Substance Abuse and HIV
Situation in Malaysia
Vicknasingam B Kasinather, PhD
Centre for Drug Research
Universiti 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
8,701
18,004
414
314
3
55
7,172
18,262
52,925
TOTAL
* 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
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Proportion initiating illicit use of each substance
Timeline of drug use initiation
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Heroin
ATS
ATS abuse and HIV status
Percentage reporting HIV+
40
35
32.9
p<0.001
30
25
18.5
20
15
10
5
0
Lifetime ATS
No ATS
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