Prevention for Key Population
March 23, 2017
April 2, 2018
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“The implementation of the Harm Reduction programme through Methadone Maintenance Therapy and Needle & Syringe Exchange Programme has shown positive results, with many kicking drug addiction and leading a quality life. The success of the two programmes reflects the spirit of smart partnership and commitment between the government and private and non-government organisations in reducing the numbers of Malaysians hooked on drugs.”

Datuk Seri Dr Liow Tiong Lai, Minister of Health (Source: New Straits Times, 22 Feb 2010).

The Needle & Syringe Exchange Programme (NSEP)

remains on the front line of the harm reduction approach to reduce HIV vulnerability among people who inject drugs. Introduced by the Ministry of Health in partnership with the Malaysian AIDS Council in 2006, the NSEP broke new grounds in providing direct community-based health care services for people who inject drugs nationwide. Through 17 NSEP sites, more than 24,000 registered people who inject drugs were served in 2010, with over 300,000 NSEP kits containing fresh needles and syringes distributed.

Activities of the NSEP in Malaysia include:
  • Exchanging used needles and syringes for sterile ones
  • Safe disposal of used injecting materials
  • Reaching out and educating PWID on HIV/AIDS and other related health issues
  • Providing PWID with referrals, rehabilitation, health and welfare agencies
  • Encouraging safer sex practices through education and condom distribution

Harm Reduction

1What is Harm Reduction?
Harm reduction refers to policies, programs and practices designed to reduce the harms associated with psychoactive drug use by individuals who are unable or unwilling to stop using it.  That defines a specific aspect is the focus that emphasizes the prevention of harm from drug use prevention and focus on the drug user as an individual. (IHRA Briefing, Pg 1)
2What is NSEP?
NSEP is acronym of Needle Syringe Exchange Program.  It reduces the risk of HIV infections and other infectious diseases associated with needle sharing among injection drug users.
3Malaysia approach related to NSEP
Malaysia adopted the approach in Drop In Centre (DIC) and Outreach Worker. Drop in Center providing:
  • Needle exchange
  • Counselling
  • Light treatment
  • Meals
  • Rest place
4Outreach workers
Outreach workers are former drug users who have been trained to carry out the NSEP. They will go to “port” and do the work NSEP accordance with the Guidelines approved by the Ministry of Health.
5The average age of clients who visited DIC
For NSEP have guidelines that state that IDU under 18 years old cannot be visited DIC. They should refer to other agencies such as AADK. Client age is between 25-50 years.
6How many Outreach sites in Malaysia and where is located?
There are 17 Outreach Sites in all states except Sabah and Sarawak. All this outreach site maintained by the MAC partner organisations under. The locations are as follows:
  • Kedah (Cahaya Harapan)
  • Penang (AIDS Action Research Group)
  • Wilayah Persekutuan Kuala Lumpur
  • Chow Kit (IKHLAS)
  • Selangor (Insaf Murni)
  • Melaka (Kelab Rakan Melaka)
  • Kelantan (SAHABAT)
  • Terengganu (CAKNA)
  • Pahang (Drug Intervention Community)
  • Johor(Intan Life Zone)
7What is Methadone Maintenance Therapy (MMT)
MMT is a drug replacement therapy using methadone as a means of reducing drug injecting activity.
8The extent to which MMT managed to reduce the harm?
  • Drug users not feel high when using it
  • Reduce drug related crime
  • Reduce the desire to inject
  • Provide opportunities for IDUs to recover and return to work
9Is it against the law if we have/carry more than three packets of condoms?
There are no legal provisions on condom. However, condom can be used as evidence of the circumstances (circumstantial evidence) if arrested the alleged solicitation for sexual purposes. (Soliciting sex)
10Does NSEP contribute to the increase in the number of drug addicts in Malaysia?
There is no evidence to support this statement. In fact, in many studies done, NSEP actually reduce the rate of injection drug users because of the referral services.


Community-based outreach and education programmes are key in improving access to HIV prevention and treatment services for key affected populations who are often marginalised due to stigma and discrimination. Outreach workers, a vast majority of whom are members of the key affected populations themselves, are deployed as peer educators to disseminate targeted information, education and communication materials about HIV prevention, sexual and reproductive health, medical and legal aid referral services, as well as safe sex commodities such as condoms and lubricants. This programme also aims to address gender and sexuality issues, and drug use, violence and other compounding factors that intensify HIV vulnerability.

In 2010, approximately 68,000 outreach contacts were made with sex workers (SWs), transsexuals (TSs) and men who have sex with men (MSM) collectively through the work of ten Partner Organisations nationwide, with more than 500,000 condoms distributed.


