Kuala Lumpur – Working on HIV prevention – getting out the word about safe sex and how to avoid infection – is an uphill battle at the best of times in conservative societies.
In Muslim-majority Malaysia, both premarital sex and homosexuality are taboo, which makes it hard to talk about the issues.
The "creeping Islamization" of the country of about 30 million is another complicating factor, said Bakhtiar Talhah, the head of the Malaysian Aids Council.
The openly gay 42-year-old said the public religion department in one state recently banned intervention programmes for men who have sex with men (MSM).
This means that those who carry out prevention and awareness programmes for the MSM community cannot go to hotspots and teach people about safe sex.
"People are still talking about HIV as a lifestyle issue when it is a public health one," added Bakhtiar, who himself is HIV positive.
Islamization also affects civil servants who increasingly seek to implement policy based on traditional Muslim law, Bakhtiar said.
The Malaysian Department of Islamic Development, a body that manages and plans Islamic matters, has guidelines on how to handle HIV and Aids issues in a country where 61.3 percent of its population is Muslim. There are no known guidelines for other religions.
"Society is becoming highly conservative," said Bakhtiar, adding that the Malaysian Aids Council was working with various governmental agencies to improve the situation, although Malaysia is still considered a role model for case management.
Malaysia has seen a shift in how the virus is transmitted, from unsafe needles to unsafe sex. It's a situation that the Health Ministry has termed "alarming," while issuing calls for preventive measures to be taken, including the increased use of condoms.
The shift is due to the government's methadone replacement therapy, and needle and syringe exchange programmes for injecting drug users.
Ministry statistics from 2015 show that 78 percent of current infections occur due to sexual activities, both homosexual and heterosexual.
Overall, there are more than 100 000 HIV and Aids cases in Malaysia.
Religious and cultural taboos against pre-marital sex, sex work and homosexuality have made HIV prevention and treatment programmes "largely impossible" in Muslim majority countries, according to Adeeba Kamarulzaman, an infectious diseases expert and Malaysian Aids Foundation chairman.
Religious and cultural values have led to stigmas and discrimination among key populations, such as female sexworkers, transgender people, men who have sex with men and injecting drug users.
Strong moral views, also among medical professionals, have increased stigmas and discrimination and forced those most in need of HIV prevention and treatment programmes away from services.
HIV research assistant Ezra Akbar, who was diagnosed with the disease in 2009, recalled having to wait hours before a CT scan as medical staff wanted him to be the last patient of the day.
He said he found dating problematic as some people would not want to go out with him once they found out about his status. He added that he then posted his status on his profile for dating apps like Grindr.
As a result, he received death threats.
"Some people asked me to go die," he said.
He still receives threats even after removing the status. On the other hand, he also gets messages from members of the MSM community who ask him questions about HIV prevention.