GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia

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GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
GLOBAL AIDS
MONITORING 2020
Malaysia HIV/AIDS Progress Report

Ministry of Health Malaysia
HIV/AIDS/Hepatitis C Sector
Disease Control Division

                              1
GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
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    MALAYSIA 2020
    COUNTRY PROGRESS REPORT TO HIV/AIDS EPIDEMIC
                                    Reporting Period:
                      January 2019 to December 2019

                                         Report prepared by:
                                  HIV/STI/Hepatitis C Section
                                     Disease Control Division
                                  Ministry of Health Malaysia
                                        Tel: +60 3 8883 4387
                                       Fax: +60 3 8883 4285

                                              Correspondence:
                                             Dr Anita Suleiman
                                          dranita@moh.gov.my

    Malaysia Global AIDS Reporting 2020
GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
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THE GLOBAL AIDS MONITORING REPORT 2020

This report was coordinated and produced by HIV/STI/Hepatitis C Section of Ministry
of Health Malaysia.

Editorial Team
Dr. Anita Suleiman (Chief Editor)
Head HIV/STI/Hepatitis C Sector, Ministry of Health Malaysia

Dr. Mazliza Ramly (Lead Author & Editor)
Senior Principal Assistant Director (Behavioral Research)
HIV/STI/Hepatitis C Sector, Ministry of Health Malaysia

LIST OF MAIN CONTRIBUTORS
1.    Dr Chai Phing Tze, HIV/STI/Hepatitis C Sector
2.    Dr Fazidah Yuswan, HIV/STI/Hepatitis C Sector
3.    En Azman Mohamed, HIV/STI/Hepatitis C Sector
4.    Dr Mohamad Naim, TB/Leprosy Sector
5.    En Parimelazaghan Ellan, Malaysian AIDS Council
6.    Pn Tamayanty Kurusamy, Malaysian AIDS Council
7.    Dr Rohemi Abu Bakar, State Health Department Perlis
8.    Dr Azlina Azlan, State Health Department Kedah
9.    Dr Janizah Abd Ghani, State Health Department Pulau Pinang
10.   Dr Ariza Abd Rahman, State Health Department Perak
11.   Dr Ismawati Ismail, State Health Department FT Kuala Lumpur & Putrajaya
12.   Dr Gurpreet Kaur, State Health Department Selangor
13.   Dr Sharifah Nor Ahmad, State Health Department Negeri Sembilan
14.   Dr Mahanim Md Yusof, State Health Department Melaka
15.   Dr Nurmawati Ahmad, State Health Department Johor
16.   Dr Shahdattul Dewi Nur Khairitza Taib, State Health Department Pahang
17.   Dr Mahani Nordin, State Health Department Terengganu
18.   Dr Nik Normanieza Nik Man, State Health Department Kelantan
19.   Dr Haseanti Hussien, State Health Department Sabah
20.   Dr Ruziana Miss, State Health Department Sarawak
21.   Dr Mohd Hafizuddin Ahmad, State Health Department FT Labuan

                      Malaysia Global AIDS Reporting 2020
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Table of Contents
State of the Epidemic ................................................................................................ 6
    Treatment Cascade .............................................................................................. 8
Prevention program ................................................................................................ 12
    Key populations .................................................................................................. 12
    Eliminating Mother-to-Child Transmission .......................................................... 14
Confronting Stigma and Discrimination .................................................................. 16
    Stigma Reduction Initiatives ............................................................................... 16
HIV and Other Infection .......................................................................................... 17
    HIV and Tuberculosis co-infection ...................................................................... 17
    HIV and Hepatitis C co-infection ......................................................................... 18
    Sexually Transmitted Infection ............................................................................ 19
Investing to End an Epidemic ................................................................................. 20
2019 galleries ......................................................................................................... 21

