Opium dependence was indigenous to countries in the Golden Triangle area in south-east Asia (SA). Heroin epidemics developed in most SA countries in the 1960s and early 1970s and remained a significant problem particularly in Myanmar, Thailand and Malaysia until now. In contrast, the island countries in SA seemed quite free from opiate abuse. Intravenous injection (IV) of drugs appeared after the heroin epidemic and currently prevails in countries with a significant opiate abuse problem. IV of opium was particularly common in the highly urbanized cities in Vietnam. Most SA countries started HIV seroscreening in IV drug users (IVDU) around the middle of the 1980s. Rapid epidemic spread of HIV infection was observed in 1988-89 in Thailand and Myanmar. The Highest prevalence of more than 80% was reported from a study of IVDUs in Yangon, Myanmar, followed by Thailand at about 40%. Although HIV infected IVDUs were identified at the same time in Malaysia and later in Singapore and the Philippines, there was no evidence of such a rapid and severe epidemic.
Matched MeSH terms: HIV Infections/prevention & control
Opium has been produced and consumed since the nineteenth century in the areas of Asia currently referred to as the Golden Crescent and the Golden Triangle. In the 1970s and 1980s, most countries from Afghanistan to Japan experienced a heroin epidemic of varying degrees of severity. Opium and heroin abuse appeared to be more severe in countries and areas where those drugs were produced, an exception being Hong Kong, which has had a large population of heroin abusers for more than two decades. Drug injecting was far more common in countries of the Golden Triangle than in those of the Golden Crescent. In Myanmar and Thailand, for example, up to 90 per cent of chronic heroin abusers practised intravenous injection, which appeared to spread to heroin abusers in nearby territories such as the State of Manipur in India. Yunnan province in China, as well as Malaysia and Viet Nam. Amphetamine abuse was more frequent in Japan and the Republic of Korea for a number of years, while illicit production and consumption in the Philippines have recently shown significant increases. The injection of amphetamines was common only in the Republic of Korea. The prevalence of injecting among institutionalized methamphetamine abusers was reported at about 90 per cent. Most countries in Asia first reported cases of infection with the human immunodeficiency virus (HIV) in the mid-1980s. An extremely rapid spead of the epidemic and high prevalence, at rates of from 30 to 90 per cent, of HIV infection among the sample of intravenous heroin abusers were observed in a few countries with a high prevalence of intravenous injecting, such as India (in the State of Manipur), Myanmar and Thailand. The rest had either few reported cases or none at all, even though needle-sharing was found to be common. Great caution should be exercised in interpreting prevalence because of vast differences in methods of assessment. Given the vulnerability of intravenous drug abusers to rapid transmission of HIV infection, the prevention of drug injecting is of paramount importance in arresting the spread of the epidemic. Efforts to contain drug abuse, though difficult, are a principal means of achieving that end.
Matched MeSH terms: HIV Infections/prevention & control
Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)
Matched MeSH terms: HIV Infections/prevention & control
A study was conducted to determine the feasibility of establishing a sentinel human immunodeficiency virus (HIV) surveillance system involving patients with sexually transmitted diseases attending private clinics and a government sexually transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk behaviours for HIV infection were also collected. A total of 84 female and 91 male patients were interviewed and tested for HIV infection; 41.7% of the women reported working as prostitutes, other occupations included masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The most common diagnosis was gonorrhoea. Other diagnoses included non-specific genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3% of the women had a hundred or more sex partners during the previous month; 99% had 6 or more sex partners. Only 4.8% of female patients had their male partners using condoms most of the time, 11.9% hardly used condoms at all. Of the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had between 6-20 different partners in the previous year. 78.0% of them had prostitutes as their sex partners most of the time. 41.8% had experiences in Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used condoms rarely. Although all patients were tested negative for HIV antibodies, lot quality assurance sampling methods indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The study has shown that it is feasible to carry out a sentinel surveillance programme among STD patients and provided useful baseline data for future comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)
Matched MeSH terms: HIV Infections/prevention & control
A study was conducted in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru to determine a local population's knowledge of HIV and their sexual behaviour in relation to it. A total of 231 men and 217 women were interviewed. The sexual culture seen is one of relatively late age of first sexual intercourse, low level of partner change and low level of condom use. Men reported a higher involvement in risk behaviour. Nearly all the respondents (95.8%) have heard of HIV/AIDS but had incorrect perceptions of its mode of transmission and its associations with risk groups. This study enable us to gain background information about our patients sexual behaviour and HIV knowledge. There is a need to continue HIV education to improve our public's HIV knowledge and the results of this study provides a baseline against which future educational interventions can be gauged.
