ACHIEVING THE U.N. S MILLENIUM DEVELOPMENT GOAL IN COMBATING HIV AND AIDS: THE MALAYSIA SCENARIO

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1 ACHIEVING THE U.N. S MILLENIUM DEVELOPMENT GOAL IN COMBATING HIV AND AIDS: THE MALAYSIA SCENARIO Wah-yun Low, * Reiko Yeap, ** Wen-ting Tong *** ABSTRACT HIV is the most common notifiable communicable disease in Malaysia after Tuberculosis, with a staggering 8,000 or more cases per year detected in recent years. As at 2009, we have a cumulative figure of 87,701 HIV cases and 15,317 AIDS cases. HIV/AIDS related death totalled 13,394 cases. The majority of cases have remained among the drug-using sub-population but, twenty years into its progression, the epidemic has now begun to reveal a diversion in its course that of increasing heterosexual transmission and, what is termed an increasing feminisation of the epidemic. That is, more people are becoming infected through heterosexual transmission and, increasingly, more women are now living with HIV. The National Strategic Plan on HIV/AIDS for , focus on 6 strategies: strengthening leadership and advocacy, training and capacity enhancement, reducing HIV vulnerability injecting drug users and their partners, reducing HIV vulnerability of young people and children, reducing HIV vulnerability of marginalized and vulnerable populations and * Wah-yun Low, Professor of Psychology, Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. The author can be reached at lowwy@um.edu.my. ** Reiko Yeap, Division of Psychology (& Behavioural Sciences), International Medical University, Kuala Lumpur, Malaysia. The author can be reached at reiko_yeap@imu.edu.my. *** Wen-ting Tong, Research Officer, Medical Education and Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. The author can be reached at tongwenting@um.edu.my. Electronic copy available at:

2 428 AJWH [VOL. 5:427 improving access to treatment, care and support. Activities include the co-ordination of outreach services provided by nongovernmental organisations by providing technical and financial assistance in HIV/AIDS programs. Intensified HIV/AIDS and health education, promotion and media campaigns are continuously carried out in the country. HIV prevention program at drug rehabilitation centres and prisons was also initiated in Sex education and harm reduction program aims to reduce the high risk behavior between intravenous drug users, e.g., sharing contaminated needles, unprotected sex. Prevention of mother-tochild transmission program was launched in 1998 at all government antenatal clinics. HIV and STI management at primary health care level was started in 2000 in health clinics throughout the country. Anonymous voluntary HIV testing was implemented, and in certain states in the country, pre-marital HIV screening was carried out. The anti-retroviral treatment program was also scaled up. Due to all these education, prevention, treatment and rehabilitative programs, incidence of HIV has decreased over the past years but more efforts are needed to halt HIV, malaria and other infectious diseases by year 2015 in the country. KEYWORDS: Infectious Disease, Millenium Development Goals, Health Indicator, Developing Country, Epidemiology Electronic copy available at:

3 2010] ACHIEVING THE U.N. S MILLENIUM 429 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS I. INTRODUCTION The number of people living with HIV/AIDS continues to grow worldwide. In 2008, it was estimated that 33.4 million people were living with HIV and a cumulative of 25 million people have died of HIV related causes. 1 The second largest number of people living with HIV/AIDS in the world is found in Asia after sub-saharan Africa. The ASEAN region within Asia consists of 10 countries namely Brunei Darussalam, Cambodia, Indonesia, Laos, Myanmar, Philippines, Singapore, Thailand, Vietnam and Malaysia. HIV/AIDS was first detected in 1984 and by 1990, all 10 countries of this region were already infected. In 2006, there were 1.6 million people living with HIV/AIDS in this region. The prevalence rate was 0.5% among people between years of age across this region but in some countries, 1.5% of all adults were living with HIV. Women over 15 years of age living with HIV comprised of 530,000 people. 2 The spreading of this virus in this region is mainly due to sexual transmission, however, for countries such as Vietnam and Malaysia, contamination of infected needles among injecting drug users is the major mode of transmission. 3 (See Table 1). 1 THE JOINT U.N. PROGRAMME ON HIV/AIDS [UNAIDS] & WORLD HEALTH ORGANISATION [WHO], 2009 AIDS EPIDEMIC UPDATE (2009), available at /JC1700_Epi_Update_2009_en.pdf (last visited Sept. 23, 2010). 2 UNAIDS & WHO, Fact Sheet: AIDS in the ASEAN Region Facts and Figures, available at (last visited Sept. 23, 2010). 3 UNAIDS, UNAIDS/WHO/UNICEF Epidemiological Fact Sheets on HIV and AIDS, available at (last visited Sept. 29, 2010); ASEAN, THE ASEAN WORK PROGRAMME ON HIV/AIDS II (2002), available at (last visited Sept. 29, 2010).

