Epidemiology and Behavioural Study of HIV Infection Among Drug Users in Peninsular Malaysia

1
Epidemiology and Behavioural Study of HIV
Infection Among Drug Users in Peninsular
Malaysia
Dr. Zainudin Abdul Wahab Disease Control
Division Ministry of Health, Malaysia zainudin_at_dph
.gov.my 13 Jan 03
2
Drug use problem in Malaysia

• No. of drug users detected in 1998 37,588
• 23 male government drug rehabilitation centres
  (DRCs) in Peninsular Malaysia
• 1 male DRC in East Malaysia
• 2 female DRCs 1 voluntary DRC
• 25 of drug users were admitted to DRCs
• Duration of stay maximum 2 years

3
HIV infection in Malaysia

• 28,541 HIV infections 1986-98
• 95 male
• 83 aged 20 - 39 yrs
• 77 among drug users
• Prevalence of HIV
• Drug users 17.6 (1997)
• Adult population lt1 (1996)
• Pregnant women lt1 (1997)

4
HIV prevalence amongdrug users 1988-1998
Source Annual Report 1998, MOH Malaysia
5
Rationale

• HIV infection in Malaysia mainly among drug users
• Current surveillance system lacks behavioural
  component

6
Objectives

• Among male drug users in government DRCs-
• 1. To determine HIV prevalence in this population
  
• 2. To describe the socio-demographic, injecting
  and sexual behaviour
• 3. To determine the risk factors and behaviour
  associated with HIV seropositivity

7
Methods (I)

• cross-sectional study design
• study population all males in DRC in Peninsular
  Malaysia, admitted June-September 1998
• sampling procedure
• Peninsular Malaysia were stratified into 4
  regions
• All 23 DRCs listed by region
• 16/23 DRCs selected using systematic random
  sampling
• All subjects selected were eligible

8
Stratification of DRCs
9
Methods (II)

• Self-administered questionnaire
• socio-demographic
• sexual behaviour
• drug use pattern (ever use)
• injecting behaviour (in 6 months before entering
  DRC)
• Blood samples tested for
• HIV
• Analysis (in STATA)
• Descriptive statistics
• Logistic regression

10
Study population

• 2181 eligible
• 1942 completed questionnaire data
• 1938 completed HIV results
• Total response rate 89

11
Socio-demographic characteristics of drug users

• Mean age 29 yrs (range 14-49)
• 82 Malay
• 64 ever sexually active
• 77 never married
• 66 first time in DRC
• Mean age of first drug use 20 yrs
• 67 had injected drugs

12
Characteristics of injecting drug users

• Mean age first injection 23 yrs
• 80 heroin users
• Median. freq. of injection 3 times per day
• 81 shared needles/syringes
• 28 shared gtonce per day
• 95 cleaned needles before re-use
• 93 had lent needles to a close friend

13
HIV Prevalence among injecting and non-injecting
drug users, by region
inject 58 52 68
76
14
Factors associated with HIV seropositivity among
drug users
15
Sexual behaviour associated with HIV
seropositivity among IDUs
OR(95CI) Adjusted for age
Ever married (20) 1.26 (1.02-1.58)
16
Risk factor associated with HIV seropositivity
among IDUs
OR(95CI) Adjusted for age
Recidivists 1.75 (1.2-2.5) h/o recent
injection 2.76 (1.5-5.0)
17
Injecting behaviour associated with HIV
seropositivity
95CI Adjusted for age
Risk Factor

18
Needle/syringes sharing behaviour and HIV
riskamong IDUs inject drugs in the last 3
monthsbefore admitted to DRC
95CI Adjusted for age
Risk Factor
19
Univariate analysis

• Older age
• Recidivist
• Longer history of injecting
• Injected drugs in previous admission
• Currently married
• Frequently shared used needles or syringes
• Used unclean needles

Increased Risk of HIV Infection
20
Multiple Logistic Regression Analysis

• Duration of injecting drugs
• Sharing of needles (recidivists)
• Region

Increased Risk of HIV Infection
21
Summary (I)

• High HIV prevalence in IDUs (10-36)
• Low prevalence in non-IDUs (1-10)
• Regional variation in HIV prevalence (highest
  in East)

22
Summary (II)

• Among injecting drug users, risk factors for HIV
  were-
• injecting drugs recently
• injecting drugs on the street
• sharing - needles
• - drugs (by frontloading)
• - rinse water
• not cleaning needles
• being married
• age 25-34yrs.

23
Conclusions

• Among injecting drug users, risk factors for HIV
  were-
• duration of injection
• sharing of needles or syringes
• The East Region
• Sexual behaviour could be a long term hazard for
  IDUs

24
Recommendations

• Behavioral Surveillance for HIV infection
• Epidemiological Surveillance

25
Acknowledgements

• National Anti-Narcotic Agency
• State Health Departments
• Disease Control Division, Department of Public
  Health
• London School of Hygiene Tropical Medicine

26
Thank You
27
Sample size
s ?p (1 p) D/n
D 1 (b 1) roh