Matched MeSH terms: HIV Infections/prevention & control*
A meeting was organized by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organisation (WHO) and the Japanese National Institute of Infectious Diseases (NIID) with the following objectives: (i) to discuss public health and economic rationale to accelerate the development and evaluation of HIV vaccines suitable for use in Asia; (ii) to review ongoing preclinical HIV vaccine research in Asia; (iii) to review the Asian experience in conducting clinical trials of HIV candidate vaccines; (iv) to explore possibilities for international collaboration between countries in the region and with other countries and institutions; and (v) to discuss issues related to availability of future effective HIV vaccines. The meeting was attended by participants from Australia, China, France, Germany, India, Japan, Malaysia, Myanmar, South Korea, Thailand, United Kingdom, and the United States of America. The HIV epidemic in Asia is rapidly spreading and has already resulted in a total of 7 million HIV infections in the region. The epidemic already has a significant public health and economic impact, which may be worse in the future, unless effective intervention programmes are successfully implemented. A safe, effective, and affordable vaccine should be considered as the best hope for a long-term solution to the HIV epidemic in Asia. Asian scientists and institutions have established a number of international collaborations to isolate and characterize prevalent HIV-1 strains (mostly belonging to subtypes C and E) and are developing candidate vaccines based on these subtypes. In the region, phase I/II clinical trials of preventative HIV candidate vaccines have been conducted in Australia, China and Thailand. Since 1993, a comprehensive National AIDS Vaccine Plan has allowed Thailand to conduct phase I/II trials of six different preventative or therapeutic candidate vaccines, and the first phase III preventative efficacy trial has been approved. The meeting identified both the needs and the opportunities to intensify international collaboration to accelerate the development of HIV vaccines in Asia.
Matched MeSH terms: HIV Infections/prevention & control*
Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.
Matched MeSH terms: HIV Infections/prevention & control
Injecting drug users (IDU) represent a small fraction of the HIV and AIDS cases in the Philippines. To determine if these people are engaging in behaviors that put them at risk for HIV, interviews were conducted with 360 male IDUs in Cebu City, Philippines, from 1997 to 1999, as part of a national surveillance system. The interviews assessed knowledge about HIV transmission, sources of information about HIV/AIDS, perceived risks of contracting HIV, needle-sharing practices, condom use, self-reported signs and symptoms of STDs and number of sex partners. Although most of the men were able to recognize behaviors accurately that put them at risk for HIV, more than two-thirds claimed that they shared needles and almost two-thirds of those who were sexually active claimed that they never used condoms. Intervention strategies must be developed for this population if the nation is to avoid the dramatic increase in HIV infection among IDUs that has been witnessed in neighboring Southeast Asian nations such as Malaysia and Vietnam.
Matched MeSH terms: HIV Infections/prevention & control
Since the first case of HIV/AIDS was identified in 1986 in Malaysia, the number of infected individuals has increased steadily each year, so that by the end of 2002 the cumulative number of people living with HIV/AIDS was 57,835 (51,256 with HIV and 6,579 with AIDS), with 5,676 AIDS deaths. The epidemic in Malaysia, currently in a concentrated epidemic stage, is primarily fueled by drug use, but there is ample evidence that heterosexual transmission has increased over the last few years. A strategic plan that includes prevention, care, support, and treatment run by both the government and nongovernmental organizations has been in place since the beginning of the epidemic. However, Malaysia will need to take a more pragmatic approach to reduce new infections (which numbered 19 each day in 2002) among the youth on whom the country relies for development. Leaders need to recognize that HIV/AIDS is not just a health issue, but also a socioeconomic concern that can eliminate all the developmental gains achieved over the years. Working together, Malaysians can overcome the epidemic, but there is a need to act quickly and to act in effective ways so that the devastating effects (already evident in the number of AIDS orphans and widows) can be reduced.