                                 Malaysia Global AIDS Reporting 2020
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List of Figures
Figure 1: Annual Reported Cases, Malaysia, 1986-2019 ………………………………………………………………………………………. 7
Figure 2: HIV Incidence Rate per 1000 Uninfected Population, Malaysia, 2010-2019 ……………………………… 7
Figure 3: Top 5 States, Percentage of New HIV Infection, Malaysia, 2019 ……………………………………………………. 7
Figure 4: HIV Testing and Treatment Cascade, Malaysia, 2019 …………………………………………………………………………. 8
Figure 5: New HIV Infection, Malaysia, 1986-2019 ……………………………………………………………………………………………………. 9
Figure 6: Percent Change in New HIV Infection by State, Between 2010-2019 …………………………………………… 9
Figure 7: AIDS-related Deaths, Malaysia, 1986-2019 ………………………………………………………………………………………………. 9
Figure 8: Distribution of Reported Cases by Gender, 1987-2019 ………………………………………………………………………… 10
Figure 9: Trend of HIV Infection by Mode of Transmission, 2000-2019 ……………………………………………………………. 10
Figure 10: Distribution of HIV New Cases by State, 2019 ………………………………………………………………………………………. 11
Figure 11: Distribution of New Infection by Age Group, Malaysia, 2019 …………………………………………………………. 11
Figure 12: NSP and OST Coverage among PWID, 2016-2019 …………………………………………………………………………… 12
Figure 13: HIV Prevalence and Safe Injecting Practices among PWID, IBBS 2012-2017 ………………………. 13
Figure 14: Coverage of Prevention Programs among Key Populations, Malaysia IBBS 2012-2017 …… 13
Figure 15: Methadone Maintenance Therapy Clinic at Government Health Facility …………………………………… 13
Figure 16: HIV and Syphilis Test Coverage, 2010-2019 ………………………………………………………………………………………… 14
Figure 17: Cascade of Services for Preventing Vertical Transmission, Numbers of New HIV Infections
and eMTCT rate, 2019 ……………………………………………………………………………………………………………………………………………………………. 14
Figure 18: HIV Vertical Transmission Rate, 2012-2019 …………………………………………………………………………………………. 15
Figure 19: MTCT of Syphilis, 2010-2019 ………………………………………………………………………………………………………………………… 15
Figure 20: Percentage of Person Aged 15 to 49 years with Discriminatory Attitudes Towards PLHIV,
2014-2019 …………………………………………………………………………………………………………………………………………………………………………………… 16
Figure 21: Proportion of Newly Enrolled PLHIV with Active TB, 2015-2019 ………………………………………………… 17
Figure 22: PLHIV Newly Enrolled in HIV Care Started on IPT, 2015-2019 …………………………………………………… 17
Figure 23: HCV Epidemic in Malaysia, 2003-2019 …………………………………………………………………………………………………… 18
Figure 24: Proportion of PLHIV Starting on ART Who Were Tested for Hepatitis C, 2013-2019 ………… 18
Figure 25: Number of Men Reporting Urethral Discharge in the past 12 months, 2013-2019 ………………. 19
Figure 26: Safe Sex Practices at Last Sex, IBBS 2012-2017 ………………………………………………………………………………. 19
Figure 27: HIV Resources Availability by Source, 2017-2019 ……………………………………………………………………………… 20
Figure 28: AIDS Spending by Category, 2016-2019 ………………………………………………………………………………………………… 20

                          Malaysia Global AIDS Reporting 2020
GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
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 State of the Epidemic
HIV/AIDS Epidemic Snapshot in Malaysia 2019
Number of People           Total                77,903               AT A GLANCE
Living with HIV            Male (15+ years)     66,369
                           Women (15+ years)    11,233
                           Children (
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                                       Figure 1: Annual Reported Cases, Malaysia, 1986-2019
                       8000                                                                                                                      40

                       7000                                                                                                                      35

                       6000                          2002:    6,978                                                                  2019        30

                                                                                                                              3,564
     Number of cases

                                                                                                                                                      Notification rate
                       5000                                                                                                                      25

                       4000                                                                                                                      20
                                  1986
                                  First reported
                       3000       cases of HIV                                                                                                   15

                       2000                                                                                                                      10

                       1000                                                                                                                      5

