Rolling Out TheNational Harm Reduction Programme in Malaysia
Adeeba KamarulzamanPresident, Malaysian AIDS Council
University of Malaya
Malaysian AIDS Council 2
As of Dec 2008, cumulative total of 84,630 reported with HIV/AIDS
57% of 3693 new infections in 2008 due to injecting drug use
IDU - 1.33% of the population aged 15-64
HIV prevalence amongst injecting drug users – 11-40%
HIV prevalence amongst prisoners – 4%
HIV in Malaysia
HIV in Malaysia
Malaysian AIDS Council 3
Malaysian AIDS Council 4
• National Task Force on Harm Reduction comprising the following organizations:
• Malaysian Ministry of Health• Malaysian AIDS Council• The National Anti Drug Agency• The Royal Malaysian Police• The Prisons Department• The Malaysian Islamic Development Department• Academics
Malaysian AIDS Council 5
Methadone Maintenance Program
• Pilot Program – October 2006• 1200 individuals• Government clinics, University hospitals and
private practitioners
MMT – Current Status
• 59 government facilities, 9 private clinics– 7065 clients registered– Retention rate ~ 60%
• 10 000 clients MMT through private practitioners
• 2008 Pilot pre-release methadone program in prison– Expanded to 12 prisons , ~ 200 prisoners
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• January 2006: Pilot program
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Needle Syringe Program
Location NGO partner Target coverage for first year
Kuala Lumpur IKHLAS 400
Johor Bharu Intan Life-Zone 400
Penang AARG 400
Malaysian AIDS Council
CAHAYA HARAPAN ALOR SETAR
AARG SEBERANG PERAI
ACC PULAU PINANG
DIC PAHANG JENGKA
KAWAN KUALA LUMPUR
SAHABAT KOTA BHARU
DIC PAHANG KUANTAN
ILZ JOHOR BAHRU
IKHLAS KUALA LUMPUR
MMA KUALA TERENGGANU
INSAF MURNI SEMENYIH
OUTREACH SERVICES ONLY OUTREACH AND DROP IN CENTRE SERVICES
EXISTING SITES
SITES TO BE OPENED IN 2009
EXISTING SITES
ILZ KLUANG
NSEP SITES 2009
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Models of NSEP Operation • Drop In Centres
– NSEP will be conducted within Drop In Centers
– stand-alone premises– provide NSE and other
services
• Outreach Services– a mix of strategies used to
effectively target IDUs– may be an out-of-hours
service– allows increased access for
IDUs
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NSEP Activities• Provision of sterile needles and syringes• Safe disposal of used injecting equipment • Provision of leaflets on health and drug issues• Referral to drug, health and welfare agencies
– includes drug and HIV treatment centers and voluntary counseling & testing (VCT)
• Counseling on drug & HIV related matters• Encourage safe sex (education, condoms)• Establish links with relevant local agencies
• police, AADK, health, religious and welfare organizations
• Establish networks with local IDUs• Community education
NSEP 2006 2007 2009*
Targeted Client 1,200 7,200 13,000No. NSEP Client
4,357 6,658 14,200
Regular Clients 1,707 2,663 9,200
% Reg. Clients
39.2% 40.5% 65.0%
Used N&S * Return Rate 58.60% 62.20% 83.0%
> 2.0 million needles and syringes distributed
2006 2007 2009
NGO-Based
• Sites 3 5 9
• Outreach point 42 64 106
NSEP at Health Clinics 0 0 12
Challenges• Abstinence-only approach is still deeply rooted and embraced in
Malaysia • Becoming NSEP or MMT client makes a drug user an easy target
for harassment, discrimination and arrest• Lack of skilled human resource
• Difficulties reaching out to clients – mobile
• Lack of support services available to IDUs – Shelters, Job Placement
• Access to ARVs
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Disharmonisation of Drug Policy
• “Public Enemy Number One” • Drug-Free Society by 2015 • Stringent drug policy • Stricter enforcement • Huge resource spent to
manage, develop and maintain Drug Rehabilitation Centres
• Public arrests and round-ups of drug users
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• Harm reduction in Malaysia is like a “sandcastle” built up by community organizations and then torn down by enforcement activities
Jaa, MAC IHRC 2009
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