HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64-86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners' willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.
The use of substances to enhance human abilities is a constant and cross-cultural feature in the evolution of humanity. Although much has changed over time, the availability on the Internet, often supported by misleading marketing strategies, has made their use even more likely and risky. This paper will explore the case of Mitragyna speciosa Korth. (kratom), a tropical tree used traditionally to combat fatigue and improve work productivity among farm populations in Southeast Asia, which has recently become popular as novel psychoactive substance in Western countries. Specifically, it (i) reviews the state of the art on kratom pharmacology and identification; (ii) provides a comprehensive overview of kratom use cross-culturally; (iii) explores the subjective experiences of users; (iv) identifies potential risks and side-effects related to its consumption. Finally, it concludes that the use of kratom is not negligible, especially for self-medication, and more clinical, pharmacological, and socioanthropological studies as well as a better international collaboration are needed to tackle this marginally explored phenomenon.
ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected
Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3rd-5th September 2019
Introduction: Smoking kills 5 million people a year and it is known to cause several types of cancer and chronic diseases. Majority of smokers started smoking during adolescence and therefore preventing tobacco use among adolescents is critical to prevent them from future smoking. Our study aims to investigate the prevalence of current cigarette smoking and its associated factors among male adolescents in Malaysia.
Methods: Data was obtained from the National Health and Morbidity Survey (NHMS): Adolescent Health Survey (AHS) 2017 which was a cross-sectional study. A two-stage stratified cluster sampling design was used to select a nationally representative sample of school-going adolescents in Malaysia. Data collection was conducted using a validated self-administered questionnaire. Multiple logistic regression analysis was performed to identify the associated factors of current cigarette smoking among male adolescents in Malaysia.
Results: Approximately one-fifth (22.4%) of male adolescents were current cigarette smokers. Male adolescents who aged 16-17 years, from rural schools, those whose parents were widowed/ divorced/ separated, those who had either one or both parents/guardians who used tobacco product, those who were current illicit drug users and current alcohol users were more likely to be current cigarette smokers.
Conclusion: A substantial percentage of Malaysian male adolescents were current cigarette smokers. Anti-smoking campaigns and tobacco prevention initiatives should be targeted at adolescents at risk to prevent them from becoming cigarette smokers.
Study name: National Health and Morbidity Survey (NHMS-2017)
A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.
Studies have consistently shown that childhood maltreatment is a significant risk factor for the development of drug addiction across human lifespan. Yet, little is known about the prevalence of childhood maltreatment history among drug addicts in Malaysia. The dataset presented in this article provides demographic information on 200 drug addicts recruited from two rehabilitation centres in Malaysia, the prevalence of different types of childhood maltreatment history and the correlation between all types of maltreatments. Analyses of the data can provide insights into the prevalence of maltreatment history and development of drug addiction, therefore indispensable for mental health professionals designing appropriate interventions for the drug addicts. The data can also provide baseline data for comparative studies in terms of childhood maltreatment history and drug addiction across different countries.
OBJECTIVES: Stigma towards people living with HIV/AIDS (PLWHA) is strong in Malaysia. Although stigma has been understudied, it may be a barrier to treating the approximately 81 000 Malaysian PLWHA. The current study explores correlates of intentions to discriminate against PLWHA among medical and dental students, the future healthcare providers of Malaysia.
METHODS: An online, cross-sectional survey of 1296 medical and dental students was conducted in 2012 at seven Malaysian universities; 1165 (89.9%) completed the survey and were analysed. Socio-demographic characteristics, stigma-related constructs and intentions to discriminate against PLWHA were measured. Linear mixed models were conducted, controlling for clustering by university.
RESULTS: The final multivariate model demonstrated that students who intended to discriminate more against PLWHA were female, less advanced in their training, and studying dentistry. They further endorsed more negative attitudes towards PLWHA, internalised greater HIV-related shame, reported more HIV-related fear and disagreed more strongly that PLWHA deserve good care. The final model accounted for 38% of the variance in discrimination intent, with 10% accounted for by socio-demographic characteristics and 28% accounted for by stigma-related constructs.