                         0                                                                                                                       0
                                1985
                                1986
                                1987
                                1988
                                1989
                                1990
                                1991
                                1992
                                1993
                                1994
                                1995
                                1996
                                1997
                                1998
                                1999
                                2000
                                2001
                                2002
                                2003
                                2004
                                2005
                                2006
                                2007
                                2008
                                2009
                                2010
                                2011
                                2012
                                2013
                                2014
                                2015
                                2016
                                2017
                                2018
                                2019
                                                                                 TOTAL          Notification rate

                         Figure 2: HIV Incidence Rate Per 1000                                             Figure 3: Top 5 States, Percentage of New
                        Uninfected Population, Malaysia, 2010-                                                   HIV Infection, Malaysia, 2019
                                          2019
    0.25
                                                                                                    Selangor                                 30.4%
                                                                                         0.2
     0.2                0.19 0.19 0.19 0.19
                                                     0.18          0.18           0.18
                                                            0.17          0.17                         WPKL                   12.6%
    0.15
                                                                                                        Johor            9.5%
     0.1

                                                                                                     Sarawak            8.1%
    0.05

              0
                                                                                                      Penang            8.1%
                         2010

                                2011

                                       2012

                                              2013

                                                     2014

                                                            2015

                                                                   2016

                                                                          2017

                                                                                  2018

                                                                                         2019

                                                                                                              0.0%    10.0%    20.0%     30.0%             40.0%

                                                        Malaysia Global AIDS Reporting 2020
GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
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In 2019, the estimated people living in HIV (PLHIV) in Malaysia is around 87,000.
However, through our national surveillance system, close to 78,000 PLHIV were
notified out of which, 0.4% were children below 15 years of age. There were 3,564
people newly infected with HIV notified in 2019 (Figure 1), slightly more than half
(56%) of estimated new HIV infection in 2019. Estimated HIV incidence rate per 1000
uninfected population is showing an increasing trend in the past two years (Figure
2). The overall epidemic is concentrated in urbanized states of Selangor, Kuala
Lumpur, and Johor that contribute more than 50% of new HIV cases in Malaysia
(Figure 3).

Treatment Cascade
    Figure 4: HIV Testing and Treatment Cascade, Malaysia, 2019

Countries are left with just 1 year to reaching the fast track target of 90-90-90 by
2020. In that regard, Malaysia has achieved 89%-56%-85% which means in 2019,
89% of PLHIV in Malaysia know their status, 56% of them were receiving treatment,
and 85% of them were virally suppressed (figure 4). Linkage to care still represents
the single greatest challenge for Malaysia to reach 90-90-90 target as the highest
gap to reaching 90-90-90 target stood at number of PLHIV needed to access
treatment.

                               Malaysia Global AIDS Reporting 2020
GLOBAL AIDS MONITORING 2020 - Malaysia HIV/AIDS Progress Report Ministry of Health Malaysia
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                            Figure 5: New HIV Infection, Malaysia, 1986-2019

                                                                                                                                                                      Malaysia has done a tremendous
                                                                                                                                                                      work in reducing the annual number
                                                                                                                                                                      of new HIV infections since its peak
                                                                                                                                                                      in 2002 with our Harm Reduction
                                                                                                                                                                      Program. However, since 2010, the
                                                                                                                                                                      trend has reached a flat line. There
                                                                                                                                                                      has been only a modest 0.9% decline
                                                                                                                                                                      in the annual number of new HIV
                                                                                                                                                                      infections in Malaysia since 2010
                                                                                                                                                                      (Figure 5).

