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

Malaysian AIDS Council 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

Malaysian AIDS Council HIV in Malaysia Malaysian AIDS Council

Malaysian AIDS Council

Malaysian AIDS Council 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

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

Malaysian AIDS Council 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

Needle Syringe Program January 2006: Pilot program Location NGO partner Target coverage for first year Kuala Lumpur IKHLAS 400 Johor Bharu Intan Life-Zone Penang AARG Malaysian AIDS Council

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

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

Malaysian AIDS Council 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

NSEP 2006 2007 2009 NGO-Based Sites 3 5 9 Outreach point 42 64 106 NSEP at Health Clinics 12   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% Used N&S * Return Rate 58.60% 62.20% 83.0% > 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

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

Malaysian AIDS Council 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