Malaysia. Key Data Issues and Suggestions

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2 DECEMBER 2011 REFERENCE SOURCES This review of reference sources is categorized into two groups, namely general sources and country sources. The general sources include the regional or global documents, such as the Report on the Global AIDS Epidemic, Towards Universal Access Progress Report, The World Health Report, World Health Statistics, State of World Population, The Human Development Report, and data from the UN Population Division, and The World Bank Database. The country sources are classified into two: 1) surveys 2) others and 3) recent Journal Articles. The surveys include the HIV Sentinel Surveillance Survey (HSS), Behaviour Surveillance Survey (BSS), Integrated Biological and Behavioural Survey (IBBS). The others include studies, research and guidelines. Most reference documents utilized for Malaysia are available in electronic format and can be accessed through the internet. Some documents are available as hard copy version only. GENERAL SOURCES All the general sources of data on Malaysia are available. The socio-economic and demographic information/indicators are drawn from these sources. An overall picture of the HIV epidemic in Malaysia can be presented with the help of these general sources. COUNTRY SOURCES Surveys Data from population-based survey such as DHS or MICS are not available for Malaysia. Ministry of Health Malaysia, & WHO/WPRO. (2002). Prevalence Survey of Sexually Transmitted Infections among Sex Workers and Women Attending Antenatal Clinics, Malaysia Yap, I. (2009) The Integrated Bio-Behavioural Surveillance (IBBS) Survey 2009 Malaysia: Preliminary Findings. PowerPoint Presentation. Other Sources Scope. (2011). The Harm Reduction Study Visit Evaluation Report: Kuala Lumpur 9th-15th January. Resource Center Malaysian AIDS Council. (2010). AIDS in Malaysia Ngadiman, S. (2009). HIV/AIDS Situation in Malaysia Tai, R., & PT Foundation. (2009). MSM HIV Infection in Developed East and S.E Asia 10 August th ICAAP Bali: The Malaysian Situation. Power Point Presentation. 2

3 UNODC, & UNAIDS. (2009). Malaysia Country Advocacy Brief- Injecting Drug Use and HIV.Federation of Reproductive Health Associations Malaysia. (2009). Female Sex Workers and their Clients Interventions through Sexual and Reproductive Health. Ministry of Health Malaysia, & UNICEF. (2008). Women and Girls: Confrontation HIV and AIDS in Malaysia. Jaafar, S. H., Suhaili, M. R. H., Noh, K. M., Ehsan, F. Z., et al. (2007). Malaysia Primary Health Care Key to Intersectoral Action for Health and Equity. WHO. (2007). Sexual and Reproductive Health of Adolescents and Youths in Malaysia: A Review of Literature and Projects Ministry of Health Malaysia, & WHO. (2004). Consensus Report on HIV/AIDS: Epidemiology in Ministry of Health Malaysia, Riji, H. M., & Pataki-Schweizer, K. J. (2002). HIV/AIDS: The Realities, The Challenges. World Health Organization, & Ministry of Health Malaysia. (2001). Consensus Report on STI, HIV and AIDS Epidemiology Malaysia. WHO. (1999). STI/AIDS Situation in Malaysia Koon, T. Y. (undated). The Federation of Reproductive Health Associations Malaysia (FRHAM) & United Nations Population Fund (UNFPA) Project Second (Final) Report. Report on HIV/AIDS and Sex Work in Malaysia: Female Sex Workers. Recent Journal Articles Bachireddy, C., Bazazi, A. R., Kavasery, R., Govindasamy, S., Kamarulzaman, A., & Altice, F. L. (2011). Attitudes Toward Opioid Substitution Therapy and Pre-Incarceration HIV Transmission Behaviors among HIV-infected Prisoners in Malaysia: Implications for Secondary Prevention. Drug and Alcohol Dependence, 116(1-3), (Limited Access) Hasanah, C., Zaliha, A., & Mahiran, M. (2011). Factors Influencing the Quality of Life in Patients with HIV in Malaysia. Quality of Life Research, 20(1), (Limited Access) Kanter, J., Koh, C., Razali, K., Tai, R., Izenberg, J., Rajan, L., et al. (2011). Risk Behaviour and HIV Prevalence among Men who have Sex with Men in a Multiethnic Society: A Venue- Based Study in Kuala Lumpur, Malaysia. Int J STD AIDS, 22(1), (Limited Access) Narayanan, S., Vicknasingam, B., & Robson, N. M. H. (2011). The Transition to Harm Reduction: Understanding the Role of Non-Governmental Organisations in Malaysia. International Journal of Drug Policy, 22(4), (Limited Access) Amal, R. N., Aisah, M. Y., Fatmah, M. S., & Hayati, M. I. N. (2010). Trichomoniasis in Cosmopolitan Malaysia: Is it Under Control or is it Under Diagnosed? Southeast Asian Journal Tropical Medicine Public Health, 41(6), (Limited Access) Ghailan, K. Y., Jusoh, A., Rizal, M., Ezat, S., et al. (2010). Impact of HIV/AIDS Morbidity on Households Economy in Malaysia. Global Journal of Health Science, 2(2). (Open Access) 3

