Post on 14-Jan-2016
description
Substance Abuse and HIV Situation in Malaysia
Vicknasingam B Kasinather, PhDCentre for Drug ResearchUniversiti Sains Malaysia
• 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
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
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 8,701 18,004 414 314 3 55 7,172 18,262 52,925
* Source: Detection and Supervision Unit National Anti Drugs Agency
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 ?
Recent changes, Malaysia (cont’d)
• 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
Recent changes, Malaysia (cont’d)
• 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
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
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)
Amphetamine Type Stimulants (ATS)
• Methamphetamine seizures in East and Southeast Asia nearly half of world’s 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
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
Timeline of drug use initiation
ATS abuse and HIV status
32.9
18.5
0
5
10
15
20
25
30
35
40
Per
cen
tag
e re
po
rtin
g H
IV+
Lifetime ATS No ATS
p<0.001
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
Future Research Needs
1. Epidemiological studies to better understand the behavioral link between ATS use and HIV
2. Development of improved treatment interventions for diverse populations of drug users, and prevention strategies for high risk individuals (e.g., ATS abusers)
Thank you