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The following is an excerpt from an ANCD report:

The link between amphetamine-type stimulant use and the transmission of HIV and other blood-borne viruses in the Southeast Asia region.

Malaysia is a federal constitutional monarchy consisting of 13 states and three federal territories. It shares borders with Thailand, Indonesia and Brunei Darussalam. The country has a population of 28.1 million, 1.6 million of whom live in the capital, Kuala Lumpur. The population age structure is predominantly young, with more than one-third of Malaysia’s population 14 years or under and a median age of 23.8 years.

Amphetamine-type stimulant use

Although heroin and cannabis remain the drugs of most concern in Malaysia, the use of crystal methamphetamine and ATS pills increased by 10 per cent between 2008 and 2009 (United Nations Office on Drugs and Crime, 2010b). The injection of crystal was reported for the first time in Malaysia in 2008 (United Nations Office on Drugs and Crime, 2010b).

Manufacture, trafficking and seizures

Eleven ATS manufacturing operations were dismantled in 2009, one less than the 12 closed down in 2008 (United Nations Office on Drugs and Crime, 2010b). The Global SMART Program reported that a significant quantity of crystal methamphetamine is being produced in Malaysia. This is supported by the seizure of large quantities of precursor chemical. More than 100 000 ATS pills and 1160kg of crystal were seized during 2009. The quantity of crystal methamphetamine seized in 2009 was almost double that in 2008, while the number of pills seized was half that seized in 2008 (United Nations Office on Drugs and Crime, 2010b). The increase in reports of transnational criminal involvement in the manufacture of ATS is of concern.

While the majority of the ATS pills and small quantities of crystal are trafficked into Malaysia from Myanmar, most of the crystal methamphetamine is produced domestically (United Nations Office on Drugs and Crime, 2010b).

Injecting drug use

Estimates of the number of PWID in Malaysia vary between a mean of 205 000 in 2002 to 195 000 in 2006 and 235 000 in 2009 (Hagarty, 2010). The 2009 figure is in contrast to the 170 000 PWID reported in the 2010 Global SMART Program report (United Nations Office on Drugs and Crime, 2010b). The injection of crystal was first reported in 2009 and no estimates of the number of people who inject crystal methamphetamine were available (United Nations Office on Drugs and Crime, 2010b).

Drug-related arrests

Drug-related arrests for amphetamines (type not specified) and ATS declined between 2008 and 2009 (United Nations Office on Drugs and Crime, 2010b). Of all drug-related arrests in 2009, only 8 per cent were for ATS drugs (1131 for crystal and 84 for amphetamine).

Drug treatment

Malaysia’s drug laws are among the most stringent in the world and compulsory centres (n=28) were run by the government until 2009. In July 2010, the Government of Malaysia opened the first Cure and Care Clinic. The Cure and Care Clinics are a shift away from institution-based rehabilitation to voluntary open access services for drug users, their families and their employers. More Cure and Care Clinics are in the process of being opened across the country. A total of 15 645 people were admitted to drug treatment, the vast majority of them men (United Nations Office on Drugs and Crime, 2010b). There are no ATS-specific drug treatment services in Malaysia and most ATS users enter community drug treatment centres.

HIV in the community and among injecting drug users

The prevalence of HIV among the general population is 0.5 per cent with 87 710 cumulative cases reported since 1986 (UNAIDS, 2010a). Until 2008, 70 per cent of HIV infections were thought to be the result of injecting drug use (Devaney, Reid & Baldwin, 2006). However, 2009 data suggest that 55 per cent of new infections were the result of injecting and 32 per cent resulted from sexual transmission. HIV among PWID is 22 per cent and the vast majority are men (UNODC, 2010a). Behavioural surveys of high-risk groups indicated 22 per cent of PWID were infected with HIV, 11 per cent of sex workers and 4 per cent of MSM. The HIV epidemic in Malaysia is said to be driven by injecting drug use, female sex workers, MSM and transgender people.

HIV testing

Testing for PWID is by referral from NSP sites. In the 2006–2007 period it was reported that 100 per cent of PWID and MSM had been screened for HIV and knew their results. However, figures for 2008–2009 indicated that only one-third of PWID and 20 per cent of sex workers had been tested for HIV and knew the results (Malaysia Ministry of Health, 2010). Malaysia reports that increased availability of testing had resulted in more people being tested but fewer returning for the results.

HIV anti-retroviral treatment

ART is available in Malaysia, however no details of ART for PWID are reported (World Health Organization, 2010b).

Prevention education

Malaysia is currently piloting HIV life skills for secondary school students in 20 schools.

Harm reduction

Malaysia adopted a harm reduction approach in 2005 and the Third National Strategic Plan calls for both NSPs and condom programs for PWID. There are now 240 NSP sites across Malaysia, many run by NGOs (Hagarty, 2010). More than 2 million needles and syringes were distributed by 23 needle distribution sites at a rate of 9 (7–13) needles and syringes per PWID per year (Hagarty, 2010). As of 2010, the Government of Malaysia reported 10 664 active OST patients (personal communication, Dr Bergenstorm, June 2011).