1 / 18

Substance Abuse and HIV Situation in Malaysia

Substance Abuse and HIV Situation in Malaysia. Vicknasingam B Kasinather , PhD Centre for Drug Research Universiti Sains Malaysia. Population: 28 million GDP per capita: $14,275 Industrialized market economy Federal constitutional monarchy

kenda
Download Presentation

Substance Abuse and HIV Situation in Malaysia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Substance Abuse and HIV Situation in Malaysia Vicknasingam B Kasinather, PhD Centre for Drug Research UniversitiSains Malaysia

  2. Population: 28 million • GDP per capita: $14,275 • Industrialized market economy • Federal constitutional monarchy • Islam is the largest and official religion (61%) • Major heroin abuse problem since the 1970s • Proximity to Golden Triangle

  3. Drug abuse policies in Malaysia • Before 2001, primarily supply-side policies and measures • Oversight by the Internal Security Ministry and the National Anti-Drug Agency • Criminalization of drug possession and use, drug testing (e.g., road blocks, areas of high concentration of drug users, workplaces, entertainment venues) and detention of suspected drug users • Drug use, testing positive for drugs, possession of drugs or drug paraphernalia, seeking medical help for drug use problems results in registration in the national database of drug users • Many registrants remanded to 2 year detention in rehabilitation centers • Severe criminal penalties • Possession of 15 grams (1/2 ounce) of heroin or 200 grams (seven ounces) of marijuana classified by the law as trafficking in drugs • Mandatory death sentence for possession of 30 grams of heroin

  4. Number of drug users detected and placed under supervision by the government (2012) * Source: Detection and Supervision Unit National Anti Drugs Agency

  5. Recent changes, Malaysia • In response to the continuing problems with heroin dependence and the emerging epidemic of HIV/AIDS resulting from injection drug use, Malaysia introduced opiate agonist maintenance treatments (OMT) - Buprenorphine approved in 2002 • Currently, approximately 380 general medical practice offices offer agonist maintenance treatments for ~10,000 patients - Methadone approved in 2003 • Currently, there are 27,756 active patients in 333 government run MMT centres • Naltrexone registered ?

  6. Recent changes, Malaysia (cont’d) • Previously existing programs/measures were retained with plans for slow, gradual elimination or restructuring • Currently, 21 government drug rehabilitation centers are still open (1 center for females) with the total of 5,102 residents/inmates undergoing rehabilitation in 2012 • 42 Cure and Care Service Centres in Malaysia – 1,836 residential and 176,929 non-residential inmates/patients in 2012 • MMT programs were also introduced to prisons • beginning with 1 prison in 2008 • expanded to 18 MMTs in prisons by 2011

  7. Recent changes, Malaysia (cont’d) • NSEP started in 2006 and has reached out to 34,244 IDUswith an average distribution of needle/syringe sets about 116 per IDU in a year (2011) • However, the proportions of clients being referred to VCT and MMT are low • ~10% NSEP clients are referred for VCT • ~4% referred and entered MMT Source: Malaysia 2012, Global AIDS Response, Country Progress Report

  8. Overview of the HIV epidemic in Malaysia 2011 Source: Ministry of Health Malaysia

  9. Percentage of new HIV cases by risk factor Source: Ministry of Health (2011)

  10. Amphetamine Type Stimulants (ATS) • Methamphetamine seizures in East and Southeast Asia nearly half of world’s total, UNODC says: ‘Significant increase’ in availability, use, arrests and seizures makes meth top illicit drug threat in region, says UNODC (12 Dec 2012) ATS Seizures in Malaysia (2012)

  11. Epidemiological Surveys • Between 2006 and 2008 USM and Yale researchers conducted a series of surveys among not-in-treatment injection drug users in three cities in Malaysia (Penang, Kuala Lumpur, and Johor Bharu) • 1st survey: October - November 2006 • 2nd survey: June - September 2007 • 3rd survey: January - March 2008 (wave 1) and October 2008 - March 2009 (wave 2) • A total of 732 IDUs were surveyed • 680 males and 53 females • Participants were a convenience sample recruited in neighborhoods with known shooting galleries and needle syringe exchange programs • Collected information included demographics, drug use history and current patterns of use, self-reported HIV status, behavioral risks, and urine toxicology screens

  12. Timeline of drug use initiation

  13. ATS abuse and HIV status p<0.001

  14. COATS Studies • In collaboration with Yale School of Medicine, USM started a research unit in the Medical school to develop medical treatments for Co-occurring Opioid (heroin or morphine) and amphetamine-type stimulants (ATS) dependence (COATS) and to conduct cognitive/neuropsychological and epidemiological studies of ATS and heroin abusers in Malaysia. • We are currently conducting several small pilot studies of medications targeting ATS abuse/dependence in Suboxone maintained, opiate dependent individuals

  15. Future Research Needs • Epidemiological studies to better understand the behavioral link between ATS use and HIV • Development of improved treatment interventions for diverse populations of drug users, and prevention strategies for high risk individuals (e.g., ATS abusers)

  16. Thank you

More Related