4 430 AJWH [VOL. 5:427 Table 1: Summary of HIV/AIDS among ASEAN member countries. 3 *ASEAN Work Programme on HIV/AIDS II, 2001 **Figures at the end of 1999-Data not available III. SOCIO-DEMOGRAPHY OF MALAYSIA Malaysia, situated in the South East Asia region, has a total landmass of 329,845 square kilometres. The country is separated by the South China Sea into two regions, West Malaysia (Peninsular Malaysia) and East Malaysia on the island of Borneo, and consists of 13 states and three federal territories (Kuala Lumpur, Labuan and Putrajaya). Malaysia borders Thailand, Indonesia, Singapore and Brunei. The population of the country

5 2010] ACHIEVING THE U.N. S MILLENIUM 431 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS is estimated at over 28 million. 4 The annual population growth rate from is 2.1. The crude birth rate is 17.6 while the crude death rate is 4.5 in the year In 2010, majority (68.1%) of the population is between years old with 27.2% less than 15 years of age and 4.7% of its population is 65 years old and above. 5 The life expectancy at birth for a male Malaysian is estimated to be 72 years, while for a female Malaysian is 76.8 years. 6 The Gross Domestic Product and the GDP Growth Rate (constant 2000 prices) in the first quarter of 2010 is RM 133,899 million (US$ 41,843) 10.1%. 7 Malaysia s population comprise of many ethnic groups, with the Malays making up the majority estimated at 49.6%, followed by Chinese (22.9%), Bumiputera (10.7%), Indians (9.3%), Others (1.3%) and non-malaysians (8.8%). 8 III. HIV/AIDS TRENDS AND PATTERNS IN MALAYSIA The first case of HIV infection in Malaysia was detected in late But even before that, a Taskforce on AIDS was already set up. The Malaysia government adopted multifaceted approaches to tackle the issues of HIV/AIDS in Malaysia in terms of prevention, treatment, care and support. One of the earliest measures taken to prevent the virus from spreading is the safe blood programme whereby donated blood were routinely screened in Since then many other programmes and national policies have been set up to curb this disease from spreading in the nation. Among other programmes that has been implemented are such as media campaigns, PROSTAR (Health Programme without AIDS for Youth), counselling, healthy lifestyle, HIV screenings, health education, school programmes, Harm Reduction Programme, PMTCT (Prevention of Mother to Child Transmission), ARV (Antiretroviral) therapy and much more. These programmes look into different phases of the disease and target specific group of people from healthy to high risk individuals and individuals with initial and progressive stages of the disease. Such strategies provide 4 Department of Statistics Malaysia, Monthly Statistical Bulletin Malaysia, June 2010, d=53&lang=en (last visited Sept. 29, 2010). 5 Department of Statistics Malaysia, Demographic Indicators, Malaysia, 2009, gov.my/portal/index.php?option=com_content&view=article&id=205%3afree-download&catid=6 1&Itemid=53&lang=en (last visited Sept. 29, 2010). 6 Id. 7 Department of Statistics Malaysia, National Product and Expenditure Accounts First Quarter 2010, May 13, 2010, icle&id=446%3anational-product-and-expenditure-accounts-first-quarter-2010-updated &catid=38%3aquarterly-gross-domestic-products&itemid=61&lang=en (last visited Sept. 29, 2010). 8 Supra note 4.

