This presentation was presented in National AIDS Conference Malaysia 2014

1. WHAT NEED TO BE DONE
GAME CHANGER – PAST AND FUTURE
MINISRY OF HEALTH MALAYSIA

2. Reported HIV and AIDS-related deaths, Malaysia 1986
– 2014 (Jan-Jun)
Cumulative HIV = 103,348
Cumulative deaths = 16,742
PLHIV (end of 2013) = 86,606

3. Reported HIV cases by mode of transmission and
PWID/Sexual transmission ratio, Malaysia 2000-2013

4. MALAYSIA HIV SITUATION BY AGE GROUP

5. MALAYSIA HIV SITUATION BY RISK FACTORS

6. MALAYSIA HIV SITUATION BY GENDER

7. HIV Prevalence among KP at selected cities 2012
5.8
6.8
18.9
4.9
5.7 6.0
11.5
1.4
9.8
1.6
16.5
4.4
1.1 1.3
0
3.7
0
2
4
6
8
10
12
14
16
18
20
FSW
(2012)
MSM
(2012)
PWID
(2012)
TG
(2012)
HIVprevalence(%)
National
Melaka Historical City
Kuantan
Kota Kinabalu
Kuching
KL IBBS 2009
10.5 (n=551)
KL IBBS 2009
22.1 (n=630)
KL IBBS 2009
9.3 (n=540)
KL VDTS 2009
3.9 (n=517)

8. Cascade for HIV treatment and care, Malaysia, 2013
85,322
59,725
17,202
14,622
10,235
5,118
0
50,000
100,000
Diagnosed PLHIV Enrolled in care Initiated ART Retained on ART
after 12 months
Received viral load
test
Suppressed viral
load*
Number
* Number of patients initiating ART who are still on ART at 12 months
and have VL of <1000copies/ml
263.0 245.4
370.8
333.9
0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
400.0
450.0
500.0
National Melaka
Historical City
Kuantan Kota Kinabalu
MedianCD4atARTinitiation

9. HIV SCREENING IN MALAYSIA,
2000 - 2013
(2013: 0.01%)
0.0
0.5
1.0
1.5
2.0
0
500,000
1,000,000
1,500,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percent
No.screening
No. screening Detection Rate

10. WHAT WE ALREADY KNOW
 Reducing trend
 Predominantly male
 Increasing female but slow
 Majority PLHIV : PWID
 Sexual transmission… past 3 years >50% new
cases:
 Heterosexual (majority)
 MSM
 Age group….maintained
 ARV coverage….. 52.2% (2014 June)

11. WHAT WE ALREADY KNOW
 Screening
 Accessibility good
 Numbers improving
 But ….. KP may be still not reached
 Workable intervention
 Need aggressive intervention….

12. HIV Prevalence in adult population, Malaysia1986-2030
(AEM My2014)

13. UNDERSTANDING the epidemic

14. UNDERSTANDING the epidemic

15. WHAT NEED TO BE DONE!

16. NEW TREATMENT TARGET FOR 2020
 90% PLHIV know their status
 90% diagnosed with HIV receive sustained ART
 90% of all who receiving ART will have viral
suppression
90-90-90

17. FAST TRACK STRATEGY
 Provide life saving HIV treatment
 Every 10% increase in treatment coverage, there is 1%
decline of new infection
 Treatment as prevention……….
 Treatment to discordant married couple
 Option B+ to pregnant mothers
 Strengthen & Bold prevention services for KP
 Reach them
 Community testing …..T&T ….. Referral guideline
 MSM & reaching hidden MSM

18. FAST TRACK STRATEGY
 Targeted intervention at high HIV prevalence
 Priority areas
 Implement proven interventions
 Condoms
 Harm Reductions
 Male circumcision
 Appropriate massage esp. on SRH
 Consolidated effort eg. CGZ

19. WHERE APPROPRIATE

20. SUMMARY OF KEY INTERVENTIONS
HIV PREVENTION STATUS
1. The correct and consistent use of condoms with condom-compatible lubricants is
recommended for all key populations to prevent sexual transmission of HIV and
sexually transmitted infections (STIs).
2. Among men who have sex with men, PrEP is recommended as additional HIV
prevention choice within a comprehensive HIV prevention package. (NR)
3. Where sero-discordant couples can be identified and where additional HIV
prevention choices for them are needed, daily oral PrEP (specifically tenofovir or
the combination of tenofovir and emtricitabine) may be considered as a possible
additional intervention for the uninfected partner
4. PEP should be available to all eligible people from key populations on a
voluntary basis after possible exposure to HIV.
5. Voluntary medical male circumcision is recommended as an additional, important
strategy for the prevention of heterosexually acquired HIV infection in men,
particularly in settings with hyper-endemic and generalized HIV epidemics and
low prevalence of male circumcision.

21. SUMMARY OF KEY INTERVENTIONS
HARM REDUCTION FOR PWID STATUS
6. All people from key populations who injects drugs should have access to
sterile injecting equipment through needle and syringe programmes
7. All people from key populations who are dependent on opioids should
be offered and have access to opioid substitution therapy
8. All people from key populations with harmful alcohol or other substance
use should have access to evidence-based interventions, including brief
psycho-social interventions involving assessment, specific feedback and
advice.
9. People likely to witness an opioid overdose should have access to
naloxone and be instructed in its use for emergency management of
suspected opioid overdose. NR

22. SUMMARY OF KEY INTERVENTIONS
HIV TESTING AND COUNSELLING (HTC) STATUS
10. Voluntary HTC should be routinely offered to all key populations both
in the community and in clinical settings. Community-based HIV testing
and counselling for key populations linked to prevention, care and
treatment services, is recommended, in addition to PITC.
HIV TREATMENT AND CARE
11. Key populations living with HIV should have the same access to ART and
ART managements as other populations
12. All pregnant women from key populations should have the same access
to services for PMTCT and follow the same recommendations as women
in other populations

23. SUMMARY OF KEY INTERVENTIONS
PREVENTION AND MANAGEMENT OF CO-INFECTION AND
C0-MORBIDITIES
STATUS
13. Key populations should have the same access to TB prevention,
screening and treatment services as other populations at risk of or
living with HIV.
14. Key populations should have the same access to hepatitis B and C
prevention, screening and treatment services as other populations at
risk of or living with HIV.
15. Routine screening and management of mental health disorders
(depression and psycho-social stress) should be provided for people
from key populations living with HIV in order to optimize health
outcomes and improve their adherence to ART. Management can range
from co-counselling for HIV and depression to appropriate medical
therapies.

24. SUMMARY OF KEY INTERVENTIONS
SEXUAL AND REPRODUCTIVE HEALTH STATUS
16. Screening, diagnosis and treatment of STI should be offered routinely
as part of comprehensive HIV prevention and care for key populations.
17. People from key populations, including those living with HIV, should be
able to experience full, pleasurable sex lives and have access to range
of reproductive options.
18. Abortion laws and services should protect the health and human rights
of all women, including those from key populations.
19. It is important to offer cervical cancer screening to all women from key
populations.
20. It is important that all women from key populations have the same
support and access to services related to conception and pregnancy
care, as women from other groups.

25. WHAT ELSE
 Depend on us
 Sit and discuss
 Understand the epidemiology
 Design appropriately
 Deliver
 Sustain
 Review regularly including M&E
 Adjust accordingly for the need.

26. TERIMA KASIH