1. Islam & Harm Reduction Adeeba Kamarulzaman
Faculty of Medicine, University of Malaya
Member, IAS Governing Council

2. Intervention Outcome Summary of studies Evidence Statement
Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness
Intervention
Outcome
Summary of studies
Evidence Statement
Needle and
syringe
programmes (NSP)
Injecting risk behaviour (IRB)
43 studies
Sufficient evidence to support the
effectiveness
HIV
16 studies
Tentative evidence to support the
Opiate Substitution Treatment (OST)
IRB
35 studies
8 studies
McArthur G et al. IJDP Jan 2014

3. “Mega-Epidemics”
Wolfe D. Lancet August 2010

5. The higher purposes of Islamic law Maqqasid Syariah
Preservation of
Faith
Life
Intellect
Progeny
Wealth

6. Legal maxims in Islam
“A lesser harm may be tolerated in order to eliminate a greater harm”
“A particular harm may be tolerated in order to prevent a general one”
“Public interest (Maslahah ammah) must be given priority over private concerns”
“Harm must be treated and benefits must be brought forth”

7. Jan 2004 Formation of Harm Reduction Working Group
June 2005 MOH approves harm reduction programs
June 2005 Formation of National Harm Reduction Task Force
Oct Pilot MMT program implemented
Feb Pilot NSP program implemented
April Cabinet Endorsement for Harm Reduction Program

8. National Task Force on Harm Reduction
Ministry of Health
Ministry of Internal Security
Police
National Antidrugs Agency
Prisons Department
Malaysian AIDS Council
JAKIM
Academia

9. MALAYSIAN HARM REDUCTION PROGRAM 2005-2015
NSP 2006 – 2010
Reduce HIV vulnerability among IDU
NSP 2011 – 2015
prevent / reduce infection, improve QoL of PLHIV, and reduce the social and economic impact
Up scaling of harm reduction program
2001
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Jan 29,05 : PM statement on MDG HIV
Jan 15 – endorsement of MMT by MTMDK
June 3, 05 : MoH annoucement on NSEP
June 23,05 : NTFHR
Oct, 05 : MMT piloted
Review of SOP
2nd Review of SOP
Piloted Klinik Kesihatan Angkat Project
3rd Review of SOP
NSPEA consultation
MMT in prison and NADA
NSEP at health clinic
Endorsement of up scaling of harm reduction in NSP
Endorsement of up scaling MMT by JRP meeting
Harm Reduction program by Global Fund
Support activities of harm reduction by HIV/AIDS Alliance funding
NSPEA preparatory work
Feb 2006 : NSEP piloted
April 2006 – Malaysia cabinet Endorsement on HR
The Declaration of Commitment on HIV/AIDS adopted by United Nation General Assembly Special Session on HIV/AIDS (UNGASS) in 2001, for which Malaysia was a signatory :
Proposal of harm reduction

10. NUMBER OF REGISTERED PATIENTS ON OST AND OST CENTERS 2006 – 2014
YEAR
2006
2007
2008
2009
2010
2011
2012
2013
2014
No. of registered patients at Govt Facilities (Cumulative)
1,241
4,018
7,065
10,730
15,869
20,955
27,756
33,444
37,555
No. of registered patient at Private Facilities (Cumulative) NA
12,566
17,976
21,203
23,010
23,257
24,324
31,805
37,261
Total No. of registered patient (Cumulative)
16,584
25,041
31,933
38,879
44,212
52,080
65,249
74,816
Public OST Facilities 17 66 75
162
240
292
333
446
472
Private OST Facilities
306
300
382
365
366
Total OST centers
(Govt + GP Setting)
372
381
462
540
674
715
811
838
Source :
Disease Control Division, MoH Malaysia

11. NSP PROGRAM – 2014
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
NSP Site : NGO 45 70
114
218
224
221
529
576
540
NSP Site :
Health Clinic 6 22 73 76
152
TOTAL
120
240
297
605
728
692
Registered Clients (cumulative)
4,357
6,658
12,230
18,377
24,999
34,244
55,298
72,686
85,693
Needle & Syringe return rate
58.6%
62.2%
63.2%
65.9%
56.4%
63%
58.9%
61.5%
60.0%
Source : Ministry of Health, Malaysia

12. Malaysia Annual Reported HIV Cases 2000-2014
AIDS/STI Section, Ministry of Health Malaysia. 2015

13. Transformation of Compulsory Drug Detention Centers into Voluntary Treatment & Care Centers

14. Major Developments since 2010
COMPULSORY REHABILITATION
OPEN ACCESS AMBULATORY VOLUNTARY CENTRES
19 CURE & CARE REHABILITATION CENTRES
11 CURE & CARE 1MALAYSIA CLINICS
Sangeeth Kaur IAS 2013

15. C&C – Outcome Study
28663 had received services at C&C or CCSC between 2010 and April 2013
Of 313 interviewed
56.3% - Helped maintain employment
54.3% - Continued education
77.6% - Improved family relations
72.1% - Obtained permanent homes
75.9% - Prevented arrest into prisons

16. New HIV Infections
With Harm Reduction
Without Harm Reduction
Prevented New HIV Infections
20,903
34,220
39%
3,596
27,118
87%
27,979
134,345
79%

17. Cost Savings in Direct Health Care
By preventing HIV transmissions among PWIDs, the harm reduction programmes allowed the government to accrue savings from direct health care costs
Cost-saving in direct health care (mil. RM)
47.06
(30.53 – 58.50)
209.53
( – )
909.47
( – )
Direct health care cost savings from avoided infection are expected to increase over time due to
disease progression for those who are not on treatment
require higher intensity health care and higher health care cost for government

19. People Who Inject Drugs & the Heroin Trade
There are 625,000 PWID in MENA
Mumtaz G, et al. HIV among people who inject drugs in the Middle East and North Africa: Systematic review and data synthesis. PLoS Medicine, in press.

20. Emerging HIV Epidemics among People Who Inject Drugs
At least one-third of MENA countries are affected by emerging HIV epidemics among PWID
Only in the last few years
Pakistan one of the worst globally; Libya has the highest prev rate among IDUs
Mumtaz G, et al. HIV among people who inject drugs in the Middle East and North Africa: Systematic review and data synthesis. PLoS Medicine, in press.

21. Cairo Declaration of Human Rights
"All men are equal in terms of basic human dignity and basic obligations and responsibilities, without any discrimination on the basis of race, colour, language, belief, sex, religion, political affiliation, social status or other considerations. True religion is the guarantee for enhancing such dignity along the path to human integrity."