6 432 AJWH [VOL. 5:427 different types of approaches from health awareness and promotion to reducing risks of HIV infections and provision of treatment and support to those who are already infected with HIV. The Malaysian government also collaborates with many other agencies within the country such as non-governmental organisations, namely, Malaysia AIDS Council, PT Foundation, Federation of Reproductive Health Associations Malaysia, community-based organisations, private sectors and even private healthcare practitioners to implement various programmes and campaigns to address issues regarding HIV/AIDS. Partnerships were also formed with international organisations, such as, World Health Organisation (WHO), United Nations Population Fund (UNFPA), United Children s Fund (UNICEF), United Nations Development Programme (UNDP), and UNAIDS. This will keep Malaysia abreast with other nations with regards to HIV/AIDS issues. This paper examines the current situation and progressions towards addressing HIV/AIDS issues in Malaysia. IV. SITUATIONAL ANALYSIS OF HIV/AIDS IN MALAYSIA Malaysia, the home to one of the fastest growing AIDS epidemics in the East Asia and Pacific region, nine people are tested positive for HIV daily. 9 Between the first detected case in 1986 and December 2009, 87,710 men, women, and children reportedly infected with HIV, while 13,394 have died of HIV/AIDS. 10 (See Figure 1) 9 Malaysian AIDS Council & Malaysian AIDS Foundation, 2009 Annual Report, at 5, 2009, available at (last visited Sept. 29, 2010). 10 Id.

7 2010] ACHIEVING THE U.N. S MILLENIUM 433 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS Figure 1 The Malaysian HIV Epidemic ( ) 11 The common HIV transmission among men was through injecting drug use with prevalence of approximately 22.1%. 12 As for women, heterosexual transmission is the main mode of transmission with the prevalence of 70%. 13 The majority of infected men and women were age between 20 and 49 years. 14 (See Figure 2) Young people between ages years old comprised of almost 36% of cumulated reported infections by December Id. 12 Ministry of Health Malaysia, UNGASS Country Progress Report, January 2008-December 2009, at 10 (Mar. 2010). 13 Id. 14 Department of Statistics Malaysia, Social Trends in Malaysia. Series 11/2009, at 4, 2009, available at id=101&itemd=53&lang=en (last visited Sept. 29, 2010). 15 Supra note 9.

8 434 AJWH [VOL. 5:427 Figure 2: Age group distribution of HIV/AIDS cases in Malaysia ( ) 16 In terms of ethnicity, Malays hold the record for being the largest group to have reported HIV infections (71.0%) followed by Chinese (14%) and Indians (8%). 17 (See Figure 3) 16 Supra note Supra note 9.

9 2010] ACHIEVING THE U.N. S MILLENIUM 435 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS Figure 3 Reported HIV Infections by Ethnicity in Generally, HIV infections among Malays and Indians were usually through injecting drug use, while for Chinese, heterosexual transmission predominated among them. 19 (See Figure 4) 18 Id. at THE U.N. COUNTRY TEAM MALAYSIA, ACHIEVING THE MILLENNIUM DEVELOPMENT GOALS, SUCCESSES AND CHALLENGES (2005).

10 436 AJWH [VOL. 5:427 Figure 4: Distribution of New HIV Cases by Ethnicity and Mode of Transmission, Malaysia, HIV transmission in Malaysia continues to be mainly through the sharing of needles among drug users at 55.2%, though much lower than the 74.7% reported in year This is followed by heterosexual contact (26.7%) and homosexual contact (5.3%), in which the figures has increased from the report in year 2000, which was 17.6% and 1.2% respectively (See Figure 5). It seems that sexual transmission of HIV is on the rise from 18% of new reported cases in year 2000 to 32.0% by (See Figure 5) 20 Id. at Id.; supra note 12, at Id.

11 2010] ACHIEVING THE U.N. S MILLENIUM 437 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS Figure 5 Percentage of new HIV cases by risk factor 23 Although men represent the majority of reported HIV infections and AIDS cases (more than 90%). However, the rate of infection among women is also on the rise from 9.4% in 2000 to 19.1% in (See Figure 6) The HIV epidemic in Malaysia has now begun to reveal a diversion in its course that of increasing heterosexual transmission and, what is termed an increasing feminisation of the epidemic. That is, more people are becoming infected through heterosexual transmission and, increasingly, more women are now living with HIV. This is projected in the trend of the increasing number of HIV infected women and decreasing number of HIV cases among men reported from year Id. 24 Ministry of Health Malaysia, Percentage of Reported Cases of HIV by Sex (2010), available at (last visited Sept. 29, 2010). 25 Id.

