1. Malaysia: Needle Syringe and Exchange Program (NSEP)

2. MALAYSIA: AN OVERVIEW

5. Malaysia Total population in 2011: 28.3 million
Life expectancy 2011=72.1 male, female
Ethnically and religiously diverse (Malays 65.1%, Chinese 26%, Indians 7.7%)
Religion is highly correlated with ethnicity
Long history of colonization:
Portuguese
Dutch
British
=Asian Financial Crisis

6. Malaysian Government
Malaysia is a federal constitutional monarchy and a parliamentary democracy. The Head of State is the Yang di-Pertuan Agong (King). The Head of Government is the Prime Minister, who is also the head of the Cabinet.

7. Malaysia’s development as a Welfare Regime
After the long history of colonization: economic transformation (agrarian to industrialized).
Incidence of poverty from 49% of all households in 1970 to 16% by 1990.
More economically driven=economic expenditure has consistently received priority over social services.
Refer to Ministry of Finance Report 2010

8. Malaysia’s development as a welfare regime
Mixed of universalistic and targeting approaches.
Healthcare system=principles of universal access, but divided into two sectors—the public and private.
Civil service pension scheme, the Employees Provident Fund, public welfare programs.
Social expenditures receives 32.92% from the total of public expenditure since the 1990s.

9. HIV/AIDS AND IDUs

10. HIV/AIDS and IDUs 1986-2002=steady increased of HIV/AIDS cases
2002=57, 835 HIV cases and 5,676 AIDS deaths
Since the 1990s,IDU is the most common method of HIV transmission (74.2% in 2002)
=males=90% of those infected with HIV (93.76%), AIDS deaths (93.3%)
Lose potential human resources due to HIV epidemic.

11. HIV and AIDS cases

12. NSEP: A MODEL PROGRAM

13. WHY NSEP?
CULTURAL
HIV and IDUs more prominent in Malays Muslim (majority, male aged 19 to 59 yrs. Old, 70-90%)
POLITICAL
In 2005, failed to achieve one out of eight Millennium Development Goals
Cost of FOC HAART

14. NSEP Description 2005, the government announced to implement NSEP
In February and March 2006
Three states (big cities, high numbers of IDUs)
Government provides USD 1.8 million to start NSEP

16. NSEP in Malaysia MAC allocates NSEP funding to NGOs
Drop in centers (DICs), 16 in 2009 to
Outreach workers (that cover 240 NSEP sites)
Exchanging used needles and syringes for sterile ones.
Safe disposal of used injecting materials.
Reaching out and educating people who inject drugs (PWID)on HIV/AIDS and other related health issues.
Providing PWID with referrals, rehabilitation, health and welfare agencies.
Encouraging safer sex practices through education and condom distribution.

17. NSEP=SIMILARITIES & DIFFERENCES
IDUs
ZER0-DRUG TOLERANCE
NSEP
PREVENTION
&
MANDATORY
SCREENING
NSEP=SIMILARITIES & DIFFERENCES

18. NSEP differences and similarities
Differences=drug use (Drug Laws and treatment/rehabilitation centers).
Drug laws to approach IDUs (Dangerous Drug Act 1952
Similarities=HIV/AIDS=use NGOs to provide NSEP.
NGOs = provide social services to address HIV/AIDS issues since 1987 (first HIV cases).
Malaysian AIDS Council (MAC)-main NGOs or umbrella for all NGOs that related with HIV/AIDS social services.

19. STRENGTHS, WEAKNESSES AND CURRENT ISSUES

20. Behavior surveillance survey (BSS) I & II (n=300)
NSEP
BSS I (APRIL 06)
-49% always use new and clean
-44% NSEP
-52% sharing
BSS II (DEC 07)
-41% always new and clean
-88% NSEP
-42% sharing
Behavior surveillance survey (BSS) I & II (n=300)

21. NSEP STRENGTHS Reduced HIV transmission among the IDUs
74.2% in 2002 to 71.2% in 2007.
In 2009=18, 377 IDUs accessing NSEP
In 2011=8,904 new registered clients = 33, 344 IDUs access NSEP within 5 years

22. ACHIEVEMENTS & COVERAGE 2011

23. Weaknesses
Malaysia=conservative government=society= considered any program involving drug users as a waste because history reveals that many drug users did not recover fully (90% relapse rates).
NSEP sites=public sensitivities
Some stakeholders (religion leaders, police, law enforcement, prison departments, rehabilitation centers)=view this program as wasteful, contrary to religious belief and law.

24. Current issues
In 2003, government declared a ‘Year of Total War against Drugs’.
Conflict with law enforcement (Dangerous Drug Law/Act) 1952 and Ops Tapis Law
In 2000=80, 8893 drug users were arrested under the Ops Tapis law, increasing to 135,159 by 2003
ACCESS TO NSEP? STILL LESS THAN 15%

25. TERIMA KASIH!