CONCLUSIONS: It is critical to reduce stigma among medical and dental students to eliminate intentions to discriminate and achieve equitable care for Malaysian PLWHA. Stigma-reduction interventions should be multipronged, addressing attitudes, internalised shame, fear and perceptions of deservingness of care.
KEYWORDS: HIV/AIDS; Malaisie; Malasia; Malaysia; VIH/SIDA; cuidados sanitarios profesionales; discriminación; discrimination; estigma; homosexuality; professional healthcare students; stigma; stigmatisation; substance abuse; étudiants en profession de soins de santé
The leaves from Mitragyna speciosa (Korth.) trees, also known as kratom, are traditionally used in Southeast Asia as a mild psychotropic agent. We investigated the demographic characteristics of persons who used both kratom cocktail and benzodiazepines (BZO) in a sample drawn from a rural area in Penang, Malaysia, and the reasons for BZO use. Seventy-seven participants who currently use a kratom cocktail along with BZO were recruited through snowball sampling for this cross-sectional study. The participants were male, and the majority were Malays (99%, n = 76/77), single (57%, n = 44/77) and employed (91%, n = 70/77). BZO was used with kratom cocktail 1) to increase euphoria; 2) to reduce dependence on methamphetamine; 3) to promote sleep; 4) to ease methamphetamine-associated psychological symptoms and 5) to decrease the craving for kratom. There were no significant differences in the intake of kratom use (p = .751), BZO use duration (p = .259), frequency (p = .188) and quantity (p = .888) of BZO use in the last 7 days, and quantity of BZO use in the last 30 days (p = .337) between kratom users and kratom poly-drug users. An awareness of the health consequences of the co-use of kratom with BZO is needed to prevent untoward health incidents.
Citation: Jin H. Healthcare Student Attitudes Toward Vulnerable Patient Populations: Potential Impact For Perpetuating Suboptimal Care. PhD Thesis. Yale University, United States, 2013.
Objective: Stigma endorsed by healthcare providers has been found to be a barrier to care for vulnerable populations, including HIV-infected, people who inject drugs (PWID), and men who have sex with men (MSM) in multiple clinical contexts. We therefore sought to better understand the extent to which stigma is levied toward these three populations by medical and dental students.
Design: This cross-sectional study assessed the attitudes of 1,296 medical and dental students towards HIV-infected, PWID, and MSM patients.
Methods: Students were asked to score their attitudes towards these patient groups using a feeling thermometer, indicating their attitudes on a sliding scale from 0, meaning very negative, to 100, meaning very positive.
Results: The mean attitude score towards the general patient population (M = 76.50, SD = 20.35) was significantly higher than the scores for HIV-infected patients (M = 54.04, SD = 20.99), PWID patients (M = 37.50, SD = 24.41), and MSM patients (M = 32.13, SD = 29.33).Further, certain demographic variables, most notably religion, ethnicity, and personally knowing someone of these populations, were associated with significant differences in attitudes.
Conclusion: Healthcare students represent the next generation of clinicians who will be responsible for HIV prevention and treatment efforts in the future. Our findings suggest that negative attitudes towards these patients is extremely high, and it is therefore crucial to design interventions to ameliorate the negative attitudes of medical students towards vulnerable populations.
Approximately 2.5% of the Malaysian population is currently living with hepatitis C virus (HCV) infection. Yet, the public awareness of the disease is limited and under-screening remains a major challenge. With the support of international non-for-profit organizations, the Ministry of Health in Malaysia recently launched a one-week nationwide hepatitis C screening campaign in conjunction with the World Hepatitis Day. For the first time, the rapid diagnostic test (RDT) for HCV screening was introduced in public health institutions. This campaign involved 49 hospitals and 38 health clinics across the country, targeting the adult general population with unknown HCV infection status. Of the 11 382 participants undergoing the RDT, 1.9% were found to be positive for hepatitis C antibody (anti-HCV) and were referred to on-site medical departments or nearby hospitals for confirmatory testing and treatment. Men, the Malay ethnic group, intranasal and injection drug users and ex-prisoners were shown to have higher odds of being positive for anti-HCV. In addition to serving as a model to educate the general population about the disease, this campaign demonstrates the feasibility of decentralizing HCV screening, particularly by promoting the use of RDT, and linking the HCV-infected patients to care in Malaysia.