4 Zahari, M. M., Hwan Bae, W., Zainal, N. Z., Habil, H., Kamarulzaman, A., & Altice, F. L. (2010). Psychiatric and Substance Abuse Comorbidity among HIV Seropositive and HIV Seronegative Prisoners in Malaysia. The American Journal of Drug and Alcohol Abuse, 36(1), (Limited Access) Kamarulzaman, A. (2009). Impact of HIV Prevention Programs on Drug Users in Malaysia. Journal of Acquired Immune Deficiency Syndromes, 52, S17 S19. (Open Access) Tee, Y., & Huang, M. (2009). Knowledge of HIV/AIDS and Attitudes Towards People Living with HIV among the General Staff of a Public University in Malaysia. Sahara J, 6(4), (Open Access) Vicknasingam, B., Narayanan, S., & Navaratnam, V. (2009). The Relative Risk of HIV among IDUs not in Treatment in Malaysia. AIDS Care, 21(8), (Limited Access) Anwar, M., & Sulaiman, S. A. S. (2008). Evaluation of the Management of Sexually Transmitted Infections (STIs) by Private Practitioners in Pulau Pinang, Malaysia. Malaysian Journal of Medical Sciences, 15(4), (Open Access) Vicknasingam, B., & Navaratnam, V. (2008). The Use of Rapid Assessment Methodology to Compliment Existing National Assessment and Surveillance Data: A study Among Injecting Drug Users in Penang, Malaysia. International Journal of Drug Policy, 19, (Open Access) Wong, L. P., Chin, C. K. L., Low, W. Y., & Jaafar, N. (2008). HIV/AIDS-Related Knowledge among Malaysian Young Adults: Findings from a Nationwide Survey. Journal of the International AIDS Society, 10(148). (Open Access) Chawarski, M. C., Mazlan, M., & Schottenfeld, R. S. (2006). Heroin Dependence and HIV Infection in Malaysia. Drug and Alcohol Dependence, 82(Supp 1). (Limited Access) INDICATORS HIV prevalence and epidemiological status: HIV Sentinel Surveillance (HSS) was piloted in 1993 in 4 states and it included ANC clinic attendees, new STI patients, and newly diagnosed TB patients. However, the system was discontinued at the end of To date, HIV surveillance comprised of HIV/AIDS case reporting and routine screening of 11 population groups, namely: ANC attendees (government facilities), blood donors, drug rehabilitation centers inmates, prison inmates, confirmed TB cases, STI (sexually transmitted infections) cases, patients with suspected clinical symptoms, traced contacts of confirmed persons with HIV, premarital couples, migrant workers, and participants of harm reduction programme. However, there is no established system for systematic case reporting of STI and limited data is available among key affected populations. Integrated Biological and Behavioural Survey (IBBS) conducted in Kuala Lumpur in 2009 could provide data on HIV prevalence among female sex workers, transgender, and people who inject drugs (PWID). HIV prevalence among men who have sex with men (MSM) is also available from venue-based study in However, there is a paucity of data on HIV prevalence among key affected populations in the earlier years and it is difficult to observe the trends. Data on population size estimates of key affected populations and key populations at higher risk are available from the national consensus workshop HIV infection estimates are also available for 2001, 2007, and

5 Vulnerability and HIV knowledge: Data on HIV knowledge is limited among key affected populations as well as youth and general population. Knowledge data among sex workers (including transgender) is available from BSS 2004 and IBBS 2009 whereas the data is very limited among MSM. For PWID, it is available from BSS 2004, BSS 2006 and IBBS Though the full report is not available in the public domain, journal article on the findings of nationwide survey among Malaysian young adults in 2008 shed some light on the level of knowledge among young population. HIV knowledge among general population is not available. Risk behaviours: Most recent data among key affected populations are available from IBBS 2009 and venue-based survey among MSM in 2009 though it is limited to Kuala Lumpur. Although the reports are not available in the public domain, BBS 2002 was conducted among PWID; BSS 2004 was carried out among PWID and male, female and transgender sex workers in five states; and BSS 2006 among PWID in Kuantan city respectively. The findings from one-time behavioural studies are also available through journal articles. Socio-economic impact of the epidemic: HIV expenditure by spending categories and financing sources is available for 2008 and A few studies on impact of HIV/AIDS on household economies are available through journal articles. National response: Data on HIV testing among key affected populations of female sex workers, PWID, and MSM are available for 2009 whereas the prevention coverage data is limited to female sex workers and PWID. Other indicators related to national response such as ART coverage and prevention-of-mother-to-child transmission related indicators are also available from the Universal Access reports and the Global Reports. OVERALL IMPRESSION AFTER THE DATA REVIEW Strengths Biological and behavioural data is available among transgender. Data on population size estimates are available from the national consensus report Weaknesses Scarcity of serological and behavioural data among key affected populations to understand the epidemic and to observe the trends. In addition, most recent data available is not nationally representative and it is limited to Kuala Lumpur and its environs. Similarly, paucity of literature on other key populations at higher risk such as clients of sex workers. 5