12 438 AJWH [VOL. 5:427 Figure 6 Percentage of reported HIV cases by sex 26 Although at present, Malaysia is labelled as a country with a concentrated epidemic since the HIV prevalence has been less than 1% among the general population but consistently higher than 5% (between 3% and 20%), 27 the rising prevalence, despite the government s efforts to control the spread of HIV/AIDS, has called upon the review of the effectiveness of the programs launched under the United Nation s Millennium Development Goals, particularly in halting and reversing the spread of HIV/AIDS. The national response to HIV/AIDS has been in collaboration between the government, Non-Governmental Organizations (NGOs) and civil society since its emergence. In 1992, the Malaysian AIDS Council (MAC) was established as an initiative of the Ministry of Health Malaysia to be an umbrella organization of NGOs working on HIV/AIDS issues. 28 It provides counselling, outreach programs, training, education and awareness raising. National Coordinating Committee on AIDS, chaired by the secretary general of health, was established to facilitate intersectoral collaboration for action. The MAC, representing 37 NGOs, also sits on the committee as a 26 Id. 27 Supra note 19, at MALAY. AIDS COUNCIL, MALAYSIAN AIDS COUNCIL STRATEGIC PLAN (2008), available at pdf (last visited Sept. 23, 2010).

13 2010] ACHIEVING THE U.N. S MILLENIUM 439 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS representation of the civil society. The number of NGOs has increased to 42 in V. NATIONAL STRATEGIC PLAN OF ACTION ON HIV/AIDS The Strategic Plan of Action on HIV/AIDS was developed in The plan was revised in 1998 with input from various relevant ministries, departments and NGOs. The Strategic Plan for the Prevention and Control of HIV/AIDS was developed and documented. Further revision took place to comply with current national priorities related to HIV/AIDS. The updated Malaysia s National Strategic Plan on HIV/AIDS for has six national strategic plans coordinated by the MAC. The six strategies include strengthening leadership and advocacy, enhancing training and capacity, reducing HIV vulnerability of IDU and their partners, young people, children, and other marginalised and vulnerable populations. The plan also aims at improving access to treatment, care and support for people infected with HIV/AIDS. 30 A. Prevention and Screening The majority of the cases were detected through screening processes conducted at drug rehabilitation centres, antenatal clinics, and correctional institutions. In 1986, the first screening program was established, and as of 2005, there were more than 70 HIV screening centres throughout the country. Routine screening was done nationwide through various screening programmes on selected groups such as women receiving antenatal care in government facilities, drug rehabilitation centres (DRC) inmates, prison inmates classified as high risk (i.e., drug users, drug dealers and, sex workers), confirmed tuberculosis cases, sexually transmitted disease (STD) cases, patients with suspected clinical symptoms, traced contacts of confirmed persons with HIV, premarital couples, migrant workers and participants of harm reduction programme and blood donors. 31 Blood donors were screened to prevent HIV infection through blood transfusion. The low rates of HIV transmission through blood transfusion can be attributed to the efficiency of the blood screening program implemented in Malaysia with only cumulative 31 HIV cases and 20 AIDS cases over 23 years since The prevalence of HIV positive cases detected through 29 Id. 30 Id. 31 Supra note19, at Malaysian AIDS Council, Total Numbers of HIV Cases and Related Deaths Reported in Malaysia (2010), available at _for_2009.pdf (last visited Sept. 29, 2010).