                                                                                                                                                                      Several states showed strong
                                                                                                                                                                      decline in new infections between
                                   Figure 6: Percent Change in New HIV Infection by                                                                                   2010 and 2019, such as Kelantan,
                            6                 State, between 2010 & 2019
                                                                                                                                                                      Terengganu, and Pahang (Figure 6).
Percent change in new HIV

                            4
                            2                                                                                                                                         In contrary, most urbanized states
                            0
                                                                                                                                                                      like Selangor, Kuala Lumpur and
                   -2
                   -4
                                                                                                                                                                      Penang showed increasing trend.
                   -6
                                Kelantan

                                           Terengganu

                                                        Pahang

                                                                 Johor

                                                                         Perak

                                                                                 Melaka

                                                                                          Perlis

                                                                                                   Labuan

                                                                                                            Kedah

                                                                                                                    Sabah

                                                                                                                            NS

                                                                                                                                 Sarawak

                                                                                                                                           WPKL

                                                                                                                                                  Penang

                                                                                                                                                           Selangor

                                                                                                                                                                      The reported AIDS-related deaths
                                                                                                                                                                      last year had increased slightly in
                                                                                                                                                                      2019 compared to 2010 (Figure 7).
                                                                                                                                                                      Sabah was the only state with
                                                                                                                                                                      declined     AIDS-related     deaths
                                                                                                                                                                       greater than 50% during the 10-year
                            Figure 7: AIDS-related Deaths, Malaysia, 1986-2019
                                                                                                                                                                       period. While, Selangor had the
                                                                                                                                                                       highest increment of AIDS-related
                                                                                                                                                                       deaths of more than 100% during
                                                                                                                                                                       the same period. Since the
                                                                                                                                                                       beginning of the epidemic, the
                                                                                                                                                                       reported cases were predominantly
                                                                                                                                                                       male (Figure 8).

                                                                                                   Malaysia Global AIDS Reporting 2020
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                                Figure 8: Distribution of Reported Cases by Gender, 1987-2019
                       8000                                                                                                                                                    80

                       7000                                                                                                                                                    70

                       6000                                                                                                                                                    60

                                                                                                                                                                                    per 100,000 population
     number of cases

                       5000                                                                                                                                                    50

                       4000                                                                                                                                                    40

                       3000                                                                                                                                                    30

                       2000                                                                                                                                                    20

                       1000                                                                                                                                                    10

                          0                                                                                                                                                    0
                              1986
                              1987
                              1988
                              1989
                              1990
                              1991
                              1992
                              1993
                              1994
                              1995
                              1996
                              1997
                              1998
                              1999
                              2000
                              2001
                              2002
                              2003
                              2004
                              2005
                              2006
                              2007
                              2008
                              2009
                              2010
                              2011
                              2012
                              2013
                              2014
                              2015
                              2016
                              2017
                              2018
                              2019
                                               Female                Male                Male-specific rate                         Female-specific rate

                                          Figure 9: Trend of HIV infection by Mode of Transmission, 2000-2019

                                PWID                                Hetero                                    Homo                                 Vertical
                                Blood/organ transfer                Indeterminate                             PWID/Sex ratio
                       100.0%                                                                                                                                                  6.0
                        90.0%
                                                                                                                                                                               5.0
                        80.0%
                        70.0%
                                                                                                                                                                               4.0
     Proportion

                        60.0%

                                                                                                                                                                                              Ratio
                        50.0%                                                                                                                                                  3.0
                        40.0%
                                                                                                                                                                               2.0
                        30.0%
                        20.0%
                                                                                                                                                                               1.0
                        10.0%
                         0.0%                                                                                                                                                  0.0
                                 2000

                                        2001

                                               2002

                                                      2003

                                                             2004

                                                                    2005

                                                                           2006

                                                                                  2007

                                                                                         2008

                                                                                                2009

                                                                                                       2010

                                                                                                               2011

                                                                                                                      2012

                                                                                                                             2013

                                                                                                                                     2014

                                                                                                                                            2015

                                                                                                                                                   2016

                                                                                                                                                          2017

                                                                                                                                                                 2018

                                                                                                                                                                        2019

 In the past one decade, the country observed gradual changes in the HIV epidemic
 landscape from predominantly PWID to more sexual transmission (Figure 9). The
 proportion of sexual transmission has increase to more than 90% in 2019.

