On progress on harm reduction programs in Malaysia

http://thestar.com.my/news/story.asp?file=/2009/5/17/focus/3922295&sec=focus

Needle syringe exchange programme injects hope
Sunday May 17, 2009

IN the fight to reduce the spread of diseases like HIV, Malaysia is one of many countries that have turned to harm reduction efforts, including the somewhat controversial needle and syringe exchange programme (NSEP).

The NSEP, which started out in three states as a pilot programme, looks set to be available in at least one site of each state in the peninsula by next year.

NSEP is a component of harm reduction efforts implemented by the Health Ministry. The other is methadone maintenance therapy (MMT).

Health Minister Datuk Seri Liow Tiong Lai says the programme will be expanded throughout the country via health clinics and partnership with related non-governmental organisations (NGOs) under the Malaysian AIDS Council (MAC).

There are seven health clinics which have NSEP and there are expected to be 12 by end of year.

The HIV epidemic in Malaysia is mainly driven by injecting drug users (IDUs). The Minister says 71.2% of reported HIV cases from 1986 to Dec 2008 were IDUs.

“The decision to implement the NSEP is to prevent the transmission of HIV infection among the IDUs,” Liow says, adding that distributing clean needles and syringes can help reduce the risky behaviour of needle-sharing.

The Cabinet has allocated RM100mil for a five-year period, beginning 2006, under the National Strategic Plan on HIV/AIDS.From this, RM43.1mil is being channelled to the NSEP.

As of December last year, 12, 230 IDUs were registered with the programme under NGOs. Another 253 are registered at health clinics. The target is to include 15,000 IDUs by next year.

Liow says Malaysians are wise and mature enough to understand the concept of NSEP and the ministry has outlined several steps to further curb the spread of HIV in its five-year strategic plan.

“NSEP will serve as a driving force towards a wide range of harm reduction-related activities such as information, education and communication on risk reduction, HIV testing and counselling, health screening, anti-retroviral treatment and psycho-social care and support,” he adds.

On the involvement of health clinics, Liow says IDUs are regarded like any other patients in need of treatment.

He says the stigma towards IDUs was obvious in the early days when NSEP was started in the clinics but this has changed..

“The acceptance of patients to the programme and IDUs is much better. We hope the stigma will be eliminated in the near future,” he says.

MAC president Prof Dr Adeeba Kamarulzaman notes that while Malaysia has come a long way in its harm reduction efforts, tmuch more needs to be done.

“The big challenge is to reach out to more people. A target of at least 60% of drug users must have access to these services,” she says.

Towards this, there must be more NSEP outlets, outreach workers for rural areas like Felda and fishing villages, and expansion of the MMT by including more general practitioners (GPs).

She says it is not ideal to have a health system where methadone is given free through government centres while patients pay if they go to GPs.

“We need to look at existing laws and policies which give rise to a lot of problems. Among the challenges the council faces include finding the right people for the job and law enforcement.

“While MMT is probably better understood among those who have seen its effects on people they know, the majority have yet to understand it.

“The NSEP, on the other hand, is still viewed negatively by society,” she says.

As an advocate of harm reduction, Prof Dr Adeeba wants to see greater coverage by both the NSEP and MMT.

However, she says they are only part of the picture. Other things need to be done such as re-integrating drug users into society and job placement, and anti-retroviral therapy for the HIV-infected.

“Most importantly, as a country, we need to seriously relook our drug policy,” she says.

“We need to really understand the problem and, more importantly, reexamine laws that treat drug users in the same vein as traffickers.

“Putting small-time drug users into ‘rehabilitation’ and/or prison is not going to solve any of these problems.” – By AUDREY EDWARDS