1. Review in slides
Malaysia

2. Content Basic socio-demographic indicators
HIV prevalence and epidemiological status ( )
Risk behaviors ( )
Vulnerability and HIV knowledge ( )
Economics of AIDS ( )
National Response ( )
Archive

3. Basic socio-demographic indicators
Total population (in thousands)
27,914 (2010)2
Annual population growth rate
1.5% ( )2
Population aged (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% ( )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:
3. World Bank World Development Indicators & Global Development Finance ;
4. WHO World Health Statistics 2010
5. UNDP Human Development Report 2010
6. UN Population Division - Population Prospects: The 2008 Revision, Population Database

4. National response

5. 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

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

7. 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

8. 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

9. % 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

10. Ministry of health and UNAIDS 2008

11. Ministry of health and UNAIDS 2008

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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

23. slides compiled by www.aidsdatahub.org
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