Combined prevention programs within criminal justice systems examples from malaysia
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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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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

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


Project harapan study design

Project Harapan: Study Design

Project Harapan


Project harapan initial findings

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%


Pilot study methadone dose matters

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


Harapan tb

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


Hiv group

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


Results

Results


Hiv in drug treatment rehabilitation centers

HIV in Drug Treatment & Rehabilitation Centers


Hiv diagnosis treatment care

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


Hiv diagnosis treatment care1

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


Combined prevention programs within criminal justice systems examples from malaysia

A COMPREHENSIVE HIV/AIDS PREVENTION AND TREATMENT PROGRAMME IN DRUG REHABILITATION CENTRES IN MALAYSIA

NATIONAL ANTI-DRUGS AGENCY (NADA)

MINISTRY OF HOME AFFAIRS

MALAYSIA


Objective

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


Combined prevention programs within criminal justice systems examples from malaysia

National AntiDrugs Agency

Methadone Maintenance Program

2007 - 20011

2007

2008

2009

2010

2011


Combined prevention programs within criminal justice systems examples from malaysia

NADA MMT PROGRAM

  • 33 CCSC

  • 8 Klinik C&C 1Malaysia

  • 2 PUSPEN


Combined prevention programs within criminal justice systems examples from malaysia

FASILITI


Medical evaluation

MEDICAL EVALUATION

NADA MALAYSIA


Challenges

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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