                                                        Malaysia Global AIDS Reporting 2020
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            Figure 10: Distribution of HIV New Cases by State, 2019              More than 70% of the new
                                                                                 HIV cases reported in 2019
                                             Kelantan,
                   Perlis, 0.5%    Terengganu, 3.0%        Pahang, 3.1%
                                                                                 were contributed by 6
                                      1.8%
                      WP Labuan,                                                 states - Selangor, Kuala
       Selangor,        0.4%                                    Melaka, 3.2%
        30.4%                                                                    Lumpur, Johor, Sarawak,
                                                                  Negeri
                                                                 Sembilan,       Penang, and Sabah (Figure
                                                                   3.5%          10).
                                                                  Perak, 4.6%

                                                                   Kedah, 5.0%

        WP KL,
        12.6%                                                    Sabah, 6.3%

                                                         Pulau Pinang,
                                                             8.1%
                   Johor, 9.5%              Sarawak,
                                              8.1%

     Figure 11: Distribution of New Infection by Age Group, Malaysia, 2019

 More than 70% of new HIV infections were among people aged 20 to 39 years. While
 infection in children below 13 years old has remained lower than 1% consistently
 from the beginning of the epidemic (Figure 11).

                                    Malaysia Global AIDS Reporting 2020
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 Prevention program
 Key populations
                                                                                FSW            MSM                    PWID         TG
     Population size estimatea                                              22,000        220,000                     75,000     37,000
     HIV prevalenceb                                                            6.3%       21.6%                      13.5%       10.9%
     Know their HIV statusb                                                 35.1%          43.3%                      38.9%       43.0%
     ART coverageb                                                          22.5%          62.6%                      34.6%       34.0%
     Condom use last sexb                                                   83.5%          65.4%                      25.7%       83.3%
 aSize                                    Estimation of Key Population Malaysia, 2018
 bIBBS                                    2017

                                              Figure 12: NSP and OST Coverage among PWID, 2016-
                                                                     2019
     Needle-syringes per PWID per year

                                         30                                                    90.0%
                                                                                               80.0%                   Access to Harm
                                         25
                                                                                               70.0%                   Reduction Services
                                                                                                       OST coverage

                                         20                                                    60.0%
                                                                                               50.0%                   remains uneven
                                         15
                                                                                               40.0%                   especially NSEP
                                         10                                                    30.0%
                                                                                               20.0%
                                                                                                                       marked by highly
                                         5
                                                                                               10.0%                   punitive approaches to
                                         0                                                     0.0%                    drug use.
                                                  2016        2017       2018      2019

                                                      NSP coverage (n)      OST Coverage (%)

 Given that sharing injection paraphernalia is the main mode of transmission in
 Malaysia since the beginning of the epidemic, Harm Reduction Program that consist
 of Needle and Syringe Exchange Program (NSEP) and Opioid Substitution Therapy
 (OST) remained the mainstay of prevention programs to PWID in Malaysia. The OST
 Program coverage offered at selected government and private health facilities since
 2006, has shown an increased to more than 70% since 2017 (Figure 12). While the
 NSEP program, implemented through smart partnership with NGO under MAC at
 their outreach points throughout the country has reported a significant reduction in
 program coverage of less than 50% since 2017. This is in line with the National

                                                                     Malaysia Global AIDS Reporting 2020
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                              Figure 13: HIV Prevalence and Safe Injecting                                       Strategic Plan for Ending AIDS that
                                Practices among PWID, IBBS 2012-2017                                             encourage opioid injectors to shift to
                         20                                                  120                                 OST to ensure better ART uptake.