14 440 AJWH [VOL. 5:427 screening of donated blood had been consistently low with only 0.034% in 2002, % in 2003 and 0.077% in Under the Prevention and Control of Infectious Disease Act of 1988, all HIV infections must be reported to the nearest district health authority. Surveillance is carried out to obtain data on the epidemiological profile and identify emerging risk groups; routine HIV screenings among Injected Drug Users (IDUs), sex workers, prisoner and other high risk groups are conducted to monitor the spread of HIV. In order to prevent mother-tochild transmission, since 1988, all women seeking antenatal care in government facilities nationwide are also tested. The coverage has improved from 49.7% in 1998 to 98.1% in Although antenatal screening is not mandatory for women who seek antenatal care in private hospitals, it is estimated that more than 70% of women nationwide seek antenatal care at public healthcare facilities. 36 There is a lower number of detected HIV positive mothers (171 mothers) who underwent the Prevention of Mother to Child Transmission (PMTCT) programme in the year 2009 compared to 2001 (79 mothers) and 2008 (200 mothers). 37 Following the effectiveness of this programme, 96% of children born by HIV positive women were free from HIV. 38 B. Public Education and Awareness Early in the 1990s, Healthy lifestyle campaigns were launched in an effort to create public awareness and to prevent the transmission of HIV/AIDS. An intensive AIDS media campaign was introduced in 1991 with the theme Prevent AIDS Now while specific programs for youths, inmates of correctional institutions were also initiated. Among the programs, a program called PROSTAR Program Sihat Tanpa AIDS untuk Remaja (Health Programme without AIDS for Youth) was launched in 1996 to empower youths to practice a healthy lifestyle to enable them to withstand negative influences. Through PROSTAR, youths are equipped with information about AIDS, high-risk activities and other issues. As of December 2005, PROSTAR has conducted a total of 5,871 activity sessions where as many as 815,157 adolescents between the ages of 13 to 25 years 33 Ministry of Health Malaysia & WHO, Consensus Report on HIV and AIDS Epidemiology in 2004: Malaysia (2004), available at D9-BF7A-AEDCBF4A5E22/0/Consensus_Report_MAA_2004.pdf (last visited Sept. 29, 2010). 34 Rozaidah Talib, The State of the Epidemic in Malaysia, in FIGHTING A RISING TIDE: THE RESPONSE TO AIDS IN EAST ASIA (Tadashi Yamamoto & Satoko Itoh eds., 2006) Supra note 12, at Siti Norjinah, Rapid Assessment of HIV and Infant Feeding Work Malaysia (2005), available at (last visited Sept. 29, 2010). 37 Supra note 12, at Id.

15 2010] ACHIEVING THE U.N. S MILLENIUM 441 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS were educated on HIV/AIDS. 39 Many of these activities were organised by peer motivators. In 2004, majority of HIV infections among women (67.6%) occurred through sexual transmission, that is, most women were infected by their spouse or sex partner and most of them were housewives. 40 The increasing percentage of HIV cases among women, from 1.2% in 1990 to 9.4% in 2000, and 19.1% in and its effect on women is an indication that the disease has gone beyond affecting just IDUs and sex workers. In 1997, an awareness campaign Women and AIDS was launched to raise awareness about issues related to HIV/AIDS and reproductive health. However, because of the subordinate status of women, where in most cases, are not able to demand their partner to undergo HIV screening nor use condoms, specific programs were also developed by the Ministry of Women, Family, and Community Development to provide training on parenting, healthy lifestyles, and responsible sexual behaviour to families. In response to the evolving scene of HIV/AIDS prevalence among gender with the increasing number of female HIV cases in the country, also termed as the feminisation of HIV/AIDS, a special taskforce was set up in the National Advisory Council of Women to address this issue. Premarital HIV Screening was launched in 2001 starting with a single state, Johor in South Malaysia. This programme was implemented by the Religious Department of the State Government. In January 2009, it became mandatory for all Muslims couples in Malaysia who are to get married to undergo HIV testing. Muslims couples are required to submit a certificate that discloses their HIV status to the State Religious Departments. The prevalence of HIV/AIDS cases through premarital HIV screening has decreased with HIV positives cases detected in 2006 compared to 67 cases 43 detected in In Malaysia, the non-muslims are not obligated to participate in this mandatory screening, however, they are encouraged by the Government to undergo voluntary premarital HIV screening. C. Harm Reduction With the majority of HIV/AIDS infection in Malaysia attributed to injecting drug use, one of the HIV/AIDS responses is through the Harm Reduction Approach. In reducing vulnerability among IDUs and their 39 PROSTAR Activities, (last visited Sept. 29, 2010). 40 Rohani Ali, Wanita dan HIV/AIDS (Women and HIV/AIDS), presented at the UNFPA-UNDP- AFFPD Forum with Women Parliamentarians on HIV/AIDS, Drugs and Poverty (Mar. 12, 2006), available at (last visited Sept. 23, 2010). 41 Supra note Supra note Id. at 42.

