Malaysia tackles disease spread among drug users

The drug addicts emerge quietly from a jungle in Malaysia’s southernmost state of Johor, smiling shyly as they drop their bloodstained syringes into a pail and wait for new ones.

Exchanging clean needles for used ones is common in many Western countries, which see it as necessary to reduce harm among addicts who might otherwise share needles and spread diseases such as HIV/AIDS and hepatitis.

But in mostly Muslim Malaysia, where drug addicts carry a very heavy social stigma, adoption of the harm reduction programme is seen by public health experts as a milestone.

“The trend now is that drug addicts are infecting their wives, who can then pass diseases to their children,” said Sivakumar Thurairajasingam, a psychiatrist and vice president of the help group Intan Life Zone Welfare Society.

Explaining the rationale of “harm reduction”, he added: “Some people will take time to change no matter what you do. If you give them methadone, they will just sell it. They are going to inject drugs anyway, so you make sure they do it safely.”

With 13 out of every 17 newly diagnosed HIV cases in the country being injecting drug users, activists managed to convince the government to try the needle exchange programme in 2006.

So far, it appears to be working in Johor state, where the HIV/AIDS problem is most severe. Malaysia has over 81,000 HIV/AIDS cases, of which more than 14,125 are in Johor.

“Needles are expensive, between two (55 U.S. cents) and five ringgit each and if you don’t have clean needles, you are sure to share. We would even sharpen the needle continuously till it gets too short to be used,” said an Intan social worker and former drug addict, who asked not to be identified.

There were 269 newly diagnosed HIV cases in the first half of 2008 in Johor, compared to 605 in all of 2007, according to statistics from Malaysia’s Ministry of Health.

UPHILL BATTLE

For Lyn, a 42-year-old addict, clean needles would have to come free or the alternative would be to share.

“Everyday I earn 20 ringgit, 15 ringgit is used for drugs and 5 ringgit is for my son, I always save some for my son. I want to quit but even if I do, when I see my friends, I will still shoot drugs,” she told Reuters.

When they started the programme, the social workers had a tough time getting the authorities on their side.

“At first, the police couldn’t understand what we were doing. They opposed our programme as they thought we were encouraging people to take drugs. They handcuffed our staff,” said Nashrudin Jafrey, head of Intan’s Harm Reduction programme.

“Now the police don’t interfere with us or try to get information from us like who the pushers are.”

Malaysia gets its heroin from the infamous Golden Triangle, the area bordering Myanmar, Laos, Vietnam and Thailand.

However, younger addicts are now mixing their heroin with psychotropic drugs like ecstasy (methylenedioxymethamphetamine), ice (methamphetamine) and ketamine to get more powerful effects.

“You need much more heroin to get that high, so it is cheaper to spike to get that effect,” said Jafrey.

But doctors warn of the dangers of psychotropic drugs.

“The complications of psychotropic drugs are many. For ice and ecstasy, we see heart and lung problems and breathing difficulties, even brain damage,” said Peggy Chu, a doctor who has treated many young drug addicts in Hong Kong.

“Heroin creates physical dependence, but we can help with things like methadone. But psychotropic drugs create psychological dependence, it’s more difficult to handle.”

(US$1 = 3.597 ringgit)

By Tan Ee Lyn
KAMPONG PASIR PUTIH, Malaysia (Reuters Life!)