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TAKING STOCK OF HIV PREVENTION – WHERE ARE WE ?

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.

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TAKING STOCK OF HIV PREVENTION – WHERE ARE WE ?

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  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 ………. GLOBAL, ASEAN AND THE MALAYSIAN scenarios

  3. GLOBAL HIGHLIGHTS AS OF DECEMBER 2005 Total 38.6 M [33.4 – 46.0 M] Adult 36.3 M [31.4 – 43.4 M] Women 17.3 M [14.8 – 20.6 M] Children < 15 yrs 2.3 M [1.7 – 3.5 M] Total 4.1 M [3.4 – 6.2 M]Adult 3.6 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 2.4 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 in2005 AIDS deaths in2005 Source : UNAIDS

  4. HIV STATISTIC IN ASEAN, 2005 Source: Ministry of Health UNAIDS 2005

  5. HIV EPIDEMIC PROFILE, MALAYSIA, 1986 - 2005 • CUMULATIVE TOTAL: • From 4 cases in 1986 . . . • 70,559People 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 20 -39 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, 1986 - 2005 % 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) Chaired by Minister of Health AIDS Taskforce (Formed in 1985) 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 2006-2010 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 1988 (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 31 2005, 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 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

  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 2006-2010 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 YOUIf we can do some good, WE SHOULDBut, if We can Make a Difference, WE MUST !

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