Rolling Out TheNational Harm Reduction Programme in Malaysia

Adeeba KamarulzamanPresident, Malaysian AIDS Council

University of Malaya

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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

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• 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

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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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