Matched MeSH terms: HIV Infections/prevention & control
Occupational risk of Human Immunodeficiency Virus (HIV) infection is a matter of concern for health care workers. We conducted a study to gauge the level of awareness amongst HCW (doctors and nurses) working in Hospital Sungai Petani regarding the post-exposure prophylaxis in case of needle stick injuries from confirmed or suspected cases of HIV. Nineteen Doctors (56%) and 13 nurses (25%) were aware of correct risk of transmission. None identified all the four risk fluids correctly. 94% of doctors and 98% of nurses correctly stated that washing the site with soap and water is the initial procedure, but only few (1/10 of doctors and 1/3 of nurses) knew whom to contact immediately after injury. Twenty three doctors (67%) and 41(78%) nurses were aware of the use of Zidovudine but only 10 participants were aware of the use of second drug. Only 6 doctors (17%) and 8 nurses (15%) knew the correct duration of post-exposure prophylaxis. Twenty-three doctors (67%) and 35 nurses (67%) knew that the drugs were available in Hospital Pharmacy and 11 doctors and 12 nurses knew the approximate cost of therapy. On the average about 50% of doctors and nurses have fair knowledge of post exposure prophylaxis against HIV. Ongoing awareness and training are necessary to improve the same.
Matched MeSH terms: HIV Infections/prevention & control*
PURPOSE: To examine differences between Australian-born and Asian-born first-year university students in Sydney in their sexual behavior and knowledge about the prevention and transmission of human immunodeficiency virus (HIV) and other sexually transmissible infections (STIs).
METHODS: Students were recruited from a stall during the student Orientation Week in both 2002 and 2003 at the University of New South Wales. A short questionnaire was completed and returned anonymously. Data on age, gender, country of birth, sexual behavior, and sexual health knowledge were collected. A score was calculated based on the sum of the correct answers given to 12 HIV/STI transmission and prevention questions. The students were then divided into three groups according to their country of birth (Australia, Asia, and elsewhere) and their knowledge scores were compared. Students born in certain Asian countries were also asked their perception of the HIV epidemic in their home country compared with Australia.
RESULTS: A total of 1185 first-year students completed the questionnaire. Although older on average, Asian-born students were less likely to have had sexual intercourse and had had fewer sexual partners. They also had consistently poorer HIV/STI knowledge scores than Australian-born students. Students born in China, Hong Kong, Indonesia, Malaysia, and Singapore but not Thailand underestimated the prevalence of HIV in their country of birth in comparison with Australia.
CONCLUSION: The combination of poorer knowledge, apparent misconception of the extent of HIV epidemic in their home country (or Australia), and potential later frequent travel indicates a potential risk for later transmission of HIV/STIs. The university is an underused setting for prevention health education.
Matched MeSH terms: HIV Infections/prevention & control*
INTRODUCTION: This study aimed to qualitatively explore adolescents' sexuality and their relation to human immunodeficiency virus (HIV) risk in Malaysia.
METHODS: This study was conducted in 2002 among 16 male and female private college students aged between 18 and 22 years old, all of whom were sexually active. Semi-structured individual interviews were carried out.
RESULTS: There were definite differences in gender roles in terms of how adolescents perceived sex, selection of sex partners and communication with their partners. Definitions of stable and casual relationships differed between males and females. Most participants were concerned about pregnancy rather than sexually transmitted diseases or HIV infection when they interpreted safe sex. Reasons for not practising safe sex include trust between sex partners, complacency, low perception of risk, and negative attitudes towards condom use.
CONCLUSION: These findings were closer to those observed in the developed countries. The findings from this study will serve as a guide to plan for local adolescent health education. It can also serve as a basis for more in-depth quantitative and qualitative research on adolescent sexuality.
Study site: Students, private colleges, Klang Valley, Malaysia
Matched MeSH terms: HIV Infections/prevention & control*