Transcript Rolling Out The National Harm Reduction Programme in Malaysia Adeeba Kamarulzaman President, Malaysian AIDS Council University of Malaya.

Rolling Out The
National Harm Reduction
Programme in Malaysia
Adeeba Kamarulzaman
President, Malaysian AIDS Council
University of Malaya
HIV in Malaysia
 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
– 4% 2
M a l a y s i a namongst
A I D S C o u nprisoners
c i l
HIV in Malaysia
HIV Infections by Gender
1986 and 2008
N=84630
100%
90%
96.0%
91.9%
90.5%
92.2%
91.0%
90.0%
89.2%
80%
88.0%
85.0%
83.6%
80.9%
Percentage
70%
60%
% Men
50%
% Women
40%
30%
20%
10%
8.1%
9.5%
7.8%
9.1%
10.0%
10.8%
12.0%
15.0%
16.4%
19.1%
4.0%
0%
M a l a y s i a n
A I D S
Year
C o u n c i l
3
Malaysian AIDS Council
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• National Task Force on Harm Reduction
comprising the following organizations:
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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 M a l aC yosui na cn i lA I D S
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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
Malaysian AIDS Council
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Needle Syringe Program
• January 2006: Pilot program
Location
NGO partner
Target coverage for
first year
Kuala Lumpur
IKHLAS
400
Johor Bharu
Intan Life-Zone
400
Penang
AARG
400
M a l a y s i a n
A I D S
C o u n c i l
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NSEP SITES 2009
OUTREACH SERVICES ONLY
OUTREACH AND DROP IN CENTRE SERVICES
EXISTING SITES
EXISTING SITES
CAHAYA HARAPAN ALOR SETAR
SAHABAT KOTA BHARU
AARG SEBERANG PERAI
ACC PULAU PINANG
DIC PAHANG KUANTAN
DIC PAHANG JENGKA
KAWAN KUALA LUMPUR
IKHLAS KUALA LUMPUR
SITES TO BE OPENED IN 2009
ILZ JOHOR BAHRU
MMA KUALA TERENGGANU
INSAF MURNI SEMENYIH
ILZ KLUANG
M a l a y s i a n
A I D S
C o u n c i l
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
M a l a y s i a n
A I D S
C o u n c i l
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NSEP Activities
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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
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police, AADK, health, religious and welfare
organizations
Establish networks with local IDUs
Community education
M a l a y s i a n
A I D S
C o u n c i l
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NSEP
2006
2007
NGO-Based
• Sites
3
• Outreach
point
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NSEP at
Health Clinics
0
5
64
2006
2007
2009*
Targeted Client
1,200
7,200
13,000
No. NSEP Client
4,357
6,658
14,200
Regular Clients
1,707
2,663
9,200
% Reg. Clients
39.2%
40.5%
65.0%
58.60% 62.20%
83.0%
2009
9
106
Used N&S
* Return Rate
0
12
> 2.0 million needles and syringes
distributed
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
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“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
Malaysian AIDS Council
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