Data from the Malaysian National Drugs Agency December 2013 Report, showed that among 7864 drug users, 632 were abusing Amphetamine Type Stimulant. Rates of admission due to Methamphetamine abuse in pregnancy are higher compared with men and non- pregnant lady in the United States.1 A number of issues may complicate the management of pregnant women who abused methamphetamine such as the low motivation for them to come forward voluntarily for treatment, the high rates of fetal and maternal complications due to methamphetamine abuse,2,3 and the inavailabiliy of effective treatment for methamphetamine dependence.
Study on motivational readiness for change is crucial to promote understanding of behavioural change among Methadone Maintenance Tretment (MMT) patients. A widely used method recently is via Stages of Change and Treatment Eagerness Scale for drug abusers (SOCRATES-8D). The aims of this study were to; 1) determine the general level of readiness for change, 2) assess differences in terms of readiness to change (RtC) based on socio-demography and clinical characteristics and 3) compare RtC with different health-related quality of life (HRQOL) levels. Methods: A convenient sample of MMT volunteers from Terengganu, Malaysia was enrolled. The SOCRATES-8D was administered (3 subscales; Likert-type responses 1-5; higher score, better RtC). Data was analysed using SPSS 15, employing descriptive statistics and non-parametric tests for score comparisons. Results: The mean age of 55 Malay respondents was 37.0 years, male (98.2%), = lower secondary qualification (65.5%) and addiction period > 15 years (52.7%). Generally the Recognition level was "low", Ambivalence and Taking Steps were moderately-rated. Most of them within unsatisfactory levels of RtC. Abusers with < 20 months treatment were significantly "more ready" for behavioural changes (p0.05). Conclusion: Findings demonstrated that patients were rather ready to adopt positive behavioural changes regardless of their sociodemographic backgrounds. Thus continuous efforts and psychosocial support from various authorities should be geared towards enhanced readiness as part of ensuring the success of MMT programme in the future.
Objective: In Malaysia, opioid abuse is an acknowledged problem with severe health and economic repercussions. Until recently, drug addicts were mainly criminalised and forcefully rehabilitated in correctional facilities. However, the high relapse rates of this approach, coupled with the high rates of blood borne infections among drug users, led to increasing acceptance of a healthcare-based approach in the rehabilitation of drug addicts. Methadone was among the medications introduced as substitution maintenance therapy in 2005 and Universiti Malaya Medical Centre (UMMC) is a centre for MMT. This study aimed to determine the effects of MMT on quality of life in patients here. Methods: The sample was 46 patients who attended the Psychiatric outpatient clinic in fill in UMMC. The instrument used to assess quality of life was the WHOQOL-BREF. Results: The study design was cross-sectional with retrospective elements. Baseline QOL scores were obtained from case records and follow-up scores from the month of September 2007. Statistically significant improvements in all four domains of WHOQOL-BREF were found. Physical: p
Study site: Psychiatric outpatient clinic, Universiti Malaya Medical Centre (UMMC
A study was undertaken to identify the oral health status and treatment needs of 403 drug abusers enrolled in a drug rehabilitation center in Perak, Malaysia. The prevalence of dental caries was 97.0%. Calculus was present in 82.1% of the dentate individuals, but only 14.6% had pockets greater than 3mm. The mean DMFT observed was 11.7, with missing teeth (MT=9.6) constituting the major component. Denture needs were high (67.2%), but only 11.4% of individuals had prostheses.
The number of relapsing addicts is increasingly worrying from year to year. This study was conducted
to examine at the relationship between defense mechanisms and the level of readiness to change in
relapsing addicts. Although the drug addicts have been treated at the treatment center, however,
repeated cases of drug addicts still occur. Six research questions were developed to see how far the
variables consisting of defense mechanisms could correlate with readiness to change among addicts
who were undergoing treatment. This study was carried out involving 125 addicts in two separate
treatment centers in Melaka and Selangor. The selected sample were addicts who have undergone a
relapse phase at least once in drug addiction. Statistical data analysis using Statistical Packages for
Social Sciences 20 (SPSS-20) were used to analyze the data. Statistical descriptive is used to view the
results of demographic data constructed. T-test and ANOVA are used to see the relationship between
the variables. The regression analysis is used to predict the defense mechanisms with the stage of
readiness to change among relapsing addicts. The results showed that the defense mechanism had a
significant relationship to the stage of readiness to change among samples. The results of this study
provide information on treatment services in the drug rehabilitation to improve the treatment method
appropriately to the drug addicts in preventing relapse.
