Review in slides Malaysia

Content Basic socio-demographic indicators HIV prevalence and epidemiological status (1986-2009) Risk behaviors (2006-2009) Vulnerability and HIV knowledge (2007-2009) Economics of AIDS (1993-2002) National Response (2005-2009) Archive

Basic socio-demographic indicators Total population (in thousands) 27,914 (2010)2 Annual population growth rate 1.5% (2010-2015)2 Population aged 15-49 (thousands) 15,082 (2008)6 Percentage of population in urban areas 72% (2010)1 Crude birth rate (births per 1,000 population) 20.4 (2008)3 Under-5 mortality rate (per 1,000 live births) 6 (2008)4 Human development index (HDI) - Rank/Value 57/0.744 (2010)5 Life expectancy at birth (years) 74.7 (2010)5 Adult literacy rate 92.1% (2005-2008)5 Ratio of girls to boys in primary and secondary education (%) 103 (2007)3 GDP per capita (PPP, $US) 14,011 (2009)3 Per capita total health expenditure (Int.$) 604 (2007)4 Source: 1. UNFPA The State of World Population 2010 2. UN Statistics Division 2010: http://unstats.un.org/unsd/demographic/products/socind/population.htm 3. World Bank World Development Indicators & Global Development Finance ;http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2 4. WHO World Health Statistics 2010 5. UNDP Human Development Report 2010 6. UN Population Division - Population Prospects: The 2008 Revision, Population Database

National response

Percentage of populations at higher risk reached with HIV prevention program, received HIV test in last 12 months and knew the result, 2009 Source: Power point presentations of Preliminary Findings of IBBS 2009 by Malaysian AIDS Council

Number people receiving highly active anti-retroviral therapy (HAART), 2003-2009 Source: National HIV/AIDS Treatment Registry _presented by Dr.Christopher KC Lee

Number of adults and children with advanced HIV infection who are in need and who are receiving ART, 2007 Source: WHO_UNAIDS_UNICEF_Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector, 2008

Number of HIV+ pregnant women who are in need and who are receiving ART to prevent mother-to-child transmission of HIV, 2007 Source: WHO_UNAIDS_UNICEF_Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector, 2008

% of pregnant women in ANC counseled and tested for HIV, 2002-2007 Of 298,367 antenatal clinic attendees tested for HIV in 2007, 0.1% HIV+ Ministry of health 2008

Ministry of health and UNAIDS 2008

Ministry of health and UNAIDS 2008

HIV routine screening Women receiving ANC at government facilities (voluntary) Blood donors Inmates in selected drug rehabilitation centers Inmates in selected prisons and correctional centers TB and STD cases in sentinel sites Foreign workers Pre-marital HIV testing (mandatory in some States) Ministry of Health

HIV and AIDS reporting and surveillance Case Notification 342 Act 1988 and 98 (Infectious Disease Control Act) Behavioral and biological surveillance among most at risk population (sporadic) STD Surveillance (sentinel site clinics) VCT sites (anonymous) Routine testing in hospitals and health centers Ministry of Health

Adapted from Prof. Dr. Adeeba , 2008 Policy environment Ensure that the balance between drug law enforcement, and health and social measures, helps the control HIV among and from injecting drug users Current policies that criminalize sex work and homosexuality make it difficult ensuring high rates of condom use Continued harassment and raids on sex workers and MSM prevent them from accessing prevention services and drives them further underground. Adapted from Prof. Dr. Adeeba , 2008

National AIDS Strategic Plan, 2007 With measurable objectives? NO Prioritization by sub-populations YES Prioritization by geographic regions? Standardized packages of response? Estimate unit costs of packages? Estimated cost based on 80% coverage? Estimate total resource needs? Plan for delivering at scale? Partly Identify and plan human resources? Design and specify operational plans? UNGASS Country report, 2008

Assessment of M&E system 2007 A M&E plan of the NSP YES The M&E budget is secured Endorsed by major stakeholders Partly Functional M&E unit NO Strategy for data collection Well-defined standardized set of indicators HIV sero-surveillance Common M&E framework Behavioural surveillance Guidelines on data collection tools Strategy for assessing data quality Strategy for data dissemination and use, including yearly publication National and sub-national database Civil society participation Operational research

Progress in drug treatment facilities 28 government centers managed drug rehabilitation centers. In 2008 About 10,00 patients New cases about 50% 658 HIV positive 30 prisons The number of arrest of drug users increased from 144,550 (2006) to 159,490 (2007) Source: National narcotic Agency, Ministry of Internal Security. Drug Report Jan- Sept 2008 National narcotic Agency, Drug Report Jan- Sept 2008

Progress in Harm reduction since 2005 Public Health Based approach, combined with NGOs for needle and syringe programmes (NSP) 11 sites. Comprehensive approach - NSP, Methadone Maintenance Treatment (74 MMT clinics) and Care, Support, Treatment (CST) Started in prisons in 2008 > 1.3 M needles and syringes distributed as of June 2008 Over 40,000 heroin injectors enrolled in drug substitution treatment (95% enrolled in private treatment) Adapted from Prof. Dr. Adeeba , 2008

Factors that Hamper Progress of Harm Reduction (1) Needs plan and budget for scaling up. High level of stigma and discrimination Overlap between SW and injecting drug use Limited government capacity and infrastructure to develop, scale up and monitor harm, reduction programmes Adapted from Wodak, UNDOC and Lee

Factors that Hamper Progress of Harm Reduction (2) Disproportionately low allocation of national AIDS budget for HIV prevention and harm reduction among IDU Limited research, surveillance and M&E data for planning, implementation and scaling‐up Adapted from Wodak, UNDOC and Lee

Discussion about the HIV epidemic in Malaysia (1) Limitations in the current HIV surveillance system -HIV cases reporting- make difficult to asses if the HIV epidemic is decreasing among IDU. There is no doubt that the vast majority of new HIV infections are still among injecting drug users. The increase of the coverage of harm reduction program and substitution therapy should stay the priority.

Discussion about the HIV epidemic in Malaysia (2) The rise in the number HIV infection among women and girls through heterosexual transmission, from 6 percent of reported HIV cases to 16 % ten years later, has been observed in other countries in the region. Sexual transmission of HIV and comprehensive delivery of services to women should be strengthened Policies on harm reduction , including substitution therapy should continue to receive political support and be based on evidence

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