PETALING JAYA, Oct 12 — Now in its 10th year in Malaysia, the harm reduction programme has sought to lower HIV infections and there has been some measure of success.
The number of injecting drug users (IDUs) being infected with the virus has dropped over the years, bringing the number of new HIV infections down.
Infection through heterosexual transmission is now a headache that needs to be resolved by the stakeholders.
Harm reduction in Malaysia consists of the needle and syringe exchange programme (NSEP) at the site, and methadone maintenance therapy (MMT).
The model adopted is one where non-governmental organisations reach out to IDUs and provide them with not only clean needles and syringes but also counselling that can eventually see them being referred for MMT.
MMT is usually carried out at government hospitals and health clinics.
Among the harm reduction programmes is the non-governmental organisation Sahabat’s programme at Bukit Bunga.
It is carried out with Population Services International (PSI) through its southern Thailand harm reduction programme.
Still regarded as controversial, the programme is supported by local health and law enforcement authorities, including the state’s health department and police.
Outreach workers are allowed to carry out their duties on Thursdays.
Work of the NGOs
Malaysian AIDS Council executive director Dr Ilias Yee said the site was different from others being run by their partner organisations simply because it was located in an area that was considered “no man’s land” as it did not fall under the jurisdiction of Malaysia or Thailand.
Jurisdiction only become relevant when the IDUs head back to their respective countries.
“It is a porous site. There are users who come from as far as the Jeli district in the morning, inject and then get on with their daily lives. They are almost not going to be in any trouble with the law.”
From the start of the programme in 2012 until August this year, 389 clients have been served, including 90 Thais.
A total of 59,108 clean needles have been distributed, with a recovery rate of 57 per cent.
Dr Ilias said outreach workers were trained to meet the needs of their clients, although more was still needed to carry out such work.
In terms of measuring the success of a harm reduction programme, he said it was based on social factors, including whether they were able to gain employment, reconnect with their estranged families and treatment referral.
He emphasised the NSEP was not just about clean needles.
“Each encounter between an outreach worker and client is to bring down the harm,” he said.
“This is a big difference from using and sharing needles underground.”
Sahabat president Tan Sri Zaman Khan said the border situation in the area was different due to the people who lived by the river.
“If you wanted sugar, you can just shout across the river for it. It is not like the border on the other side where there is no one. Here, you have things like rubber estates on both sides,” he said.
“Your cousin or sister-in-law might be living on the other side.”
Zaman said although drugs were still illegal, there was an understanding with the authorities to carry out the outreach work.
“It is a matter of helping people.”
PSI Thailand Foundation senior regional coordinator Ladda Ningoh said their work in the area was successful because it was popular among IDUs.
“There is a large number of people who are injecting drugs in the Waeng district in Narathiwat. We need to help them,” she said.
“Plus, the police do not disturb us because we are helping them.”
There are two drop-in centres in Narathiwat.
“If we don’t do this, they will end up using the old needles and share it among friends. This can bring about HIV infection,” she said.
For the sake of public health
It is a fact that drugs and crime are interrelated. But Kelantan state health director Datuk Dr Ahmad Razin Ahmad Mahir opined that the situation could have been worse in recent years if not for the implementation of harm reduction.
He said there used to be stigma among the public and even healthcare staff as they were frightened to deal with drug users.
“Syringes and sometimes condoms are being given out. They think it is encouraging them to continue injecting themselves.”
“The reality is you cannot stop them. When they are injecting drugs, they use clean syringes. When they have sex, it’s safe sex with condoms,” he said.
Dr Razin said the public were more accepting of the drug users, resulting in more IDUs seeking help at health clinics besides having programmes to reach out to them.
The number of new infections among IDUs has reduced drastically from a peak of 5,176 in 2002 to 680 last year.
Overall, the number of HIV infections have been on the decline since 2002 (6,978 new cases) to 3,393 in 2013.
There was a slight increase last year, to 3,517 new infections.
Cumulatively, there are 105,189 HIV/AIDS cases since 1986.
In Kelantan, there were 1,239 new cases in 2005 and the number has since dropped to 227 last year. Dr Razin attributes the decline to the introduction of harm reduction.
On IDUs at Bukit Bunga, he said while there were three official entry points, there were many illegal ones that were used for the movement of people and goods.
“We have to make sure the NSEP and harm reduction programme is a success. That intervention is done irrespective of nationality,” he said.
Batu Gajah asssistant medical officer Ibrahim Yunus, who was among the early champions of the Bukit Bunga project, said it started with approaching one of the “senior” IDUs to help in approaching those at the “port”.
“We went with him. Some of them ran away when they saw us. But he helped us talk to them,” he said.
Kelantan deputy narcotics department director DSP Roslan Yusof said despite the support given to harm reduction programmes, police still carried out the necessary enforcement to nab drug offenders.
Methamphetamine (pil kuda) is the top drug of choice for users in Kelantan.
This was followed by heroin, that Roslan revealed had a purity of 60 to 70 per cent — a higher level of content compared to that which is being sold in other states.
Routine operations are carried out in the state or based on information from the public.
Monitoring the Malaysia-Thailand border is under the military, with the support of other government agencies.
As of September this year, 10,300 people were arrested in the state for various drug offences, with 70 per cent of them being drug users.
From that number, some 50 per cent used heroin.
The number of offenders nabbed at the border was 292.