HIV and Harm Reduction

I am glad to read that the HIV cases have dropped drastically since the introduction of Harm Reduction Program in 2005.

I recalled vividly the amount of resistance that I have to face from all people when I first brought up this issue in the Cabinet in 2005.

I was called by one Menteri Besar of a PAS government that I was probably the most stupid Health Minister that this country has ever had.

Since under the Needle Exchange program, the MOH has been giving needles and condoms to high-risk individuals and HIV carriers. A lot of people reacted with horror to my suggestion although it is proven to be successful in many other countries.

I must admit some of the resistance came from Ministry of Health officials who think that this is religiously correct to oppose to the Harm Reduction project.

To ensure that the Harm Reduction program is a success, I also push for Methadone replacement therapy for the addicts who constitute the main source of HIV infection thru the sharing of needles.

Under the Methadone replacement therapy, the drug addicts are no longer dependant on the needles but of oral intake of liquid methadone.

In this respect, I must thank the Prime Minister and Deputy Prime Minister for their strong political will and support to the program.

It was with their support that the program was able to push through the Cabinet and the special committee on HIV.

Today, I am glad to know that the number of HIV cases has dropped from 6756 cases in 2003 to 3452 cases (end of this year).

In order to sustain these successes, it is important that there should be:

1) Education with greater awareness

2) Treatment

3) Counseling

4) Funding

5) Training of MOH health personnel and counselors

6) Continuous close work with NGOs especially the AIDS council and supporting group

7) Political commitment and common sense.

We cannot depend on pre-marital mandatory HIV testing to control HIV infection. It is only good at that point of time and provides a false sense of security.

It is education and awareness of HIV spread that is more important.

The logistic involved in mandatory testing is huge and the pick-up rate is low, which is about 5 cases per 10, 000 testing. These resources should be used for counseling and treatment of HIV patients.

A lot of HIV patients are not captured in our usual medical services provider and are poorly managed.

A better understanding of its mode of transmission of HIV and its prevention is the best tool to fight HIV, not mandatory pre-marital testing.

With better understanding, individual will go for testing voluntarily.

There must be confidentiality and follow-up management if test is positive.

减害计划（Harm Reduction）自2005年实行以来，爱滋病例明显地大幅度减少，对此我觉得欣慰不已。

还记得在2005年,我首次向内阁提呈“减害计划”的建议时，受到多方极力反对。一位回教党州务大臣甚至拨电予我，斥责我是有史以来最笨的卫生部长。

卫生部推行的针筒交换计划，是为吸毒者和爱滋病带菌者等高风险群体分发针筒和安全套。目的并非鼓励这些人士吸毒和性交，而是减少通过共用针筒和性行为传染爱滋病。尽管针筒交换计划证实在多个国家取得成功，但国内人士却对我提出这项建议感到可怕。

我必须承认，在卫生部也有一些官员基于宗教因素而反对“减害计划”。为了确保“减害计划”奏效，我也争取以美沙酮替代疗法为因共用针筒而感染爱滋病的的吸毒者进行治疗。

美沙酮替代疗法，是让吸毒者口服液体美沙酮取代注射，摆脱对针筒的依赖。

上述计划得以推行，我必须感谢首相和副首相的支持。在两位最高领导的全力支持下，有关计划才能在内阁会议和爱滋病特委会获得通过。

今天，我很高兴国内的爱滋病例再次减少，截至今年年杪，爱滋病已降至3452宗，相比于2006年的6756宗少了3304宗。

要持续这项成就，以下因素缺一不可：

1) 教育

2) 治疗

3) 辅导

4) 资助

5) 为卫生部医药人员和辅导员提供培训

6) 与非政府组织，特别是大马爱滋病理事会和爱滋病支援组织持密切合作

7) 政治承诺和基本常识

我们不能依靠强制性婚前检验来预防爱滋病疫，更重要的是教育群众。

要实行婚前检验需要庞大的后勤，而且事倍功半，成效不大，在每1万接受检验的人群当中，平均只检测出5宗感染爱滋病病例。既如此，不如善用这些资源为爱滋病患提供治疗和辅导。

强制婚前检验不是打击爱滋病的最佳方法，了解病毒的传播途径，掌握防范措施才是最有效的做法。只有增进对爱滋病的了解，人们才会主动接受检验和防范。

此外，若证实被感染，医院和有关当局必须高度保密病人的一切资料，这是保护和照顾病人的基本责任。