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DR HJ JALAL BIN HALIL KHALIL DR HJ JALAL BIN HALIL KHALIL

DEPUTY DIRECTOR OF DISEASE CONTROL, DEPUTY DIRECTOR OF DISEASE CONTROL,

(HIV/AIDS & STI SECTION)(HIV/AIDS & STI SECTION)

DISEASE CONTROL DIVISION, DEPARTMENT OF PUBLIC HEALTH DISEASE CONTROL DIVISION, DEPARTMENT OF PUBLIC HEALTH

MNISTRY OF HEALTH MALAYSIAMNISTRY OF HEALTH MALAYSIA

FEDERAL ADMINISTRATIVE COMPLEX,FEDERAL ADMINISTRATIVE COMPLEX,

PUTRAJAYAPUTRAJAYA

TAKING STOCK OF HIV PREVENTION – TAKING STOCK OF HIV PREVENTION –

WHERE ARE WE ?WHERE ARE WE ?

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HIV/AIDS CURRENT SITUATION

………. GLOBAL, ASEAN

AND THE MALAYSIAN

scenarios

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TotalTotal 38.6 M [33.4 – 46.0 M] 38.6 M [33.4 – 46.0 M] Adult Adult 36.3 M [31.4 – 43.4 M] 36.3 M [31.4 – 43.4 M] Women Women 17.3 M [14.8 – 20.6 M] 17.3 M [14.8 – 20.6 M] Children < 15 yrs Children < 15 yrs 2.3 M [1.7 – 3.5 M]2.3 M [1.7 – 3.5 M]

TotalTotal 4.1 M [3.4 – 6.2 M]4.1 M [3.4 – 6.2 M]AdultAdult 3.6 M [3.0 – 5.4 M]3.6 M [3.0 – 5.4 M]Children < 15 yrs Children < 15 yrs 540 K [420 K – 670 K]540 K [420 K – 670 K]

TotalTotal 2.8 M [2.4 – 3.3 M]2.8 M [2.4 – 3.3 M]AdultAdult 2.4 M [2.0 – 2.8 M]2.4 M [2.0 – 2.8 M]Children < 15 yrs Children < 15 yrs 380 K [290 K – 500 K]380 K [290 K – 500 K]

Number of people Number of people living with HIV/AIDS living with HIV/AIDS in in 20052005

People newly infected People newly infected with HIV inwith HIV in 20052005

AIDS deaths inAIDS deaths in 20052005

Source : UNAIDS

GLOBAL HIGHLIGHTS AS OF GLOBAL HIGHLIGHTS AS OF DECEMBER 2005DECEMBER 2005

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HIV STATISTIC IN ASEAN, HIV STATISTIC IN ASEAN, 20052005

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 130,000 130,000 59,000 1.6% 16,000

CHINA 650,000 650,000 180,000 0.1% 31,000

VIETNAM 260,000 250,000 84,000 0.5% 13,000

LAOS 3,700 3,600 <1,000 0.1% <100

MALAYSIA 69,000 67,000 17,000 0.5% 4,000

Source: Ministry of Health UNAIDS 2005

5HIV EPIDEMIC PROFILE, HIV EPIDEMIC PROFILE, MALAYSIA, MALAYSIA,

1986 - 20051986 - 2005CUMULATIVE TOTAL:

• From 4 cases in 1986 . . .

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 In 20052005: 6,120 new cases ( average ~ about 17 cases / day );73.2% Young people aged 20 -39 years12% Females66% IDUs22.1% Heterosexuals

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Notified cases of HIV/AIDS and the prevalence of HIV in Malaysia according to total population, 1986 - 2005

0

1000

2000

3000

4000

5000

6000

7000

8000

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

HIV

AIDS

% Prev dewasa

% Prevalan total

Total cases % Prevalence

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

0

10

20

30

40

50

60

70

80

90

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

IDU 64.3 75.3 78.6 81.8 75.9 82.7 76.8 77.7 71.9 74.7 79.6 74.2 71 69.7 66

Heterosex 5.7 6.1 6.9 6 7.4 7.5 10.2 14.1 16.3 17.4 14 17.5 19.3 19.8 22.1

Vertical 0.2 0.2 0.1 0.2 0.1 0.4 0.5 0.7 0.9 1.6 1 0.9 0.9 1 1.2

91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05

% %

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PERCENTAGE OF WOMEN HAVING HIV & AIDS,MALAYSIA, 1996 - 2005

0

2

4

6

8

10

12

14

16

% o

f Tota

l Cases

HIV 4.15 5.02 6.42 8.1 9.42 7.85 9.01 9.96 10.8 12

AIDS 5.76 5.28 6.51 7.17 8.3 8.76 10.48 12.73 12.7 14.5

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Out of reported 696 HIV Infected Women in 2004;Out of reported 696 HIV Infected Women in 2004;

67.6% through sex & 19.2% IDU 67.6% through sex & 19.2% IDU

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SOME OF THE GOVERNMENT ‘S RESPONSES ……..

