Community clinics helping key population through COVID-19 pandemic : Malaysia

PT Foundation is a non-profit community-based organization that works on sexual health awareness, prevention, treatment, support and care services for key affected populations in Malaysia. We work with gay men and other MSM, transgender women, refugees, single mothers and their children, and Malaysian youth.

I am the Acting Chief Operations Officer at PT Foundation. Together with my team of 20 staff and about 60 core volunteers, we manage and operate 5 core programs at PT Foundation:

a) Jom Test – our sexual health outreach and case management program for gay men and other MSM,

b) our Community Health Care Clinic – a community-led sexual health clinic,

c) MSMPOZ – a treatment adherence support program for MSM living with HIV,

d) our 2^nd Chance Program – a psycho-social and welfare support program for children and mothers infected or affected by HIV, and

e) our Refugee Program – where we train and coordinate a HIV awareness, testing and treatment program for refugees in Kuala Lumpur.  

What was life like before COVID-19 hit Malaysia, and service availability in terms of HIV, and LGBTIQ?

Like our tourism slogan, Malaysia’s LGBTIQ scene is arguably Truly Asia. Nestled between the exciting night life and shopping that Bangkok has to offer, and the relatively more liberal lifestyle that our LGBTIQ brothers and sisters enjoy in Singapore, Malaysia offers everything in between. In our big cities like Kuala Lumpur and Penang, there are quite decent clubs, cafes and community events held weekly. An underground sauna scene and cruising grounds serves those who are more adventurous. A nascent LGBTIQ community of activists was emerging, to bring more meaning to the rainbow spectrum of gender and sexual diversity and inclusivity. Those of us who are in the smaller cities and towns are linked on the internet to dating apps and online communities catering to varied interests.  All of these strived despite the increasingly toxic social environment engineered by conservative political and religious groups who did what they could to suppress the rights of LGBTIQ Malaysians through legislation, government policies, Islamic fatwas and syariah acts, and widespread social engineering in schools, mosques, government agencies, Muslim NGOs, and the mainstream media.

With the effect of COVID-19 outbreak, how did you respond to this? Can you detail the evolving service needs of the community during lockdown, and how community groups are able to address the issues?

Covid-19 hit Malaysia in a big way in March 2020, when a surge in infections led to a national lockdown, with all shopping malls, restaurants and shops closed for almost 3 months. Fortunately, we have already build up a strong online presence through our website, social media and online outreach at gay dating platforms. Hence we switched 100% of our efforts to online when all the clubs and bars were closed. Gay dating platforms remain active during the lockdowns, and our outreach workers conduct much of their outreach via these apps.

However as the lockdown restricted mobility, many Clients were unable or reluctant to get tested during the early months of the lockdown. Hence the number of those who went for testing dropped significantly. Our Community Health Care Clinic remain operating but with reduced hours and in strict compliance to the lockdown regulations.  We recorded a 50% dip in clinic visits in March till May 2020, with a corresponding drop in PrEP prescriptions.  When the lockdown restrictions eased by June 2020, we saw an increase in testing again, though still lower than the period before the pandemic.

We also experimented with innovative means to stay engaged with the communities during the lockdown. These include online support groups, online movie streaming, and collaborating with other activists to organise a live streaming party which featured live shows and chat sessions with community leaders and social bloggers. These efforts had limited success, as there is a certain level of online fatigue, since most people were already spending most of their time online, working from home and on social media.

In June 2020, the lockdown measures were relaxed, with most people back at work, with most shopping malls and restaurants open under tightened conditions. We resumed community based testing, working with community friendly venues to conduct HIV and syphilis counseling and testing around Kuala Lumpur, and invited the community to book their free tests through our Instagram online booking. These were well received, and our testing and referrals picked up in July till September 2020. Our PrEP services at our clinic also recorded record number of Clients.

Unfortunately, a third wave of Covid-19 infections hit Malaysia in October 2020, with Kuala Lumpur and Selangor under yet another strict lockdown. It has affected our ability to conduct mobile testing, and we see a drop in visits to our clinic. The decline has not been that severe this time, but it looks like we will have to continue to innovate and adapt to the new norm.

What were the issues that the community in Malaysia experienced during this time? What are the gaps in terms of addressing the issue? 

The issues faced by the LGBTIQ communities are diverse and multi-sectorial. Challenges faced differ within the communities, with transgender people facing some of the worst persecution due to their visibility and vulnerability. Wealthier metropolitan middle class LGBTIQ face less persecution than the working class, rural LGBTIQ who have less coping skills to mitigate the challenges faced. All the communities encounter stigma and discrimination in their work place or study place, within their families and neighborhoods, and in their daily lives. All these challenges are amplified during the Covid-19 pandemic lockdown; many of us were isolated from an already limited community support systems such as lovers, partners, friends, sexual partners, and our social groups.

One of the most common issue we observed among our Clients is in their declining mental health.  Younger working class gay men and students inevitably live with their families, and may feel isolated during the lockdown. Those who are in relationships are separated from their partners, often for long periods of time especially those who are live in different regions.

