Current Substance Abuse Disorders and HIV Situation in Malaysia B. Vicknasingam (1), Singh, D (1), Suppiah, B (1), Schottenfeld, R (2) and Chawarski, M (2) 1) Centre for Drug Research, Universiti Sains Malaysia 2) Yale School of Medicine, New Haven, CT

Population: 30 million GDP per capita: $23,100 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

Introduction -From 1980s to around 2003 Malaysia’s drug policy was based solely on a prohibitionist approach. - Non-medical institutional rehabilitation approach was the main modality for rehabilitating people who use drugs (PWUD). -High relapse rates within the first six months of release were reported -Malaysia’s failure to reverse an increasing trend of HIV infection in the United Nations Millennium Development Goal (MDG) prompted the Malaysian government to re-examine its approach towards people who use drugs.

Introduction (cont’d) -The introduction of harm reduction programs in Malaysia also opened the doors for the public health sector to be involved in providing treatment for people who use drugs in Malaysia. -However, a dual track drug policy is still being practised in Malaysia. PWUD can still be mandated to undergo rehabilitation. NADA, the primary agency managing prevention, treatment and rehabilitation efforts in the country, has significant enforcement powers and plays a contradictory role in the response to drug use in Malaysia.

Arrest under section 3(1) Drug Dependents Act (Treatment and Rehabilitation) 1983, related to opiate and cannabis drug use from 2006 – 2013 Source: Royal Malaysia Police (2013)

Arrest under section 15(1)(a) Dangerous Drug Act 1952 (DDA) related to Amphetamine Type Stimulant (ATS) and Ketamine Drug use from 2006 – 2013 Source: Royal Malaysia Police (2013)

Timeline of drug use initiation (Chawarski et al., 2012)

ATS abuse and HIV status p<0.001 (Chawarski et al 2012)

Source: National Anti Drug Agency (2013) Number of People who use drugs (PWUD) detected by the National Anti Drug Agency (NADA) from year

Drug Seizures (2011 – 2014) Year HeroinKgKg CannabisKg Crystal methamphetamine Kg Liquid methamphetamine Kg , KetamineKg Amphetamine powder Kg EcstasyPills47,761634,573335,984117,702 YabaPills364,879521,384524,966557,336 Erimin 5Pills87,0125,175,069177,916467,133 Royal Malaysia Police 2015

NoName of CCRCCapacityNumber of clients 1SERDANG KG. SELAMAT BATU KURAU PERLOP SERENDAH GAMBANG BENTA KARAK RAUB JELEBU MUAR TIANG DUA PAPAR KUCHING BACHOK JELI BKT. CHABANG KOTA TINGGI JUMLAH5,0504,594 Number of PWUD receiving treatment in Cure and Care Rehabilitation Centre (CCRC)

NoStateNo of CCSCResidentsNon residents 1Perlis Kedah Pulau Pinang529320,113 4Perak526415,901 5WP Kuala Lumpur623145,057 6Selangor628627,646 7Negeri Sembilan513626,120 8Melaka Johor818614,525 10Pahang41574,384 11Kelantan Terengganu Sabah Sarawak JUMLAH542,011156,561 Number of PWUD receiving treatment in Cure and Care Service Centre (CCSC)

Methadone Maintenance Therapy (MMT) Facilities (June 2014) Source : Ministry of Health (MoH) Malaysia Type of Facility Number of MMT Facility (Cumulative by Years) (June) Hospital Health Clinic Govt G.P NADA Prison Others Total Govt TOTAL GOVT + GP : 814 (June 2014) No. GP providing OST services : 365 (source : MoH Malaysia)

Coverage: MMT patients (June 2014) Source : MoH Malaysia (June) No. of registered patient (Annual) 1,2412,7773,0473,6655,1395,0866,8015,6882,189 No. of registered patient (Cumulative) 1,2414,0187,06510,73015,86920,95527,75633,44435,633 No. of Active Patient (by end of the year) 9323,2425,0247,45510,66414,63118,40120,30720,705 Retention Rate 75%81%71%69%70% 70.1%71.3%84.1% TOTAL REGISTERED Patients at government and and private GP = 67,438 (June 2014) Cummulative number of patients on OST in private GP : 31,805

Needle and Syringe Exchange (NSEP) – Facilities and Coverage Source : MoH Malaysia Year (June) NSEP Site : NGO NSEP Site : Health Clinic TOTAL Registered Client (cumulative) 4,3576,65812,23018,37724,999 34,24455,29872,68677,179 Needle & Syringe return rate 58.6%62.2%63.2%65.9%56.4%63%58.9%61.5%62.2% * Regular client (at least once a month ): 39,163

Overview of the HIV epidemic in Malaysia 2013 IndicatorNumber/ percentage Cumulative no. of reported HIV infections since first detection in ,672 Cumulative no. of reported AIDS since ,235 Cumulative no. of reported deaths related to HIV/AIDS since ,340 Estimated no. PLHIV [EPP 2014]86,324 Total number of PLHIV [surveillance date]85,332 New HIV infections detected in 20133,393 Notification rate of HIV (per 100,000) in Women reported with HIV in Cumulative no. of women reported with HIV as of December ,956 Children aged below 13 with HIV in Cumulative no. of children under 13 with HIV as of December 20131,076 Estimated no. PLHIV eligible for treatment [EPP 2014]38,418 No. PLHIV receiving ART (surveillance data) as of December ,369 Estimated adult (15-49 years) HIV prevalence [EPP 2014]73,005 [0.44%] Source: Ministry of Health Malaysia

PERCENTAGE OF NEW HIV CASES BY RISK FACTOR Source: Minstry of Health (2013)

Conclusion - Need for a more consistent drug policy where treatment is the main priority. - There is an increase in ATS use in the country. Methadone and buprenorphine patients are also beginning to use ATS. -Sexual transmission is the main transmission mode of HIV. We need more sexual risk behaviors studies to understand this problem. -After several years of implementing treatment programs for PWUDs, it is imperative that the government not only increase the coverage of the program but to also start improving the quality of their programs. For example, only 17% and 12% of NSEP clients have been referred to voluntary counseling and testing (VCT) and MMT respectively (Global AIDS Response Progress Report, 2014). -The term Medication Assisted Treatment (MAT) should be used for methadone and buprenorphine treatment programs. Currently, the Malaysian government views this as part of the harm reduction program.

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