Integrating HIV with Addiction Treatment in Community and Custodial Health Care Services - Adeeba Kamarulzaman - ISAM 2013 Kuala Lumpur

(These are my rough notes that hopefully will give an impression of the depth and breadth of the research and researchers work-W.Hay)
The co existence of HIV in iV drug users is as low as 10% in countries where approaches have been taken to address this early. In Malaysia theres as high as 50%.


With HIV treatment TB is the cause for mortality.
Prevalence of undiagnosed pulmonaryTB among prisones is 12%  - we are instituting a tb screening program at entrance to the prisons.

HIV Epidemiologic Researahc on Outcomes (HERO) study
Longitudinal studying of HIV infection in drug users
Have high mortality.
HIV infected  IV users 7.5/1000
Unaffected IV users 1.5/1000


Modelling of combined and high coverage intervention to prevent HIV infection
Opiate agonist therapies reduce HIV
British Commbia Research Study presented showing benefit of giving retroviral therapy to those who use IV drugs

IDU(intravenous drug users) - of those with HIV only 25% are receiving retroviral therapy
IDU's often present later in the course of their HIV infections
IDU's underrepresented
-Barriers to 'seek,test, treat, and retain'
requires active outreach and overcoming the stigma that surrounds substance abuse and HIV

Addictophobia - exaggerated fear, aversion, distrimation agains drug users
since the beginning of HIV idus have been villified
Apathy - to the suffering
Inattention to adolescent , street youth, women who inject drugs
Criminal Justice System -
Criminal Justice System in Malaysia
- prisoners 40,000 9137/100000
high prevalence of mental ill, mandatory HIV teasing 6% prevalence, methadone introduced in 2009 to 12 prisons, hybrid health care system (Ministry of Health and Justice System)
No form of HIV treatment in compulsory treatment

CDDC survey
2 of 6 HIV positive
80% of all HIV known by both programs
Fair proportion didn't know their HIV status.
Comprehensive care is being provided now in different Malaysian community
Project Harapan has been started to improve situation
Implementaltion Factors
-patient factors -tb related comorbidity, disclosure
-staff factors- clinician concerns, security concerns, repeated educational sessions
Institutional level - we've been fortunate the the 2 director generals for the last 5 years have been fully behind us, we have national task force, integrating criminal justice and public health, anti retroviral treatment not that available.
needle exchange has been done as well,