1. SERO-EPIDEMIOLOGICAL surveys and studies 2. ORGANISATIONAL RESPONSES (restructuring of

organisations)3. GOVERNMENTAL INTERSECTORAL RESPONSES and

collaboration (Prisons, drug rehab centres, JAKIM, etc) – Malaysian governmental agencies

4. SPECIFIC RESPONSES & PROGRAMMES (Youths, schools, PROSTAR, women’s issues, AIDS in workplace, etc)

5. SPECIAL PROGRAMMES eg Harm reduction programmes (Methadone replacement therapy, needle exchange programmes, etc)

6. INTERNATIONAL COLLABORATION & partners (UNICEF, WHO, UNAIDS, etc)

7. OUR NGO PARTNERS (MAC, other NGOs etc) 8. FUTURE CHALLENGES

10ORGANIZATIONAL ORGANIZATIONAL RESPONSERESPONSE

Inter-Ministerial Inter-Ministerial Committee on AIDS Committee on AIDS

(1992)(1992)

The National Coordinating The National Coordinating Committee on AIDS (NCCA)Committee on AIDS (NCCA)

The National Technical Committee The National Technical Committee on AIDSon AIDS

Sub-Committee on Prevention

Sub-Committee on Treatment

AIDS Taskforce (Formed in 1985)

-Ministry of Health - Other Ministries - Non-Govt Org- Co-opt members

Chaired by Minister of Health

Chaired bySecretary General of Health

Chaired by

Director General Health

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ORGANIZATIONAL CHART ORGANIZATIONAL CHART (latest organisational restructuring)(latest organisational restructuring)

Cabinet Committee Cabinet Committee on AIDS (CCAon AIDS (CCA)

National Advisory Committee National Advisory Committee on AIDS (NACA)on AIDS (NACA)

Technical Committee Technical Committee on AIDS (TCA)on AIDS (TCA)

Chaired by Deputy Chaired by Deputy Prime Minister Prime Minister

29 June 200629 June 2006

Chaired by Minister of Chaired by Minister of Health Health

13 June 200613 June 2006

Chaired by Director Chaired by Director General of Health General of Health

25 May 200625 May 2006

AIDS/STD Section of Ministry of Health is the Secretariat to the

all committees

NATIONAL STRATEGIC PLAN ON HIV/AIDS FOR 2006-2010

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• SECRETARIAT SECRETARIAT – to the Ministerial Technical & Coordinating Committees to the Ministerial Technical & Coordinating Committees (and other national level subcommittees) on HIV/AIDS (and other national level subcommittees) on HIV/AIDS

programs.programs.

• RESPONSIBLE RESPONSIBLE – Planning, organizing, implementing, monitoring and evaluating Planning, organizing, implementing, monitoring and evaluating

the surveillance, prevention and control, patient care and the surveillance, prevention and control, patient care and support, training and research programmes and activities.support, training and research programmes and activities.

• COORDINATESCOORDINATES– Various outreach services by NGOs and provide them with Various outreach services by NGOs and provide them with

technical / financial assistance in HIV/AIDS programmetechnical / financial assistance in HIV/AIDS programme. .

