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Rolling Out The National Harm Reduction Programme in Malaysia

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

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Rolling Out The National Harm Reduction Programme in Malaysia

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  1. Rolling Out TheNational Harm Reduction Programme in Malaysia AdeebaKamarulzaman President, Malaysian AIDS Council University of Malaya

  2. 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 amongst prisoners – 4% Malaysian AIDS Council

  3. HIV in Malaysia Malaysian AIDS Council

  4. Malaysian AIDS Council

  5. 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

  6. Methadone Maintenance Program • Pilot Program – October 2006 • 1200 individuals • Government clinics, University hospitals and private practitioners

  7. 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

  8. Needle Syringe Program • January 2006: Pilot program Malaysian AIDS Council

  9. 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 Malaysian AIDS Council

  10. 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 Malaysian AIDS Council

  11. 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 Malaysian AIDS Council

  12. NSEP

  13. 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

  14. 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

  15. 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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