                                                                                   Safe injecting practices, %
                                                                             100
     HIV Prevalence, %

                         15
                                                                             80                                  In the nutshell, these programs
                         10                                                  60                                  (harm reduction) have positive
                                                                             40
                                                                                                                 impact as reflected in the declining
                          5
                                                                             20
                                                                                                                 of HIV prevalence and increasing
                          0                                                  0
                                                                                                                 continuous safe injecting practices
                                   2012            2014           2017                                           above 80% in this key population
                                                                                                                 (Figure 13).
                                Safe Injecting practices        HIV Prevalence

                                                                                                                  Figure 14 depicted results from
                          Figure 14: Coverage of Prevention Programmes
                                                                                                                  IBBS 2012 to 2017 on the
                         Among Key Populations, Malaysia, IBBS 2012-2017
                                                                                                                  coverage of prevention packages
                         80
                                                                                                                  among key populations. Access to
                         60
                                                                                                                  HIV prevention services for FSW
     Percent

                         40                                                                                       and MSM have been poor (less
                         20                                                                                       than 50%) probably because they
                                                                                                                  are the most hard-to-reach and
                         0
                                  PWID             TG           FSW          MSM                                  difficult to identify due to stigma
                                            2012        2014   2017                                               and discrimination. While for PWID
                                                                                                                  and TG populations, the coverage
                                                                                                                 of prevention packages have been
Figure 15: Methadone Maintenance Therapy Clinic at
                                                                                                                 moderate (50%-70%)
Government Health Facility

                                                        Malaysia Global AIDS Reporting 2020
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 Eliminating Mother-to-Child Transmission
                                               Figure 16: HIV and Syphilis Test Coverage, 2010-2019
                        100.5%
                                                                                                                                   0.14%
                        100.0%
                        99.5%                                                                                                      0.12%
     Test coverage, %

                                                                                                                                           Seropositive (%)
                        99.0%                                                                                                      0.10%
                        98.5%                                                                                                      0.08%
                        98.0%
                                                                                                                                   0.06%
                        97.5%
                                                                                                                                   0.04%
                        97.0%
                        96.5%                                                                                                      0.02%
                        96.0%                                                                                                      0.00%
                                  2010     2011       2012   2013      2014          2015    2016     2017    2018       2019

                             Syphilis test coverage      HIV test coverage           HIV seropositive (%)      Syphilis seropositive (%)

 HIV and syphilis test coverage for antenatal mothers to prevent vertical transmission
 in Malaysia has persistently reached beyond 95% for more than a decade, with
 seroconversion rate for both HIV and syphilis remained below 0.1% (Figure 16). This
 wide screening coverage has been persistent throughout the country since the
 Prevention of Mother-to-Child Transmission (PMTCT) program was implemented in
 1998. The PMTCT Program in Malaysia is based strongly around early detection and
 prompt treatment of HIV and syphilis for mother and baby, safer modes of delivery
 and safer infant feeding practices.

                                                                                   Figure 17: Cascade of Services for Preventing
                                                                                    Vertical Transmission, Numbers of New HIV
                                                                                         Infections and eMTCT Rate, 2019
     Malaysia became the                                                     250
                                                                                                    99.3%          95%
     first country in WPRO                                                   200

     and first Muslim                                                        150
                                                                    Number

     country globally to                                                                                                        transmission
                                                                                                                                  rate: 1.64
                                                                             100
     eliminate mother-to-                                                                                                        Number of
                                                                                                                                   cases: 1
                                                                              50
     child transmission of
     HIV and Syphilis in                                                       0
                                                                                     Estimated      Women      Infant of HIV  New child
     2018                                                                            pregnant receiving ARV mother tested
                                                                                    women living to prevent VT    within 2
                                                                                                                               infection
                                                                                                                             through VT
                                                                                      with HIV                   months of
                                                                                                                   birth

                                                  Malaysia Global AIDS Reporting 2020
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 An estimated 99.3% of HIV-positive pregnant women were receiving ARV in 2019
 resulted in 1.64% transmission rate of mother-to-child transmission (Figure 17). This
 vertical transmission rate for HIV has reached the WHO elimination target (less than
 2.00%) in both programmatic and estimated (Spectrum) data since 2016 (Figure 18).
 Similarly, reported congenital syphilis have been less than 10 cases per 100,000 LB
 persistently since 2010, which is far below the elimination indicator of less than 50
 cases per 100,000 LB (Figure 19).