16 442 AJWH [VOL. 5:427 partners, harm reduction initiatives, namely Methadone Maintenance Therapy (MMT) and Needle and Syringe Exchange Program (NSEP) are being implemented in The implementation of these programmes has reported to show positive outcomes. In terms of country policy level, drug use which was previously considered as a criminal offense is also now treated as a health issue. Healthcare personnels are now involved together with law enforcement officers in dealing with drug use. The MMT also enables HIV positive drug users who are on the MMT programme to be given better access to the anti-retroviral therapy (ART). 44 In addition, these programmes also contributed to the reduction in unsafe injecting drug use behaviours 45 and increased employment rate among drug users who attends the MMT programme. 46 All these ultimately bring down the risk of HIV transmission. The country now has 74 MMT services. As of 31 December 2007, a total of 4,135 drug addicts had been registered and enrolled into the Government MMT programme. 47 In April 2008, the MMT programme was extended into the prison system starting with a pilot project in Pengkalan Chepa prison. Methadone availability is being enhanced and monitored by the Ministry of Health. Currently, MMT is being introduced into more government hospitals and clinics, private healthcare practitioners and including the National Anti-Drug Agency (NADA) service centres. There is an elevated number of MMT clients each year from 2006 to In 2009 alone, 3,665 people participated in this programme which makes up the total number of active clients of MMT programme to be 7,455 people. 48 One of the main preventive efforts carried out by Malaysian Government is The Needle and Syringe Exchange Program (NSEP). It is a programme collaborated by Ministry of Health Malaysia and Malaysian AIDS Council and was commenced in February Initially, this proposed programme was rejected strongly as it was thought that it will encourage drug use. However, the findings in the Report on the Millennium Development Goal (MDG) by the Economic Planning Unit and UNDP in May 2005 revealed that the sole Millennium Development Goal that has yet to be achieved by Malaysia is to stop HIV/AIDS from spreading. Thus, this propelled the initiation of the NSEP programme in January There had been an increasing number of NSEP clients since 2007 and until 2009, 44 Adeeba Kamarulzaman, Impact of HIV Prevention Programs on Drug Users in Malaysia, 52 J. ACQUIRED IMMUNE DEFICIENCY SYNDROMES s17, s17-s19 (2009). 45 National Task Force on Harm Reduction, Final Report. Needle and Syringe Exchange Program. Final Pilot Project Report (Ministry of Health Malay., 2007). 46 National Task Force on Harm Reduction, Implementation Status Report (Ministry of Health Malay., 2009). 47 Fabio Mesquita et al., Accelerating Harm Reduction Interventions to Confront the HIV Epidemic in the Western Pacific and Asia: the Role of WHO (WPRO), 5(26) HARM REDUCTION J. (2008). 48 Supra note 21.

17 2010] ACHIEVING THE U.N. S MILLENIUM 443 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS there are more than 18,000 Injecting drug users who are registered under this programme. 49 Besides providing sterile syringes, NSEP also promotes the safety use and disposal of needles and syringes, dissemination of education relating to HIV/AIDS and sexual issues, encourage the practice of safe sex by giving out condoms and provide referrals for NSEP clients to other centres such as Methadone Maintenance Therapy (MMT), (voluntary counseling and testing) VCT, welfare, drug treatment, and healthcare centres. 50 (See Figure 7) 49 Supra note 9, at Id.