AIDS/STI SECTION,AIDS/STI SECTION,DISEASE CONTROL DIVISIONDISEASE CONTROL DIVISION

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• Case NotificationCase Notification– 342 Act 1988 (Infectious Disease Control Act)342 Act 1988 (Infectious Disease Control Act)– Using Format HIV/AIDS-97Using Format HIV/AIDS-97

• Sero-PrevalenceSero-Prevalence- Blood donation- Blood donation- Antenatal care screening for HIV- Antenatal care screening for HIV- Correctional Institutions (medical check-ups) - Correctional Institutions (medical check-ups) - Hospitals- Hospitals- Foreign workers - Foreign workers

• Behavioural surveillanceBehavioural surveillance

• STD Surveillance (modified MSA syndromic sentinel site STD Surveillance (modified MSA syndromic sentinel site clinics) clinics)

- sentinel sites - sentinel sites

HIV/AIDS SURVEILLANCE IN HIV/AIDS SURVEILLANCE IN MALAYSIAMALAYSIA

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• Intensive AIDS media campaign since 1991 with the Intensive AIDS media campaign since 1991 with the theme “Prevent AIDS Now” theme “Prevent AIDS Now”

• Awareness campaign “Women and AIDS” in 1997Awareness campaign “Women and AIDS” in 1997• Collaboration with other sectorsCollaboration with other sectors

HIV/AIDS program at workplaceHIV/AIDS program at workplace NGO’s outreach programs (Malaysian AIDS Council)NGO’s outreach programs (Malaysian AIDS Council) School Health ProgramSchool Health Program Woman & AIDS ProgramWoman & AIDS Program

• Yearly eventYearly event World AIDS DayWorld AIDS Day PROSTAR Convention & JamboreePROSTAR Convention & Jamboree

HEALTH EDUCATION AND HEALTH EDUCATION AND PROMOTION PROMOTION

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• Initiated in 1988Initiated in 1988• In collaboration with Prisons Department, In collaboration with Prisons Department, National Drug Agency and Home Affairs MinistryNational Drug Agency and Home Affairs Ministry• Now in 27 Pusat Serenti’s, 4 correctional Now in 27 Pusat Serenti’s, 4 correctional

facilities and 33 prisonsfacilities and 33 prisons• Screening of HIV done on admission, after 6-Screening of HIV done on admission, after 6-

month and pre-release.month and pre-release.• Health education, counseling, referrals and Health education, counseling, referrals and

treatment giventreatment given• Screening of TB on HIV-positive Screening of TB on HIV-positive

inmates/prisoners.inmates/prisoners.• Screening done after obtaining informed Screening done after obtaining informed

consent.consent.

HIV PREVENTION PROGRAM HIV PREVENTION PROGRAM AT DRUG REHABILITATION CENTERS AND AT DRUG REHABILITATION CENTERS AND

PRISONSPRISONS

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• PROSTAR – PROSTAR – “Program Sihat Tanpa AIDS untuk Remaja”“Program Sihat Tanpa AIDS untuk Remaja” Specific Specific program for youths without AIDSprogram for youths without AIDS

• Initiated in 1996 Initiated in 1996

• Concept - Action By Youths, Through Youths And For YouthsConcept - Action By Youths, Through Youths And For Youths

• Creating young motivators (aged 15 – 25) to plan, organize and Creating young motivators (aged 15 – 25) to plan, organize and carry out activities to peer groups.carry out activities to peer groups.

• As of 2004, As of 2004, More than 1009 PROSTAR clubs (district & schools) More than 1009 PROSTAR clubs (district & schools)

establishedestablished 78,643 youths trained as peer motivators (PRS)78,643 youths trained as peer motivators (PRS) 5,042 related activities covering >70,000 young people (13 – 5,042 related activities covering >70,000 young people (13 –

25)25)

PROSTARPROSTAR

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• Launched in 1998 at all government antenatal Launched in 1998 at all government antenatal clinics. clinics.

• Provides counseling, HIV-testing, free ARV Provides counseling, HIV-testing, free ARV therapy and follow-up of HIV+ mothers and therapy and follow-up of HIV+ mothers and babies.babies.

• Coverage – 96.9% of antenatal mothers in 2005.Coverage – 96.9% of antenatal mothers in 2005.• As of 31 2005, 864 mothers were found HIV+As of 31 2005, 864 mothers were found HIV+• Prevalence of HIV among antenatal mothers Prevalence of HIV among antenatal mothers

0.03%0.03%• 3.8% babies were confirmed PCR+ve in 20053.8% babies were confirmed PCR+ve in 2005

PREVENTION OF MOTHER-TO-CHILD PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (MTCT) PROGRAMMETRANSMISSION (MTCT) PROGRAMME

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• Started in 2000 Started in 2000 • Now, 250 health clinics throughout the country.Now, 250 health clinics throughout the country.• Activities – risk assessment, voluntary counseling and testing Activities – risk assessment, voluntary counseling and testing

(VCT), medical exam, prophylaxis, follow-up and referrals.(VCT), medical exam, prophylaxis, follow-up and referrals.

