Imprisonment among opiate dependent patients on community based Medication Assisted Treatment - Norsiah Ali

This study looked at the reduction in re offence after being on methadone. It also showed that Malays were 1.5 x less likely to be re imprisoned.  165 patients out of 18,000.
In this country if you are found to have positive urine you would be put in 2 year observation, not being put in prison, but need to report monthly at police office.  If you had a positive urine and were caught with another positive urine you'd be put into jail..  Those under observation are first time offenders. We were only doing random monthly urine in our population.
There was a significant improvement in quality of life and reduction of stealing and physical assault.
None in program sero converted.
 
In the Question and Answer period people who had attended the off site prison treatment program yesterday

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,

All the Way Home by David Berner

All the Way Home is a book that chronicles the truly amazing and miraculous life of the X Kalay Foundation. X Kalay is a First Nations word for "The Unknown Path". It is also part memoir of it's founding member, David Berner himself.
X Kalay began in the 1960's when David Berner became a member of the Young Canadians. In the federal penitentiary he began to help a fledgling group of First Nations folk wanting to develop a half way house for aboriginals in hope of countering the almost complete recidivism of the day.
It became apparent from the start that no one wanted to just go half way but indeed wanted to go all the way on to never return to the penitentiary. To this end abstinence from drugs and alcohol became a cornerstone of this early recovery house.
The lessons learned in early years are poignantly described in colourful action sidestepping none of the violence, sex and harsh words that went into developing a working prototype which would go on to influence all subsequent recovery communities.
David Berner, born in Ottawa, studied Mathematics and Literature at University of Winnipeg thereby becoming a North Winnipeg Jewish intellectual. He and the community would incorporate all manner of eclectic ideas from the Synanon community to encounter groups led by innovative hypnotist psychologist, Dr. Lee Pulos. The free for all creativity of these early days fairly percolates from the pages as young men and women sought whatever way possible to stay clean and out of jail. Together they developed the Game, a therapeutic tool for group cohesion.
X Kalay would grow to 125 residents and a $2 million dollar budget closing in 1976 in British Columbia but living on in the Behavioural Health Foundation of Manitoba.
David Berner, actor, talk show host, television personality, provacateur, journalist is a splendid writer. He promotes the cause of abstinence fearing the emphasis on 'harm reduction' denies the humanity and potential of addicts who he has seen personally find new life in X Kalay and programs that promote such respect and honesty. His writing is reminiscent of Victor Frankl. His compassion for his fellow human and his track record of solid success are amazing.
I was deeply moved by All the Way Home and would recommend it to all who work in the field of addictions and corrections. Alone it's an amazing testimony to marginalized humans with extraordinary dreams. The potential of the human spirit shines throughout this beautiful and uplifting book of great endeavour.


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