Background
At the end of 2022, there were an estimated 86,142 people living with HIV in Malaysia. Prevalence among key populations is high; 12.9% among men who have sex with men, 7.5% among people who inject drugs, 5.9% among transgender women and 1.9% among sex workers[1]. Historical data show an increase in prevalence amongst men who have sex with men over the past decade along with transgender women.
Under the Global Gender Gap Index 2022[2], Malaysia ranks 103 out of 146 countries with stigma and discrimination against key populations in Malaysia persisting. Additionally, the 2023 Global AIDS Monitoring Country Progress Report: Malaysia[3] reports escalating prevalence of stigma and discrimination. Laws criminalizing same-sex sexual relationships persist, with Malaysia still among 67 countries that do so. Secular and Shariah laws also criminalize transgender individuals’
gender identity and expression, and gender-affirming surgeries are prohibited for Muslims. Laws against sex work further stigmatize female and transgender sex workers, who can be charged for simply carrying condoms. Services for sex workers are already known to be lacking and do not respond to non-brothel-based sex workers and other populations who engage in sex work. Additionally, there is a significant gap in gender sensitive services for women who use drugs. Legal frameworks directly contribute to significant stigma toward key populations accessing HIV healthcare.
Whilst Malaysia has continued to establish legislation, improve policies and implement various initiatives to address gender disparities, sexual and gender-based violence remains a concern with 8,902 cases of domestic violence being reported in 2021 through the One Stop Crisis Centres[4]. Although the effect of COVID-19 is believed to have impacted this figure, with
the real rate of cases likely to be higher. The World Health Organization has noted the need for a greater involvement of civil society in the prevention and treatment of gender-based violence, along with a stronger multisectoral approach to further address gaps[5]. Furthermore, accessing sexual and reproductive health services for unmarried women, young people and LGBTQI+ people remain complex and challenging.
Human rights violations, gender inequality and gender-based violence, constitute major vulnerabilities to HIV infection, as well as major barriers to HIV and other health services. The Malaysia Gender Assessment will serve to engage with communities to understand specific needs and challenges related to human rights and gender.
It is imperative that national HIV program in Malaysia address gender and intersecting inequalities as key factors for ensuring sustainability of their HIV response. Resource mobilization is necessary to scale up and maintain strategic
gender-transformative and innovative interventions that prioritize women, girls, men and boys, and key populations. This is in alignment with interventions proposed in the GC7 Malaysia National Grant.
Objectives
The objectives of the Malaysia Gender Assessment are as follows:
· Assess the gender and human rights-related barriers to HIV services including access and utilization
· Develop a five-year costed action plan to address identified barriers
It is expected that the Gender Assessment will contribute toward the integration of policies and programmes on HIV, sexual and reproductive health rights, gender-based violence, and the impact of these factors on key populations as well as providing tools for capacity-building, accountability and monitoring of progress for national authorities, community
organizations, UN partners and other key stakeholders.
Approach & Methodology
This Gender Assessment will be conducted in line with the principles and methodologies developed by and supported by the Global Fund and other related agencies. The SKPA-1 Gender Assessment Tool (developed in 2019) will be reviewed, refreshed and used as the basis of this assessment. The following methods will be used for data collection and analysis:
· A Steering Committee established to oversee the process.
· Desk review of both soft and formal literature available in the last three years (and beyond if particularly relevant), on the nature and extent of gender-related barriers to HIV service access and utility in Malaysia, including research studies, assessments, reviews, funding proposals and discussion papers.
· An inception meeting. This will bring together stakeholders and key organizations to introduce the assessment, gain input and buy-in for the methodology and identify people and organizations for key informant interviews and focus group
discussions.
· Key informant interviews and focus group discussions with identified stakeholders, service providers and other informants.
· A data synthesis and analysis workshop with key stakeholders.
· An analysis of the design, costs and results of programs and initiatives over the past five years to identify and address barriers.
· A findings workshop to present findings and the draft costed five-year action plan.
Project Team
The assessment will be conducted by two national gender expert consultants both of whom will bring demonstrated experience in working with key populations and have familiarity with the health system and experience in community consultation. One of these consultants will be appointed as the team leader to oversee the process. The team leader will have significant experience in the: (i) assessment of gender and human rights-related barriers to health service access and utility, preferably with specific experience in HIV programs in key population settings; (ii) design of interventions to reduce these barriers, particularly in resource-constrained settings, including stigma and discrimination reduction, legal service access and health service quality improvement programs; and (ii) the development of detailed and costed action plans.
Both consultants will have a proven track record in:
· Conducting complex assessment and planning processes in Malaysia or similar settings.
· Carrying out work in gender, human rights, and HIV.
· Analyzing health services to determine barriers to access and option to improve access.
· Preparing concise plain-language reports and presentations.
· Costing of interventions and preparation of detailed, implementable action plans.
· Working with key populations.
The team leader will be allocated 25 days, and other consultant will be allocated 20 days. The consultants will be contracted by Health Equity Matters under the SKPA-2 program in line with the organization’s procurement and human resources policies. The Malaysia AIDS Foundation will provide support with logistics.
Deliverables
· Detailed project plan with timelines and milestones
· Desk review
· Draft assessment report
· Draft costed five-year action plan
· Final report and action plan
Coordination and management
A Steering Committee will be established with suggested representation from the Ministry of Health, Ministry of Women, Sisters in Islam, Jejaka, Seed, Malaysian AIDs Council, Insaf Murni Foundation. The Steering Committee will appoint a Chair and will be tasked with approving the deliverables and for carrying forth the report recommendations and action plan.
The Sustainability of HIV Services for Key Populations in Asia (SKPA)-2 will fund the Gender Assessment on behalf of the partners in Malaysia. SKPA-2 is unable to provide continued funding for the implementation of recommendations arising from the five-year costed plan.
Timeline
It is anticipated that the project will be conducted over a 2-month period from May to June 2025.
*For more information on the required qualifications and experience for each role, please refer to attachment
The Sustainability of HIV Services for Key Populations in Asia (SKPA)-2 program is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) to improve the sustainability of evidence-informed, prioritized HIV services for key populations in Bhutan, Mongolia, Philippines, Sri Lanka and Malaysia. There are four program objectives:
Health Equity Matters, as principal recipient, is implementing the program in partnership with the following sub-recipients: Save the Children in Bhutan, Youth for Health in Mongolia, Action for Health Initiatives (ACHIEVE) in the Philippines, the Family Planning Association of Sri Lanka, the Malaysian AIDS Foundation (MAF) in Malaysia, and regional partners APCOM (formerly the Asia Pacific Coalition on Male Sexual Health) and the Community of Women Living with HIV Asia Pacific (ICWAP). The World Health Organization (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS) provide the program with technical support. The period of performance for the grant is from 1 July 2022 to 30 June 2025, with an extension until 31 December 2025.
