1. TAKING STOCK OF HIV PREVENTION – WHERE ARE WE ?
DR HJ JALAL BIN HALIL KHALIL
DEPUTY DIRECTOR OF DISEASE CONTROL,
(HIV/AIDS & STI SECTION)
DISEASE CONTROL DIVISION, DEPARTMENT OF PUBLIC HEALTH
MNISTRY OF HEALTH MALAYSIA
FEDERAL ADMINISTRATIVE COMPLEX,
PUTRAJAYA

2. HIV/AIDS CURRENT SITUATION ………
HIV/AIDS CURRENT SITUATION ………. GLOBAL, ASEAN AND THE MALAYSIAN scenarios

3. GLOBAL HIGHLIGHTS AS OF DECEMBER 2005
Total 38.6 M [33.4 – 46.0 M] Adult M [31.4 – 43.4 M] Women M [14.8 – 20.6 M] Children < 15 yrs M [1.7 – 3.5 M]
Total M [3.4 – 6.2 M] Adult M [3.0 – 5.4 M] Children < 15 yrs 540 K [420 K – 670 K]
Total 2.8 M [2.4 – 3.3 M] Adult M [2.0 – 2.8 M] Children < 15 yrs 380 K [290 K – 500 K]
Number of people living with HIV/AIDS in 2005
People newly infected with HIV in 2005
AIDS deaths in 2005
Source : UNAIDS

4. Estimated number of HIV positives still alive
HIV STATISTIC IN ASEAN, 2005
Country
Estimated number of HIV positives still alive
Deaths due
to AIDS
Total
Adults
(> 15 yrs)
Females
(> yrs)
Estimated prevalence
THAILAND
580,000
560,000
220,000
1.4%
21,000
MYANMAR
360,000
350,000
110,000
1.3%
37,000
CAMBODIA
130,000
59,000
1.6%
16,000
CHINA
650,000
180,000
0.1%
31,000
VIETNAM
260,000
250,000
84,000
0.5%
13,000
LAOS
3,700
3,600
<1,000
<100
MALAYSIA
69,000
67,000
17,000
4,000
Source: Ministry of Health
UNAIDS 2005

5. HIV EPIDEMIC PROFILE, MALAYSIA, 1986 - 2005
CUMULATIVE TOTAL:
From 4 cases in
70,559 People reportedly infected with HIV By Dec. 2005;
62,380 People Living with HIV/AIDS (reported) …
10,663 AIDS Cases (reported) ….and;
8,179 Deaths due to AIDS (reported)
In 2005: 6,120 new cases ( average ~ about 17 cases / day );
73.2% Young people aged years
12% Females
66% IDUs
22.1% Heterosexuals

6. Notified cases of HIV/AIDS and the prevalence of HIV in Malaysia according to total population,
% Prevalence
Total cases

7. TREND OF HIV INFECTION (RISK FACTORS), MALAYSIA 1991 – 2005% %

8. PERCENTAGE OF WOMEN HAVING HIV & AIDS, MALAYSIA, 1996 - 2005
Out of reported 696 HIV Infected Women in 2004;
67.6% through sex & 19.2% IDU

9. SOME OF THE GOVERNMENT ‘S RESPONSES ……..
SERO-EPIDEMIOLOGICAL surveys and studies
ORGANISATIONAL RESPONSES (restructuring of organisations)
GOVERNMENTAL INTERSECTORAL RESPONSES and collaboration (Prisons, drug rehab centres, JAKIM, etc) – Malaysian governmental agencies
SPECIFIC RESPONSES & PROGRAMMES (Youths, schools, PROSTAR, women’s issues, AIDS in workplace, etc)
SPECIAL PROGRAMMES eg Harm reduction programmes (Methadone replacement therapy, needle exchange programmes, etc)
INTERNATIONAL COLLABORATION & partners (UNICEF, WHO, UNAIDS, etc)
OUR NGO PARTNERS (MAC, other NGOs etc)
FUTURE CHALLENGES

10. ORGANIZATIONAL RESPONSE
Inter-Ministerial Committee on AIDS (1992)
AIDS Taskforce (Formed in 1985)
Chaired by
Minister of Health
The National Coordinating Committee on AIDS (NCCA)
The National Technical Committee on AIDS
Ministry of Health
Other Ministries
Non-Govt Org
Co-opt members
Chaired by
Secretary General of Health
Chaired by
Director General Health
Sub-Committee on Prevention
Sub-Committee on Treatment

11. ORGANIZATIONAL CHART (latest organisational restructuring)
NATIONAL STRATEGIC PLAN ON HIV/AIDS FOR
ORGANIZATIONAL CHART (latest organisational restructuring)
Chaired by Deputy Prime Minister
29 June 2006
Chaired by Minister of
Health
13 June 2006
AIDS/STD Section of Ministry of Health is the Secretariat to the all committees
Chaired by Director General of Health
25 May 2006

12. AIDS/STI SECTION, DISEASE CONTROL DIVISION
SECRETARIAT
to the Ministerial Technical & Coordinating Committees
(and other national level subcommittees) on HIV/AIDS programs.
RESPONSIBLE
Planning, organizing, implementing, monitoring and evaluating the surveillance, prevention and control, patient care and support, training and research programmes and activities.
COORDINATES
Various outreach services by NGOs and provide them with technical / financial assistance in HIV/AIDS programme.