Program_Shelter Home_Leaflet_A4_24092014_cover
1How many shelter homes for HIV in Malaysia?
Under MAC Partner Organisations we had 14 shelter homes in all states.
2List of shelters
  • Pulau Pinang
    Community AIDS Services Penang (CASP)
  • Kuala Lumpur Dan Selangor
    Rumah Solehah 1
    Rumah Solehah 2
    WAKE 1
    WAKE 2
    WAKE 3
    Faith Helping Centre 1
    Welcome Community Home
  • Johor Darul Takzim
    Intan Life Zone – Dignity 1
    Pertubuhan Harapan Kasih
  • Pahang Darul Makmur
    Casa Villa – DiC Malaysia
    Casa Harapan – DiC Malaysia
    Casa Non Kasta – DiC Malaysia
    Casa Femina – DiC Malaysia
  • Terengganu Darul Iman
    Pertubuhan Komuniti CAKNA
  • Sabah
    Sabah AIDS Support Services
    Association (KASIH)
3How many home sponsored by the Ministry of Women, Family and Community (KPWKM)?
Since 2009, all shelter home been sponsored by KPWKM.


Hospital Peer Support

Although the services of treatment, support and assistance were more widespread, but PLHIV are still faced with many challenges and obstacles to obtaining these services, particularly services for financial assistance, social and psychology.

Since some period of years, more attention is given to recognize and incorporating a peer support program to help in the continuum of support and assistance to PLHIV. Involvement and peer approach, particularly in hospitals, and home visits appears more proven its effectiveness in improving adherence to treatment and can also influence behaviour change required to undergo a more positive life.

In the early epidemic of HIV/AIDS in Malaysia, before treatment is given for free, and outreach related services is still not widespread, PLHIV support groups rely heavily on small-scale aid to understand their health condition. Currently, the treatment has been given free, and many programs treatment, care and support that have been implemented. But, as in the early epidemic in ’80s, interest is still strong on support group and cannot be disputed in helping PLHIV, families and their friends in social, education and medication aspects. Support groups can reduce feelings of loneliness often felt by PLHIV – well physically or emotionally, and able to empower them to lead a positive life.

For many PLHIV, a peer support group is the first place where they can share with others their status, and meet with others PLHIV. When a group of PLHIV can share the anxiety, fear and any other question, it is able to empower themselves, respectively, because they then realize that many PLHIV who have been through the same process, have been overcome successfully.

Among the topics are often discussed in the support group are about the ways of HIV transmission, treatment options, treatment side effects, hospitals and clinics that offer treatment and methods of safer sex practices. Most of PLHIV, the support group is the safest place for them to discuss the topic with more openly.

Support groups are often seen as one method of treatment for PLHIV – without prescription! This is because the support group members will obtain more benefits together only with other PLHIV, and thus can control and manage their health more effectively. The value of support groups cannot be trivialized and set aside.


1Definition of Program Peer Hospital Support Group
A trained team who work in hospitals to help provide services and support to PLHIV, and help in daily work at the hospital associated with PLHIV. This Peer support also implemented of home visit program.
  • Giving moral support to patients who come to the clinic for treatment
  • Provide information and explain the guidelines and policies related to the clinic, the patient or client and also a support group to help patients do not feel afraid or awkward to get treatment, help and support from hospital
  • Provide basic information about HIV/AIDS, safe sex, sexual reproductive health and opportunistic infections
  • Complement the counseling services offered at the hospital
  • To assist the clinic staff to ensure that the needs of patients/clients and matters that affect patients
  • Improve information on treatment/adherence HAART medication
3Why there should be support groups in hospitals?
  • Number of patients receiving HAART treatment is growing rapidly and will continue to increase
  • Adherence to HAART intake was complex accomplished through by own self
  • Staff at the hospital are not enough to meet the needs of patients to HAART treatment adherence and support to them
4Criteria as a peer support
  • A person living with HIV (PLHIV) for effective sharing of positive life
  • Responsible for the work done
  • Be open, no prejudice to entertain all the PLHIV
  • Sincere and honest in work responsibilities
  • Good and calibre personal lives and can be seen as a role model to the patient/client
  • Be patient to help PLHIV according to their own step
  • Able to pay attention to the PLHIV client
  • Very concerned in maintaining the confidentiality of client
  • Knowledgeable and able to assist clients with a network of related support

Responsibilities of a peer support

1Practical support
Bring new client to the specialist clinic and help them to get services such as:
a) Blood test
b) X-ray (Scope, CT scan and related others)
c) Medication treatment
d) Check-in registration as patient
e) Referral to get help from other medication with related
2Emotional support
a) A peer support is a safe place where PLHIV can express their problems and share all the tangles that are playing in their mind. Listen to their stories and try to understand the emotional problem faced by the patient/client.
b) Assist to reduce the client’s emotional problems by sharing your personal experience. Member of support group will help learn from each other’s way to accept their HIV status and live positively. At the same time, client will get strength and acceptance that they are not alone with their problems.
3Providing Information
a) Basic HIV/AIDS information (mode of transmission, risky behaviours, more secure way of life, etc.)
b) Health care and how to achieve optimal health
c) Adherence to treatment prescribed by a doctor
d) Taking medications according to the time and amount which be determined
e) Related services (SOSCO, Baitulmal, EPF, etc.)
4Encourage a peer support group meetings
If a patient/client appears to have self-confidence, encourage them to join a support group. Tell them the advantages which can be obtained by joining a support group.
Meetings involve between 3-15 people, where each peer will share their experiences living with HIV.
Meeting may involve a specialist or counselor to provide opinions and information in matters relating to:
a) Compliance in taking ARV
b) Side effects
c) Acceptance of HIV status
d) Other matters that require the expertise of a doctor or counsellor
5Home visits activities
Objective Home visit
a) understand the needs of patients and their families
b) build a friendly relationship
c) appropriate opportunity to learn about the environment, find ways to overcome common problems, encourage family participation in the activities of the patients
d) support and referral to the related agencies to reduce the burden on family
e) effective visit to enhance emotional mental development and physical condition the whole family
f) know and understand the cultural, social and environmental conditions
g) assess the elements that cause patients to feel bad about, the lack of a balanced diet, being abused or neglected by family

a) often hospitalized or had just discharge from the ward
b) no ability to independently
c) seriously ill
d) family just lost loved ones (patients) to AIDS
e) often failed to meet an appointment at the clinic of infectious diseases
f) serious chronic diseases
6Work Ethic of Peer Support
1. Understand the tasks to be done
2. Know the boundaries/limitations of the job requirements. Do not enter the hospital staff area unless requested by them and do not hold the patient files
3. Maintain the confidentiality of patient/client. If they refused to give personal information, do not force
4. Do not provide information that is incorrect/false. if do not know, ask the expert refer to the medical officer/nurse about any concerns about the questions related to medical
5. Do not make empty promises to the patient/client. pledge of all the promises made
6. Follow the instructions of the procedures prescribed by the hospital management
7. Observed behaviour in order to be in hospital/clinic
8. Do not do any personal business while on duty in hospital
9. Priority welfare of patients/clients
10. Do not ask for any compensation/wages from the patient/client
11. Wear appropriate and casual clothing. As an identifier, please use the name tag of your organization as a peer support.

Remember! As a peer support act to strengthen the relationship between patient and physician. A peer support should not act as a mediator between the patient and the hospital agency.


Drop-in Centers (DICs) are an extension to outreach activities with the aim of providing direct services for key affected populations in a non-judgmental environment. The services differ from one setting to another dependent upon the key affected populaton served, but chiefly include facilities for maintaininig personal hygiene and basic healthcare, warm meals, peer education, support groups, as well as referrals for voluntary HIV counselling and testing and legal aid.

The DIC in Penang provides the opportunity for people living with HIV (PLHIV) and their family members to participate in peer education sessions and support group activities. In Melaka, sex workers (SWs) may benefit from the sexual and reproductive health education as well as HIV and STI services offered through the DIC. Meanwhile, the DIC for women in Pahang catering to spouses and intimate partners of Injecting drug users (IDUs) enables them to access services such has peer counselling, support sessions and referrals.



MAC through its Partner Organizations delivered targeted community based interventions encompassing promotion and provision of preventive tools, behavior change communication materials and effective linkages to clinical services within an enabling environment amongst the sex workers, transgender and men who have sex with men communities.


MAC Condom Use Infographics


Position statement 2009 – UNAIDS

[Originally published in 2004 updated in 2009]

Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment

Prevention is the mainstay of the response to AIDS. Condoms are an integral and essential part of comprehensive prevention and care programmes, and their promotion must be accelerated. In 2007, an estimated 2.7 million people became newly infected with HIV. About 45% of them were young people from 15 to 24 years old, with young girls at greater risk of infection than boys.

  • The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.
  • Condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use.
  • HIV prevention education and condom promotion must overcome the challenges of complex gender and cultural factors.
  • Condoms have played a decisive role in HIV prevention efforts in many countries.
  • Increased access to antiretroviral treatment creates the need and the opportunity for accelerated condom promotion. Read