• Since 2000 till 2005, Since 2000 till 2005, • More than 19,063 cases have been seen at primary care More than 19,063 cases have been seen at primary care

clinics with 799 HIV+ cases detected so far. clinics with 799 HIV+ cases detected so far.

• In 2005, 1,433 cases of STI patients were treated at primary In 2005, 1,433 cases of STI patients were treated at primary care level (through modified syndromic approach care level (through modified syndromic approach management) management)

HIV & STI MANAGEMENT AT HIV & STI MANAGEMENT AT PRIMARY HEALTH CARE LEVEL (PPHIV)PRIMARY HEALTH CARE LEVEL (PPHIV)

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• Piloted in Johore in 2000 and now scaled-up to Piloted in Johore in 2000 and now scaled-up to other states in 2004 to nearly 500 clinics.other states in 2004 to nearly 500 clinics.

• Fast and confidential HIV testing using rapid test Fast and confidential HIV testing using rapid test kit at public health clinics.kit at public health clinics.

• Age, race and sex were recorded while Age, race and sex were recorded while confirmatory tests done when necessary.confirmatory tests done when necessary.

• By 2004,By 2004,• 9,488 screened 9,488 screened • 203 (2.2%) cases were reactive 203 (2.2%) cases were reactive • 72 (0.8%) cases were confirmed positive 72 (0.8%) cases were confirmed positive

ANONYMOUS VOLUNTARY HIV ANONYMOUS VOLUNTARY HIV TESTINGTESTING

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• Recommended HAART regimen – 1996Recommended HAART regimen – 1996

• Reported no. of PLWHA under HAART – 3,800 by Reported no. of PLWHA under HAART – 3,800 by 20052005

• MOH provides 2 drug free while the AIDS patient MOH provides 2 drug free while the AIDS patient have to buy the other 1 drughave to buy the other 1 drug

• To give 3 drugs (FREE) to qualified patientsTo 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

SCALING UP ANTI-RETROVIRAL SCALING UP ANTI-RETROVIRAL TREATMENT PROGRAMMETREATMENT PROGRAMME

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PRE-MARITAL HIV SCREENING

• Within the jurisdiction of State Religious Within the jurisdiction of State Religious Departments (based upon the decree (fatwa) Departments (based upon the decree (fatwa) passed by the State Religious Authority). HIV passed by the State Religious Authority). HIV testing is done on voluntary or mandatory basis. testing is done on voluntary or mandatory basis.

• Pre-marital HIV screening NOT DONE IN :-Pre-marital HIV screening NOT DONE IN :-

Kedah, P Pinang, N Sembilan, Sabah, Sarawak, WP Kedah, P Pinang, N Sembilan, Sabah, Sarawak, WP KL and Labuan. KL and Labuan.

• The role of Ministry of Health :- The role of Ministry of Health :-

- technical assistance (HIV screening, pre and post - technical assistance (HIV screening, pre and post testtest

counseling, follow-up, treatment and referrals) counseling, follow-up, treatment and referrals)

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‘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 2006 - 3 zones (1,200 IDUs)

• ‘Methadone Substitution Therapy’

• October 2005 - 8 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

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• 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 2006-2010 have been produced in May 2006

NATIONAL STRATEGIC PLAN (NSP) ON HIV/AIDS FOR 2006-2010

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• Strengthen the Community based groups/ Strengthen the Community based groups/ programs for Care and Support of IDUs, PLWA and programs for Care and Support of IDUs, PLWA and children orphaned by HIV/AIDS.children orphaned by HIV/AIDS.

• Scaling up ARV treatment especially among IDUsScaling up ARV treatment especially among IDUs• Intensify HIV/AIDS educationIntensify HIV/AIDS education• Sex-education & Harm-reductionSex-education & Harm-reduction• Action on HIV/AIDS by religious leadersAction on HIV/AIDS by religious leaders• Second generation of HIV surveillanceSecond generation of HIV surveillance• Economic impact of HIV/AIDSEconomic impact of HIV/AIDS

FUTURE RESPONSESFUTURE RESPONSES

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THANK YOUTHANK YOU

If we can do some good, If we can do some good, WE SHOULDWE SHOULD

But, if We can Make a Difference, But, if We can Make a Difference,

WE MUST !WE MUST !