Substance Abuse and HIV Situation in Malaysia

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Substance Abuse and HIV Situation in Malaysia
Vicknasingam B Kasinather, PhD Centre for Drug
Research Universiti Sains Malaysia
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• Population 28 million
• GDP per capita 14,275
• 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

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Drug abuse policies in Malaysia

• Before 2001, primarily supply-side policies and
  measures
• Oversight by the Internal Security Ministry and
  the National Anti-Drug Agency
• Criminalization of drug possession and use, drug
  testing (e.g., road blocks, areas of high
  concentration of drug users, workplaces,
  entertainment venues) and detention of suspected
  drug users
• Drug use, testing positive for drugs, possession
  of drugs or drug paraphernalia, seeking medical
  help for drug use problems results in
  registration in the national database of drug
  users
• Many registrants remanded to 2 year detention in
  rehabilitation centers
• Severe criminal penalties
• Possession of 15 grams (1/2 ounce) of heroin or
  200 grams (seven ounces) of marijuana classified
  by the law as trafficking in drugs
• Mandatory death sentence for possession of 30
  grams of heroin

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Number of drug users detected and placed under
supervision by the government (2012)

No. STATE SEK. 6(1)a SEK. 6(1)b SEK. 8(3)a SEK. 8(1)b SEK.9(2)a SEK.9(2)b SEK.38B(1) Prison SEK.38B(2) Fine TOTAL
1. PERLIS 63 170 0 1 0 0 115 515 864
2. KEDAH 1,343 2,044 6 25 0 0 595 901 4,914
3. PULAU PINANG 778 2,855 4 10 0 1 1,938 1,311 6,897
4. PERAK 1,589 3,161 16 16 0 2 514 1,177 6,475
5. SELANGOR 1,103 2,434 22 52 0 2 625 1,742 5,980
6. WPKL 441 924 13 8 0 2 559 601 2,548
7. NEG SEMBILAN 442 1,197 3 6 0 3 82 731 2,464
8. MELAKA 281 757 4 7 1 0 78 672 1,800
9. JOHOR 624 1,732 1 22 1 9 625 1,708 4,722
10. PAHANG 817 1,130 29 50 0 0 361 1,571 3,958
11. TERENGGANU 193 339 49 37 0 32 818 3,040 4,508
12. KELANTAN 678 914 54 55 0 2 471 3,060 5,234
13. SARAWAK 261 258 88 8 1 2 0 431 1,049
14 SABAH 88 89 126 17 0 0 391 802 1,512
TOTAL TOTAL 8,701 18,004 414 314 3 55 7,172 18,262 52,925
Source Detection and Supervision Unit National
Anti Drugs Agency
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Recent changes, Malaysia

• In response to the continuing problems with
  heroin dependence and the emerging epidemic of
  HIV/AIDS resulting from injection drug use,
  Malaysia introduced opiate agonist maintenance
  treatments (OMT)
• - Buprenorphine approved in 2002
• Currently, approximately 380 general medical
  practice offices offer agonist maintenance
  treatments for 10,000 patients
• - Methadone approved in 2003
• Currently, there are 27,756 active patients in
  333 government run MMT centres
• Naltrexone registered ?

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Recent changes, Malaysia (contd)

• Previously existing programs/measures were
  retained with plans for slow, gradual elimination
  or restructuring
• Currently, 21 government drug rehabilitation
  centers are still open (1 center for females)
  with the total of 5,102 residents/inmates
  undergoing rehabilitation in 2012
• 42 Cure and Care Service Centres in Malaysia
  1,836 residential and 176,929 non-residential
  inmates/patients in 2012
• MMT programs were also introduced to prisons
• beginning with 1 prison in 2008
• expanded to 18 MMTs in prisons by 2011

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Recent changes, Malaysia (contd)

• NSEP started in 2006 and has reached out to
  34,244 IDUs with an average distribution of
  needle/syringe sets about 116 per IDU in a year
  (2011)
• However, the proportions of clients being
  referred to VCT and MMT are low
• 10 NSEP clients are referred for VCT
• 4 referred and entered MMT
• Source Malaysia 2012, Global AIDS Response,
  Country Progress Report

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Overview of the HIV epidemic in Malaysia 2011
Indicator Number/ percentage
Cumulative no. of reported HIV infections since first detection in 1986 94,841
Cumulative no. of reported AIDS since 1986 17,686
Cumulative no. of reported deaths related to HIV/AIDS since 1986 14,986
Estimated no. PLHIV EPP 2011 81,000
New HIV infections detected in 2011 3,479
Notification rate of HIV (per 100,000) in 2011 12.18
Women reported with HIV in 2011 735
Cumulative no. of women reported with HIV as of December 2011 9,494
Children aged below 13 with HIV in 2011 65
Cumulative no. of children under 13 with HIV as of December 2011 974
Estimated no. PLHIV eligible for treatment EPP 2011 37,306
No. PLHIV receiving ART (surveillance data) as of December 2011 14,002
Source Ministry of Health Malaysia
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Percentage of new HIV cases by risk factor
Risk Factor 1990 2000 2011
Injecting drug use 470 (60.4) 3,815 (74.7) 1,348 (38.7)
Sexual transmission 41 (5.2) 964 (18.8) 1,931 (32.0)
Heterosexual 38 (4.8) 902 (17.6) 1,573 (45.2)
Homosexual 3 (0.4) 62 (1.2) 358 (10.3)
Source Ministry of Health (2011)
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Amphetamine Type Stimulants (ATS)

• Methamphetamine seizures in East and Southeast
  Asia nearly half of worlds total, UNODC says
  Significant increase in availability, use,
  arrests and seizures makes meth top illicit drug
  threat in region, says UNODC
• (12 Dec 2012)
• ATS Seizures in Malaysia (2012)

ATS 2011 2012
Ecstasy Pills 98,751 772,421
Ecstasy Powder (kg) 26.53 464.61
Yaba Pills 364,909 521,384
Syabu (kg) 1,235.58 851.82
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Epidemiological Surveys

• Between 2006 and 2008 USM and Yale researchers
  conducted a series of surveys among
  not-in-treatment injection drug users in three
  cities in Malaysia (Penang, Kuala Lumpur, and
  Johor Bharu)
• 1st survey October - November 2006
• 2nd survey June - September 2007
• 3rd survey January - March 2008 (wave 1) and
  October 2008 - March 2009 (wave 2)
• A total of 732 IDUs were surveyed
• 680 males and 53 females
• Participants were a convenience sample recruited
  in neighborhoods with known shooting galleries
  and needle syringe exchange programs
• Collected information included demographics, drug
  use history and current patterns of use,
  self-reported HIV status, behavioral risks, and
  urine toxicology screens

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Timeline of drug use initiation
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ATS abuse and HIV status
plt0.001
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COATS Studies

• In collaboration with Yale School of Medicine,
  USM started a research unit in the Medical school
  to develop medical treatments for Co-occurring
  Opioid (heroin or morphine) and amphetamine-type
  stimulants (ATS) dependence (COATS) and to
  conduct cognitive/neuropsychological and
  epidemiological studies of ATS and heroin abusers
  in Malaysia.
• We are currently conducting several small pilot
  studies of medications targeting ATS
  abuse/dependence in Suboxone maintained, opiate
  dependent individuals

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Future Research Needs

• Epidemiological studies to better understand the
  behavioral link between ATS use and HIV
• Development of improved treatment interventions
  for diverse populations of drug users, and
  prevention strategies for high risk individuals
  (e.g., ATS abusers)

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Thank you