Many missed their circle of gay friends whom they regard as their rainbow family. In big cities, where many LGBTIQ live alone, the isolation has been challenging. There are also many who faced hardship due to lost income or earnings, with some losing their jobs or businesses. We have observed more frequent use of recreational drugs, leading to a rise in dependency, spiraling into more mental health issues, such as anxiety, paranoia, depression and more serious addiction issues that require treatment and/or hospitalization. Our outreach workers are reporting more incidents of chemsex, and our case workers are seeing new diagnosis of HIV among younger gay men.  

We also recorded lower levels of HIV Testing in the past 6 months. Our Community Health Care Clinic remained open throughout, but Clients have problems leaving their homes due to the lockdown restrictions. We have some success in bringing HIV and syphilis testing to the community through our mobile community based testing but the latest lockdown has restricted our ability to organize more CBTs.

Among Clients living with HIV and who are on HAART, there are many who were unable to obtain their regular supply of medication due to the restricted movement control. Our case workers collect their medication and organize delivery to them. We also assisted to pay for the HAART medications for Malaysians and foreigners residing in Malaysia who were unable to access their medication from abroad due to the air travel and custom control restrictions, with the support of the ILGA Asia Covid-19 Emergency Fund. We further assisted Clients who were stranded in their hometowns, by rechanneling their medication to clinics near their homes. Our Buyers Club also came to the rescue of foreigners and Malaysians whose regular sources of HAART and PrEP were interrupted due to international travel restrictions.  

How have you, staff, and volunteers working for NGOs been able to stay safe from COVID-19, and be mentally prepared?

By and large, most of our staff and volunteers cope well and were resilient in dealing with the pandemic, thanks to the teamwork support. Our offices and programs remain open throughout, with flexible work from home arrangements, social distancing, temperature scanning, mask wearing, disinfecting and hand washing policies in place. There were anxious moments when we had to place some staff members in quarantine when one of our Clients tested positive for Covid-19. Thankfully, they remain negative.

As Malaysia come out of the lockdowns, what services would the community continue to require, and what would you cease, and what would you add?

Comprehensive sexual and mental health services will continue to be needed. We should advocate for better access to professional counsellors, addiction specialists and support program for meth dependency. Many of our programs face deep uncertainty in funding support as international funding for HIV work decline further, and domestic funding for key populations remain challenging. We will need more resources in managing online platforms for internet outreach, social marketing and resource mobilization. We need to migrate more of our services online such as HIV self-testing, condom and lube marketing, sexual health consultation, PEP and PrEP promotion, and managing meth dependency.

How has COVID-19 outbreak changed the way that you/your organisation and other NGOs will be working in the future?

We need to be more self-reliant and resilient. We have successfully adopting social enterprise models for some of our services like the community clinic; we will need to become even more innovative and creative in moving more of our services online, and find sustainable ways to mobilize resources to expand our services to those most in need.

What are the worries from your community about the ‘new normal’?

The LGBTIQ in Malaysia is a diverse population, segmented by gender, sexuality, race, religion, age and class. How they cope with the new normal will depend on how they can mitigate the challenges ahead, and how resilient they are in the new normal.

Within the gay men community, there is growing frustration and alienation as physical socialization is restricted and community mobilization becomes more challenging. Many of the clubs, saunas and bars may not open again due to massive losses. The social media and the dating apps will continue to dominate and influence how they live and love.

As the LGBTIQ population is a microcosm of the general population, my worry is that in the new norm, we will see more disparity in the LGBTIQ in terms of their wealth, class structures, education levels, and lifestyles. Reinforced by the social media bubbles that we live in, we may sadly see a more fragmented LGBTIQ community in Malaysia, tearing the rainbow fabric even as it is being weaved together. We may become more vulnerable to being persecuted by Malaysia’s more conservative and authoritative government and Islamic forces. Mobilising resources for HIV organisations will become more challenging as international resources are diverted to fund the pandemic recovery period and poorer countries. Local government funding and corporate may even decline further. This is a real concern in how Malaysia will be able to meet its Ending AIDS by 2025 goal.

Are there any positive lessons learnt from the effects of COVID-19?

Organisations need to be nimble, dynamic and creative in adapting to constant changes and challenges. The internet opens up innovative ways to overcome old and new challenges. We need to find new ways for the new millennials and Generation Z to be engaged and become the front drivers in charting the course forward.

The Global AIDS Strategy has been launched, is there anything you would like to say to that? 

Global AIDS Strategy in the past decade has been to shift international financing to domestic financing in middle income countries like Malaysia. However, domestic financing to community organisations to address HIV in key populations like MSM and transgenders has been problematic, as funding is narrowly limited to HIV testing and treatment services. More funding is needed for prevention services like PrEP and support systems to manage meth dependency. Also integral is a more concerted effort to create a more enabling environment for the LGBTIQ communities, but State actors have been reluctant to support such efforts