13. HIV/AIDS SURVEILLANCE IN MALAYSIA
Case Notification
342 Act (Infectious Disease Control Act)
Using Format HIV/AIDS-97
Sero-Prevalence
- Blood donation
- Antenatal care screening for HIV
- Correctional Institutions (medical check-ups)
- Hospitals
- Foreign workers
Behavioural surveillance
STD Surveillance (modified MSA syndromic sentinel site clinics)
- sentinel sites

14. HEALTH EDUCATION AND PROMOTION
Intensive AIDS media campaign since 1991 with the theme “Prevent AIDS Now”
Awareness campaign “Women and AIDS” in 1997
Collaboration with other sectors
HIV/AIDS program at workplace
NGO’s outreach programs (Malaysian AIDS Council)
School Health Program
Woman & AIDS Program
Yearly event
World AIDS Day
PROSTAR Convention & Jamboree

15. HIV PREVENTION PROGRAM AT DRUG REHABILITATION CENTERS AND PRISONS
Initiated in 1988
In collaboration with Prisons Department,
National Drug Agency and Home Affairs Ministry
Now in 27 Pusat Serenti’s, 4 correctional facilities and 33 prisons
Screening of HIV done on admission, after 6-month and pre-release.
Health education, counseling, referrals and treatment given
Screening of TB on HIV-positive inmates/prisoners.
Screening done after obtaining informed consent.

16. PROSTAR
PROSTAR – “Program Sihat Tanpa AIDS untuk Remaja” Specific program for youths without AIDS
Initiated in 1996
Concept - Action By Youths, Through Youths And For Youths
Creating young motivators (aged 15 – 25) to plan, organize and carry out activities to peer groups.
As of 2004,
More than 1009 PROSTAR clubs (district & schools) established
78,643 youths trained as peer motivators (PRS)
5,042 related activities covering >70,000 young people (13 – 25)

17. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (MTCT) PROGRAMME
Launched in 1998 at all government antenatal clinics.
Provides counseling, HIV-testing, free ARV therapy and follow-up of HIV+ mothers and babies.
Coverage – 96.9% of antenatal mothers in 2005.
As of , 864 mothers were found HIV+
Prevalence of HIV among antenatal mothers 0.03%
3.8% babies were confirmed PCR+ve in 2005

18. HIV & STI MANAGEMENT AT PRIMARY HEALTH CARE LEVEL (PPHIV)
Started in 2000
Now, 250 health clinics throughout the country.
Activities – risk assessment, voluntary counseling and testing (VCT), medical exam, prophylaxis, follow-up and referrals.
Since 2000 till 2005,
More than 19,063 cases have been seen at primary care clinics with 799 HIV+ cases detected so far.
In 2005, 1,433 cases of STI patients were treated at primary care level (through modified syndromic approach management)

19. ANONYMOUS VOLUNTARY HIV TESTING
Piloted in Johore in 2000 and now scaled-up to other states in 2004 to nearly 500 clinics.
Fast and confidential HIV testing using rapid test kit at public health clinics.
Age, race and sex were recorded while confirmatory tests done when necessary.
By 2004,
9,488 screened
203 (2.2%) cases were reactive
72 (0.8%) cases were confirmed positive

20. SCALING UP ANTI-RETROVIRAL TREATMENT PROGRAMME
Recommended HAART regimen – 1996
Reported no. of PLWHA under HAART – 3,800 by 2005
MOH provides 2 drug free while the AIDS patient have to buy the other 1 drug
To give 3 drugs (FREE) to qualified patients
Infected mothers (and HIV+ newborns) through PMTCT program
Infected children
Infected cases through contaminated blood or blood products
Health care workers infected through occupational exposure (eg needle stick injuries, dyalisis, operations, etc)
Government servants

21. PRE-MARITAL HIV SCREENING
Within the jurisdiction of State Religious Departments (based upon the decree (fatwa) passed by the State Religious Authority). HIV testing is done on voluntary or mandatory basis.
Pre-marital HIV screening NOT DONE IN :-
Kedah, P Pinang, N Sembilan, Sabah, Sarawak, WP KL and Labuan.
The role of Ministry of Health :-
- technical assistance (HIV screening, pre and post test
counseling, follow-up, treatment and referrals)

22. ‘HARM REDUCTION’ FOR IDUS
Government policy :
First announced commitment in June 2005
Principally – to be conducted as pilot project.
Needle Syringe Exchange Program (NSEP)
January zones (1,200 IDUs)
‘Methadone Substitution Therapy’
October centers (1,200 IDUs)
Aim of policy / programme : To reduce the high risk behavior between IDUs e.g. sharing contaminated needles, unprotected sex
As point entry for the IDUs to obtain other HIV related managements and services

23. NATIONAL STRATEGIC PLAN (NSP) ON HIV/AIDS FOR 2006-2010
The NSP will focus on 6 STRATEGIES:
1. Strengthening Leadership and Advocacy
2. Training and Capacity Enhancement
3. Reducing HIV vulnerability Injecting Drug Users and their Partners
4. Reducing HIV vulnerability of Young People and Children
5. Reducing HIV vulnerability of Marginalized and Vulnerable populations
6. Improving access to Treatment, Care & Support
Plan of Action for NSP have been produced in May 2006

24. FUTURE RESPONSES
Strengthen the Community based groups/ programs for Care and Support of IDUs, PLWA and children orphaned by HIV/AIDS.
Scaling up ARV treatment especially among IDUs
Intensify HIV/AIDS education
Sex-education & Harm-reduction
Action on HIV/AIDS by religious leaders
Second generation of HIV surveillance
Economic impact of HIV/AIDS

25. THANK YOU If we can do some good, WE SHOULD But, if We can Make a Difference, WE MUST !