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

2. 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 % of the population aged 15-64
HIV prevalence amongst injecting drug users – 11-40%
HIV prevalence amongst prisoners – 4%
Malaysian AIDS Council

3. Malaysian AIDS Council
HIV in Malaysia
Malaysian AIDS Council

4. Malaysian AIDS Council

5. 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

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

7. Malaysian AIDS Council
MMT – Current Status
59 government facilities, 9 private clinics
7065 clients registered
Retention rate ~ 60%
clients MMT through private practitioners
2008 Pilot pre-release methadone program in prison
Expanded to 12 prisons , ~ 200 prisoners
Malaysian AIDS Council

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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