                                     Figure 18: HIV Vertical Transmission Rate,                                                      Figure 19: MTCT of Syphilis, 2010-2019
                                                    2012-2019                                                                  9.0

                                     12.0                                                                                      8.0
     HIV vertical transmission (%)

                                     10.0                                                                                      7.0

                                                                                                       New CS per 100,000 LB
                                      8.0                                                                                      6.0

                                      6.0                                                                                      5.0

                                                                                                                               4.0
                                      4.0
                                                                                                                               3.0
                                      2.0
                                                                                                                               2.0
                                      0.0
                                                                                                                               1.0
                                            2012

                                                   2013

                                                            2014

                                                                   2015

                                                                           2016

                                                                                  2017

                                                                                         2018

                                                                                                2019

                                                                                                                               0.0
                                                                                                                                      2010

                                                                                                                                             2011

                                                                                                                                                    2012

                                                                                                                                                           2013

                                                                                                                                                                  2014

                                                                                                                                                                         2015

                                                                                                                                                                                2016

                                                                                                                                                                                       2017

                                                                                                                                                                                              2018

                                                                                                                                                                                                     2019
                                                          Programmatic Data (%)
                                                          Spectrum (%)
                                                                                                                                                Adj. New paediatric CS infection
                                                          WHO Elimination target                                                                (per 100,000 LB)

                                                                          Malaysia Global AIDS Reporting 2020
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 Confronting Stigma and Discrimination
             Figure 20: Percentage of Person Aged 15 to 49
                                                                               The level of stigma towards PLHIV in
              Years with Discriminatory Attitudes Towards                      general      population      remained
                           PLHIV, 2014-2019                                    between 20% to 50% in the last three
     60.0%                                                                     years (Figure 20). Almost a third
     50.0%                                                                     (30%) Malaysian said they would
     40.0%                                                                     avoid buying vegetables from a
     30.0%
                                                                               PLHIV vendor, and 26% Malaysian
     20.0%
                                                                               believed that children living with HIV
     10.0%
                                                                               should not be allowed to attend
     0.0%
                     2014                 2017                 2019            school with other children. Much still
               People who would not buy vegetables from a PLHIV                need to be done to eliminate stigma
               shopkeeper
               People who think children living with HIV should not be         against PLHIV.
               allowed to attend school other children

 Stigma Reduction Initiatives
                                                                                     Starting mid-2020, a HIV-
       • HCW                                                      • Identify gaps
       • PLHIV                                                    • Design           related        stigma       and
                                                                    intervention
                                                                    framework
                                                                                     discrimination         reduction
                                                                                     through a quality improvement
                               Baseline            Review of                         approach      in    government
                                                    results
                                                                                     healthcare facilities program
                                                                                     were initiated and this program
                                                                                     will be piloted at 6 states
                              Follow-up          Intervention                        (Penang, Sarawak, Kuala
                                                                                     Lumpur, Selangor, and Johor).
       • Repeat                                                   • Continuous
         questionnaire                                              intervention
       • Review                                                   • For 4 months
         performance

                                         Malaysia Global AIDS Reporting 2020
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 HIV and Other Infection
 HIV and Tuberculosis co-infection
                                                              Tuberculosis is the leading killer of
            Figure 21: Proportion of Newly Enrolled PLHIV
                      with Active TB, 2015-2019               PLHIV. The risk of developing
 25.0%                                                        tuberculosis (TB) is estimated to be
                                                              between 16-27 times greater in
 20.0%                                                        people living with HIV than among
                                                              those without HIV infection. In
 15.0%
                                                              Malaysia, proportion of newly
 10.0%                                                        enrolled PLHIV with active TB was
                                                              7.3% in 2019 compared to 19.3% in
     5.0%                                                     2018 (Figure 21). However, in 2019,
                                                              only 15.8% of PLHIV newly enrolled
     0.0%
               2015      2016      2017      2018      2019   in HIV care was started on TB
                                                              Isoniazid preventive therapy (IPT)
                                                              (Figure 22). This data is far from
             Figure 22: PLHIV Newly Enrolled in HIV Care      WHO recommendation in which all
                     Started on IPT, 2015-2019                PLHIV who are unlikely to have
 90.0%                                                        active TB (without any active
 80.0%                                                        tuberculosis symptoms) should be
 70.0%                                                        offered IPT.
 60.0%
 50.0%
 40.0%
 30.0%
 20.0%
 10.0%
     0.0%
               2015      2016      2017      2018      2019

