Opposition to harm reduction - December 2003

I was disappointed to have read the report on the recently concluded workshop of ASEAN anti-drug non-governmental organisations (“NGOs reject legalising of drugs for personal use” – NST 6/12) stating their outright rejection of the “harm reduction” approach in curbing addiction and substance abuse in this region. Having decided that “harm reduction” is a “dangerous development”, they have instead decided to continue the current approach of prosecution and criminalisation.

Despite more than three decades of an “all-out war against drugs”, immense public support and tens of millions of ringgit spent every year, this singular approach has very little positive to show as there are record high numbers of new drug users and an alarming rate of relapsed individuals who have gone through the Pusat Serenti rehabilitation process. Even more alarming, is the rate of HIV infection amongst drug users resulting in this group of society comprising 42,000 individuals or 75 percent of reported HIV cases in the country (MOH June 2002).

The harm reduction based approach, of which decriminalising of certain substances is only one option, also includes the exchange of needles to prevent the spread of infectious diseases through blood, primarily HIV. By stating their opposition to harm reduction, the anti-drug NGOs have decided to prevent a way to save the lives of drug users from HIV infection.
Evidence from other programmes conducted in Australia, Holland, Thailand, Russian Federation and many other countries facing the AIDS epidemic indicate that the harm reduction approach is more effective in decreasing the rapid spread of HIV/AIDS through needle exchange programmes.

In addition to that in June 2001, at the United Nations General Assembly Special Session on HIV/AIDS, Malaysia made a commitment through the Declaration of Commitment on HIV/AIDS, to provide HIV prevention programmes that included harm-reduction (Article 52, Declaration of Commitment on HIV/AIDS, June 2001) to prevent infection and reduce the vulnerability of the drug user community.

It is instead a dangerous development that decisions to effectively curb and prevent drug use appear to not be based on evidence and that the solution is to simply continue what doesn’t work. All-out war on drugs must be complemented with harm reduction programmes to rehabilitate, provide care and support, as well prevent HIV infection.

World AIDS Day 2003

In light of the many recent articles in the Star commemorating World AIDS Day, I would like to express my concern of the current HIV/AIDS situation in Malaysia. Every year during World AIDS Day and International AIDS Memorial Day, news of more AIDS cases both globally and nationally are read and heard. There are more stories and images of People Living with HIV/AIDS in the Malaysian media then ever before. But where does this all lead up to or achieve? The number of cases has not gone down but has in fact rapidly increased. More young people are infected with HIV every day more often than not due to ignorance of safer sex or of the need to change their behaviour to protect themselves. We have, in fact, perhaps considered it part of life that some people get AIDS. How have we come to this point where it is acceptable or tolerable for more than 7000 people to be infected with HIV and consider it part of everyday life?

Though there is immense attention and effort to improve access and affordability of HIV/ AIDS treatment for those living with HIV/AIDS, there must be equal attention to improve the effectiveness of HIV prevention programmes. With more than 7000 people detected infected with HIV in this year alone and more than 20 new cases a day, Malaysia cannot afford, both in terms of its human and financial resources, to wait for a more appropriate time to act aggressively in preventing the further spread of this disease. Already there are more than 57, 000 reported cases since the epidemic began in the country in 1986. Already we spend millions a year to fund treatment, support and prevention programmes. It is an alarming fact that despite this, more Malaysians are being detected with HIV only after already being infected for a number of years.

It is an assumption and erroneous to say that most people are already aware of how the virus is transmitted or how it is not transmitted. There has been no study done by the Malaysian AIDS Council or the Ministry of Health that has captured the Malaysian public's current state of perception and knowledge of HIV/AIDS. The Durex Global Sex Survey stands as the only existing barometer of knowledge, attitude and perception of Malaysians towards sexual reproductive health, sexual behaviour practices, STDs and HIV/AIDS. The latest survey indicates that fifty percent of young people would have sexual intercourse without condoms despite the possibility of STD and HIV infection.

Without these studies, there is no way to determine properly what has been done right and what has been done wrong.

As such, what needs to be done now is to minimise the talking and criticizing and get on with determining what needs to be done and actually doing it.

The HIV/ AIDS community, including those infected and affected with HIV/AIDS, must stand united together and be courageous to voice out and bring forth their issues to the Government. 57, 000 voices must not stay silent.

There most be more emphasis and importance on HIV/AIDS prevention. Existing HIV prevention programmes such as the Ministry of Health's PROSTAR programme must continue to be supported both by the Government and AIDS NGOs for improvement and further expansion.

The Malaysian AIDS Council must self reflect, examine and improve the effectiveness of its own HIV/AIDS programmes after 11 years and especially, having received RM 4 million in 2003 from the Government.

There must be acknowledgement of the doctors and nurses, and the women and men of the Ministry of Health's AIDS/ STD Unit for their untiring efforts and personal commitments to fighting HIV/ AIDS in the country for the past 17 years.

Let's not wait for a magic number or a loved one becomes infected with HIV to be involved. All of us must break the silence surrounding the epidemic and help prevent the spread of HIV/ AIDS in Malaysia.