Despite the growing HIV threat among injecting drug users (IDUs) in Malaysia, there is a dearth of information on their HIV risk behaviour. This study focused on identifying specific risk behaviours that distinguished HIV positive IDUs from those who were not. For the first time, data on IDUs not in treatment were obtained through a cross-sectional survey of 526 subjects recruited from five selected cities across peninsular Malaysia. A structured questionnaire and face-to-face interviews were utilised to collect detailed information on their drug use practices and sexual behaviours. On-site serological testing determined their HIV and hepatitis C status. The findings indicated that ethnic Malays, who are also Muslims, form the majority of IDUs not in treatment. Bivariate analysis identified six risk factors associated with HIV seropositivity: being 44 years or younger; not holding a regular job; initiating drug use at age 23 or younger; being a morphine user; sharing injecting equipment and having multiple-sex partners. However, only the last two remained significant in multivariate analysis. That sharing contaminated injecting equipment is a significant risk factor strongly justifies the widening of the pilot needle and syringe exchange programme initiated hesitantly in late 2005 as a reaction to the worsening HIV/AIDS situation. Condom use, though not independently significant, remains important because consistent and wider use could neutralise the second risk factor--having multiple-sex partners. The finding that injecting drug use is increasingly occurring in groups underscores the need for outreach programmes that emphasise safe injecting practices in group settings. In addition, counsellors should endeavour to convince drug users to enter treatment since being in treatment appears to reduce risk behaviours. Finally, conservative Muslim unease about harm reduction must be assuaged quickly since Malay Muslims form the majority of IDUs not in treatment.
This study determines the validity and reliability of the Malay version of the World Health Organization Quality of Life (WHOQOL) assessment instrument in patients with human immunodeficiency virus (HIV) infection. A cross-sectional study on 157 patients with HIV seen at the Infectious Disease Unit, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan was conducted. Factor analysis identified five major domains: physical needs, spirituality, social relationship, psychological, and environment. Significant correlation was found between each domain scores and the general health questions. The instrument was able to discriminate between asymptomatic and symptomatic HIV positive patients for all domain scores except for the spirituality domain. The internal consistency of the five domains ranged from 0.70 to 0.83. The intraclass correlation coefficient (ICC) ranged from 0.60 to 0.87 across all domains. In conclusion, the Malay version of WHOQOL-HIV BREF is a valid and reliable instrument in assessing quality of life in HIV positive patients.