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Combined prevention programs within criminal justice systems – examples from Malaysia

Combined prevention programs within criminal justice systems – examples from Malaysia. A Kamarulzaman , S Kaur , MN Nazar , M Azahari , C Koh , H AlDarraji , J Fu, J Wickersham, F Altice. Global Rates of Incarceration. Imprisonment per Capita. Malaysia. 39,758 prisoners 5441 in Puspen

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Combined prevention programs within criminal justice systems – examples from Malaysia

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  1. Combined prevention programs within criminal justice systems – examples from Malaysia A Kamarulzaman, S Kaur, MN Nazar, M Azahari, C Koh, H AlDarraji, J Fu, J Wickersham, F Altice

  2. Global Rates of Incarceration Imprisonment per Capita Malaysia 39,758 prisoners 5441 in Puspen 26,294 in jails (5th) Ranked 53rd Puspen 40th Driven by war on drugs Mandatory HIV testing Highest HIV prevalence in SE Asia (6%) Different from USA Nearly 40% are foreign-borne Nearly 40% are from rural areas

  3. Project Harapan: Study Design Project Harapan

  4. Project Harapan: Initial Findings • Total of 121 participants enrolled • MMT = 38 • MMT + HHRP = 38 • HHRP(M) = 22 • Control = 23 • Rate of recidivism by MMT vs. No MMT • MMT = 2.6% • No MMT = 8.8%

  5. Pilot Study: Methadone Dose Matters 100-120mg Log Rank (Mantel-Cox): Χ2 = (1, 27) 7.60, p < .01 Breslow (Gen Wilcoxon): Χ2 = (1, 27) 7.45, p < .01 Tarone-Ware: Χ2 = (1, 27) 7.69, p < .01 <80mg

  6. HARAPAN-TB • Tuberculosis is the leading cause of death in Malaysian prisons (especially HIV coinfection) • No standardized TB screening or treatment programs established in the prison setting • Patients who are ill are transferred out to government hospitals for treatment

  7. HIV Group • Incarceration times: 5 * (range 0-22) • Total previous incarceration: 67 months * (range 0-360) • Times since HIV diagnosis: 6 years * (range 6m-22years) • On HIV treatment: 6% (despite 47% requires ARV) • Sharing needles before incarceration: 91% • Previous TST: 11% • Previous TB disease (undocumented): 11% • 1 case was diagnosed with active TB through the survey * Mean

  8. Results

  9. HIV in Drug Treatment & Rehabilitation Centers

  10. HIV Diagnosis, Treatment & Care • N= 100 • 78% diagnosed in detention settings • Mean number of months since diagnosis: 64.8% • 74% have not received HIV-specific medical care since diagnosis- 34% reported ever having a CD4 - Only 18 were told their actual CD4 count J Fu et al IHRC 2011 abstract

  11. HIV Diagnosis, Treatment & Care • No access to ARVs in Puspen • No/limited medical personnel; completely reliant on external medical facilities for treatment of very sick inmates • Only 9% received HIV-specific care during this incarceration 4 forced to discontinue ART • Very immunosuppresed - CD4 counts: 15 - 140 J Fu et al IHRC 2011 abstract

  12. A COMPREHENSIVE HIV/AIDS PREVENTION AND TREATMENT PROGRAMME IN DRUG REHABILITATION CENTRES IN MALAYSIA NATIONAL ANTI-DRUGS AGENCY (NADA) MINISTRY OF HOME AFFAIRS MALAYSIA

  13. OBJECTIVE • In response to the growing drug problem and its complexity and realizing that the existing strategies are not achieving the intended effects / targets, NADA has shifted its approach from INSTITUTIONALISEDrehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINICor better known as C&C 1MALAYSIA CLINIC. • This is a paradigm shift for NADA to transform its treatment and rehabilitation services to all its clients in the country. 2 NADA MALAYSIA

  14. National AntiDrugs Agency Methadone Maintenance Program 2007 - 20011 2007 2008 2009 2010 2011

  15. NADA MMT PROGRAM • 33 CCSC • 8 Klinik C&C 1Malaysia • 2 PUSPEN

  16. FASILITI

  17. MEDICAL EVALUATION NADA MALAYSIA

  18. Challenges • Condom and needle syringe programs prohibited • Lack of a health system within these organisations • Organisational competency • Community re-entry challenges • Homelessness and shelters (HIV & methadone) • Unemployment • Family and social disruption • Stigma

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