18 444 AJWH [VOL. 5:427 Figure 7: Clients Receiving Referral Through NSEP in D. Treatment, Primary Case and Support In order to decentralise the management of HIV patients from a hospital based setting to the primary care level, the Ministry of Health is currently integrating the management of HIV patients at healthcare centers and polyclinics throughout the country. To date, more than 250 clinics are offering services including risk assessment, voluntary counselling and testing, medical examinations, prophylaxis, follow up and referral. Screening tests in Malaysia are done in two stages. The first test is called the Rapid Test. This test is able to produce results within 15 minutes and has 99.9% sensitivity and 99.8% specificity. 52 Individuals who are reactive to the Rapid Test will proceed to undergo a confirmative test, in which the results can be obtained within a period of between one week to one month. The Johor state was the first state to pilot the Anonymous Voluntary HIV Testing Programme using the Rapid Test kit at public health clinics in In 2003, this programme was successfully expanded nationwide. In 2009, a total of 19,368 people underwent this programme and it was found that the prevalence rate of HIV was 0.28% Id. 52 MINISTRY OF HEALTH MALAY. & ACAD. OF MED. MALAY., CLINICAL PRACTICE GUIDELINES MANAGEMENT OF HIV INFECTIONS IN PREGNANT WOMEN 6 (2008), available at med.org.my/view_file.cfm?fileid=246 (last visited Sept. 23, 2010). 53 Supra note 13.

19 2010] ACHIEVING THE U.N. S MILLENIUM 445 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS While there is no vaccine or cure for HIV/AIDS, the provision and access to Anti-Retroviral Therapy (ART) is the only way to keep people infected with HIV/AIDS healthy for many years and sometimes indefinitely. The recommended treatment, Highly Active Anti-Retroviral Therapy (HAART), was introduced in Following the availability and accessibility of the lower cost anti-retroviral therapy (ART) in 2004, provision of treatment to patients at no charge became possible. At present, the MOH provides two drugs at no charge, while patients with AIDS will have to buy the other one drug. The MOH is providing all three drugs at no charge to patients classified under the following categories: Infected mothers and newborns infected with HIV, children, infected individuals through contaminated blood or blood products, healthcare workers infected through occupational exposure, and government officers. VI. ACHIEVING UNITED NATION S MILLENIUM DEVELOPMENT GOAL Based on current data and progression made towards achieving the United Nation s Millenium Development Goal Six, Malaysia has potential prospect in reversing and halting HIV/AIDS by The notification rate for HIV/AIDS in Malaysia has been decreasing for the past 8 years reaching 10.8 in 2009 from 28.5 in year The increasing trend in the number of individuals screened has revealed that Malaysia is experiencing a consistent decreasing trend in the reported number of HIV cases. In addition, there were no increase in prevalence of HIV positive among antenatal mothers and the prevalence among blood donors remain at low level and premarital screening were also made compulsory nationwide to all Muslims which proved the effectiveness of the programme. The Harm Reduction Programmes also showed positive outcomes with increasing number of clients each year. All these reflected the effectiveness in policies, strategies and programmes carried out to eradicate HIV/AIDS in the country, but more needs to be done to reverse and halt HIV/AIDS by VII. CONCLUSION HIV/AIDS has far reaching implications on the country. Not only that it is undermining economic growth, it also affects human and social capital. Since its emergence, there have been mass media campaigns through television broadcast, radio, posters, booklets aimed at raising awareness about HIV/AIDS. The efforts come from the government, NGOs, as well as 54 Sha ari Bin Ngadiman, Strategies in Addressing HIV/AIDS Epidemic, presented at HIV SUMMIT 2010 Call to Action for Broad-based Responses to AIDS by Leaders at Manila, Philippines (Apr. 12, 2010).

20 446 AJWH [VOL. 5:427 the private sectors. HIV awareness, screening and prevention programmes has been increased and expanded over the years with promising outcomes of evidences such as lower rates of HIV positive mothers and IDUs recorded. Although some successes have been accomplished, ongoing efforts are still needed as the challenge remains, especially in the global trend of the feminisation of HIV/AIDS in Malaysia. In order to achieve the United Nation s MDG target, collective efforts and interventions at higher phase are needed to tackle the changing scenario.

