In Asia Pacific, an estimated 6.1 million people (5.9 million adults) are living with the human immunodeficiency virus (HIV) in 2009. In 2009, the number of newly infected HIV people in the region was estimated to be 360,000. In 2009, eight countries in the region including China, India, Indonesia, Malaysia, Myanmar, Russia, Thailand and Vietnam, reported an estimated 100,000 or more people living with HIV. Together, these eight countries accounted for 92 percent of all estimated new HIV infections in the region.

By the end of 2011, Malaysia had a cumulative figure of 94,841 HIV, 17,686 acquired immuno deficiency syndrome (AIDS) and 14,986 deaths. HIV epidemic is concentrated within the most-at-risk populations (MARPS) especially among injecting drug users (IDU), sex workers and transgender population in Malaysia. The annual number of reported new HIV cases by the Malaysian Ministry of Health (MOH) was 3,479 with the notification rate of HIV being 12.2 cases per 100,000 population in 2011. HIV prevalence rate in Malaysia was 0.07 percent in 2011.

We focus mainly on the need for increased diagnostic accuracy in HIV screening and providing multi-technological approach for HIV diagnosis. Although, the government's commitment is mandatory to strengthen HIV/AIDS prevention programmes, but issues on non-cooperation of religious bodies and law enforcement agencies are causing greater barriers on their effective implementation among MSM (men who have sex with men) and the transgender population. These issues are discussed elsewhere.

Challenge 1: HIV screening

Malaysia has voluntary product registration guidelines for invitro diagnostic kits. This has resulted in the import of HIV diagnostic test kits without any regulatory checks from the Ministry of Health (MOH), Malaysia. Many distributors have imported rapid HIV immunochromatographic test kits that exhibit sensitivity and specificity from 90 percent-to-99.5 percent. In general, it is well known that enzyme-linked immunosorbent assay (ELISA) and the western blot (WB) assays, when used in combination, are said to be 99.5 percent accurate in predicting HIV antibodies.