Ex-offenders are facing major challenges after their release to survive in the community. Among the challenges are stigma from the community, physical and mental health issues, financial problem because of unemployment and loss of significant others. They need to be guided to manage issues regarding employment, family, interpersonal relationship, and self-management. This article will discuss issues and barriers for ex-offenders to return to work or join the workforce. Past findings showed that ex-convicts and ex-drug addicts are still facing with barriers which withhold them from joining the job market. They frequently become the victims of rejection, bias, being bullied, and being segregated by co-workers. Barriers in employment may also be rooted from themselves, such as attitude problem, bad work culture, aggressive personality, and disciplinary issue. Thus, effective programmes and interventions need to be implemented for ex-offenders to increase their employability, and hence joining the community.
The number of adolescents involved in drug addiction increases every year. Statistic shows that in 2015 there were 6,406 addicts from age 13 to 24 years old compared to 4,954 detected in 2014. The majority of those addicts had major depression. It is predicted that by 2020, depression will be the second leading causes of global burden of diseases after heart disease. This study aims to identify the relationship between social support and depression among adolescent drug addicts. The study used quantitative method by distributing the questionnaires to respondents. A total of 367 adolescent drug adddicts were involved in this study. The results showed a significant negative relationship between social support and depression. The results of the study also showed that there were relationships between social support from guardian, friends and closed friends and depression. The implication of the study suggested that the role of social support such as family members and close friends are crucial to help adolecents cope with depression and addiction.
Occupation is the most important element in changing the quality-of-life continuity and the recovery of drug addicts. This study aimed to measure the level of employment sustainability among ex-clients from the National Anti-Drug Agency (AADK). This study used a quantitative approach with a cross-sectional design. A total of 130 AADK ex-clients who were in employment were selected as respondents for this study. Our findings show that the majority of AADK ex-clients can survive relatively well enough for between 1 to 2 years depending on the factors of wages, work environment, interests and skills. The finding of this study implies that former clients tend to remain only 1 to 2 years in employment if their wages and jobs are not in line with their will. The findings also found that there was a significant relationship between the job-person fit and job satisfaction with motivation. Hence, this study is capable to modify the perceptions and views of employers towards clients' initiative for being persistent at the workplace as well as improving existing policies in providing incentives to clients for being consistent on the job.
The readiness to change among drug addicts is a key strength for successful treatment. Self-awareness, self-determination, and self-efficacy have been identified as the fundamentals of readiness that should be embraced by drug addicts while in treatment. In this article, the shared data were applied to assess the effect of individual psycho-educational intervention based on integrated self-awareness and self-determination theories (i-SEAZ) on self-efficacy amongst opioid-dependent patients undergoing methadone treatment (MT). The effectiveness of the i-SEAZ module was evaluated in a total of 75 opioid-dependent MT participants from five Methadone Clinics under the Ministry of Health, Malaysia located across Klang Valley. The experimental group consisted of 38 participants who received 10 sessions of individual i-SEAZ alongside MT, whereas 37 participants of the control group only received MT. The shared data were collected through three questionnaires, namely Scale for Self-Consciousness Assessment (SSCA), Treatment Motivation Questionnaire (TMQ), and General Self Efficacy (GSE). Data collection was performed twice; the first instance was two weeks prior to initiation of i-SEAZ (pretest), and the second was two weeks post completion of i-SEAZ (posttest). The extracted data were precisely represented in terms of means and standard deviations (SDs).
BACKGROUND: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu, Kelantan.
METHODS: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st Jan 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status, and level of education.
RESULTS: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score, HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status, and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26), and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79).
CONCLUSION: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.
KEYWORDS: Kelantan; intravenous drug users; methadone; opiate treatment index
Study site: Psychiatric Clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia