In Malaysia, over half of all HIV infections are transmitted through sharing contaminated needles and syringes. To combat the spread of the epidemic, the government in 2006 spearheaded 'harm reduction' interventions (pdf) which included a program where people who inject drugs are provided unused needles and syringes in exchange for used injecting equipment. Those who are addicted to opioids such as heroin, the most commonly used illicit substance in Malaysia, can also enroll in rehabilitation for synthetic opioid replacement therapy. Synthetic opioids, taken orally, help stabilize the opioid cravings of patients, thus enabling them to work. The move to introduce harm reduction in Malaysia revealed something that caught people by surprise—many of the fishermen from port city on the east coast of peninsular Malaysia use drugs.
When I think of HIV/AIDs, symbols pop into my mind: the red looped ribbon and the free condom. They’re actually a good representation of what Thailand is doing best to combat the epidemic- massive information campaigns and the 100% Condom Program which saw the dramatic decline of HIV/AIDS among sex workers.
However, those symbols faded in my mind after I visited an old, impoverished part of Bangkok and met the people who currently are the most vulnerable to HIV/AIDS- the injection drug users.
HIV/AIDS and other blood-borne diseases are transmitted when needles are shared. Under influence, many users are also likely to have unprotected sex. There are programs called ‘harm reduction’ where drug users are provided with clean needles, syringes, and condoms to avoid transmission. Condom distribution is easy but needles are another issue.
On April 21, a few days before World Malaria Day, we announced some very encouraging results from a pilot project in Zambia through which we were testing various improvements in the public sector supply chain for lifesaving drugs. What we had been trying to do, with support from DfID and USAID, was to remove bottlenecks and get key supplies like pediatric malaria drugs off the shelves in district storage facilities and out to patients in rural areas on time.
When private sector techniques--like hiring someone to plan drug orders based on actual consumption in rural public health centers--were used to strengthen the public sector supply chain, we saw that the availability of pediatric malaria drugs nearly doubled in rural health centers in the 16 pilot districts.
This is a very significant finding, as just 7 percent of children in rural Zambia receive first-line treatment for malaria within 24 hours of developing fever (Zambia National Malaria Indicator Survey, 2008). We estimate that if these techniques are scaled up nationwide, 27,000 children could be saved from malaria deaths between now and 2015—cutting child mortality from malaria by 37 percent in Zambia.