21 2010] ACHIEVING THE U.N. S MILLENIUM 447 DEVELOPMENT GOAL IN COMBATING HIV AND AIDS REFERENCES Books THE U.N. COUNTRY TEAM MALAYSIA (2005), ACHIEVING THE MILLENNIUM DEVELOPMENT GOALS, SUCCESSES AND CHALLENGES. YAMAMOTO, TADASH & SATOKO ITOH (eds.) (2006), FIGHTING A RISING TIDE: THE RESPONSE TO AIDS IN EAST ASIA. Article Kamarulzaman, Adeeba (2009), Impact of HIV Prevention Programs on Drug Users in Malaysia, 52 JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES s17. Mesquita, Fabio et al. (2008), Accelerating Harm Reduction Interventions to Confront the HIV Epidemic in the Western Pacific and Asia: the Role of WHO (WPRO), 5(26) HARM REDUCTION JOURNAL. Norjinah, Siti (2005), Rapid Assessment of HIV and Infant Feeding Work Malaysia, available at sia.pdf. UN/WHO related Documents The Joint U.N. Programme on HIV/AIDS [UNAIDS] & World Health Organisation [WHO], 2009 AIDS Epidemic Update (2009), available at n.pdf. UNAIDS & WHO, Fact Sheet: AIDS in the ASEAN Region Facts and Figures, available at 13_epi_fs_ASEAN_en.pdf. UNAIDS, UNAIDS/WHO/UNICEF Epidemiological Fact Sheets on HIV and AIDS, available at VData/Epidemiology/epifactsheets.asp. Working Papers, Internet and Other Sources Department of Statistics Malaysia (June 2010), Monthly Statistical Bulletin, available at _content&view=article&id=539&itemid=53&lang=en. National Task Force on Harm Reduction, Final Report. Needle and Syringe Exchange Program. Final Pilot Project Report (Ministry of Health Malay., 2007). National Task Force on Harm Reduction (2009), Implementation Status Report (Ministry of Health Malaysia). Malaysian AIDS Council (2010), Total Numbers of HIV Cases and Related Deaths Reported in Malaysia, available at folder/files/hiv_info/malaysia_aids_stats_for_2009.pdf.

22 448 AJWH [VOL. 5:427 Department of Statistics Malaysia (2009), Demographic Indicators, Malaysia, 2009, com_content&view=article&id=205%3afree-download&catid=61& Itemid=53&lang=en. Department of Statistics Malaysia (May 13, 2010), National Product and Expenditure Accounts First Quarter 2010, my/portal/index.php?option=com_content&viewarticle&id=446%3ana tional-product-and-expenditure-accounts-first-quarter-2010-updated &catid=38%3Aquarterly-gross-domestic-products&Itemid =61&lang=en. Department of Statistics Malaysia (2009), Social Trends in Malaysia. Series 11/2009, available at php?option=com_content&view=article& id=101&itemd=53&lang=en. Malaysian AIDS Council (2008), Malaysian AIDS Council Strategic Plan , available at attachment/mac-strategicplan pdf. Malaysian AIDS Council & Malaysian AIDS Foundation (2009), 2009 Annual Report, available at sian-statistics/. MINISTRY OF HEALTH MALAYSIA & ACADEMY OF MEDICINE OF MALAYSIA, CLINICAL PRACTICE GUIDELINES MANAGEMENT OF HIV INFECTIONS IN PREGNANT WOMEN (2008), available at med.org.my/view_file.cfm?fileid= 246. Ministry of Health Malaysia & WHO, Consensus Report on HIV and AIDS Epidemiology in 2004: Malaysia (2004), available at w.wpro.who.int/nr/rdonlyres/47e92eb0-3f10-45d9-bf7a-aedcbf 4A5E22/0/Consensus_Report_MAA_2004.pdf. Ministry of Health Malaysia (2010), Percentage of Reported Cases of HIV by Sex, available at pdf. Ministry of Health Malaysia (March 2010), UNGASS Country Progress Report, January 2008-December PROSTAR Activities, Ali, Rohani (March 12, 2006), Wanita dan HIV/AIDS (Women and HIV/AIDS), presented at the UNFPA-UNDP-AFFPD Forum with Women Parliamentarians on HIV/AIDS, Drugs and Poverty, available at ppt. Ngadiman, Sha ari Bin (April 12, 2010), Strategies in Addressing HIV/AIDS Epidemic, presented at HIV SUMMIT 2010 Call to Action for Broad-based Responses to AIDS by Leaders at Manila, Philippines.