting use between married couples.
"You can't use anything deemed pornographic," Tai said.
"When gay men are in a place picking up other men, (brochures) are competing (for attention). You have all the good looking men there and you are giving out boring information. Who is going to read it?"
Activists stress that more must be done, with the government first acknowledging the situation and cooperating with non-government organizations in spreading anti-HIV information.
"The number of sex workers has grown in Kuala Lumpur," said Rachel, a former sex worker who is now an outreach worker with PT trying to teach safe sex.
"Some university students, housewives and office workers do sex work part-time for money."
Her colleague, Jamie, agreed: "Some of them are so scared they won't even accept condoms from us because they think we are undercover police."
Editing by Nick Macfie and Jerry Norton