                                  Malaysia Global AIDS Reporting 2020
18

 HIV and Hepatitis C co-infection
                                                                                                        Hepatitis C virus (HCV) is a
                           Figure 23: HCV Epidemic in Malaysia, 2003-2019
                                                                                                        bloodborne      virus    transmitted
                           3500                                                12
                                                                                                        through direct contact with the
      Reported HCV cases

                           3000                                                10
                                                                                                        blood of an infected person. It is

                                                                                    Notification rate
                           2500
                                                                               8
                           2000                                                                         estimated that HCV affects 2–15%
                                                                               6
                           1500                                                                         of people living with HIV worldwide
                                                                               4
                           1000                                                                         (and up to 90% of those are people
                            500                                                2
                                                                                                        who inject drugs (PWID)). In
                              0                                                0
                                                                                                        Malaysia, the national surveillance
                                  2003
                                  2004
                                  2005
                                  2006
                                  2007
                                  2008
                                  2009
                                  2010
                                  2011
                                  2012
                                  2013
                                  2014
                                  2015
                                  2016
                                  2017
                                  2018
                                  2019
                                                                                                        data showed that HCV is on the rise
                                         HCV          HCV Notification rate
                                                                                                        with notification rate of 10.55 in
                                                                                                         2019 (Figure 23). While reported
                                                                                                         HIV/HCV co-infection was 518
                            Figure 24: Proportion of PLHIV Starting on ART                              cases or 15.1% of total HCV cases
                             Who Were Tested for Hepatitis C, 2013-2019                                 in 2019. Out of which, only 19.2%
     120.0%                                                                                             of PLHIV co-infected with HCV
     100.0%                                                                                             were on treatment for HCV (Figure
      80.0%                                                                                             24).
      60.0%

      40.0%

      20.0%

             0.0%
                                  2015         2016     2017       2018       2019

     National Strategic Plan for Hepatitis B
     and Hepatitis C, 2019-2023 was
     developed with an objective to
     decrease the transmission of viral
     hepatitis, limit the complications and
     to reduce the socioeconomic impact
     of viral hepatitis

                                                      Malaysia Global AIDS Reporting 2020
19

 Sexually Transmitted Infection
                                                                                   Similar to HIV, STIs are spread
                        Figure 25: Number of Men Reporting Urethral
                         Discharge in the Past 12 Months, 2013-2019                predominantly by sexual contact,
                       3500
                                                                                   including vaginal, anal and oral sex
                                                                                   as well as through non-sexual
                       3000
                                                                                   means such as via blood or blood
                       2500                                                        products. Some STIs can spread
     Number of cases

                       2000                                                        vertically from mother to child during
                       1500                                                        pregnancy and childbirth. Majority of
                       1000
                                                                                   STIs are asymptomatic hence, the
                                                                                   surveillance for urethral discharge is
                        500
                                                                                   used to provide early warning of the
                            0
                                2013   2014   2015     2016   2017   2018   2019
                                                                                   epidemic potential of HIV from
                                                                                   sexual transmission and ongoing
                                                                                   high-risk sexual activity.

                            Figure 26: Safe Sex Practices at Last Sex,
                                                                                   Figure 25 shows an alarming
                                        IBBS 2012-2017
                                                                                   increase of reported urethral
                       90
                                                                                   discharge in men with 2296 cases in
                       80
                       70
                                                                                   2019. This trend is consistent with
                       60
                                                                                   the data in Figure 26 where safe sex
                                                                                   practices at last sex among MSM
     Percent

                       50
                       40
                                                                                   are less than 80% for all 3 cycles of
                       30                                                          IBBS surveys. When used correctly
                       20                                                          and consistently, condom is one of
                       10                                                          the most effective methods of
                        0                                                          protection against STIs and HIV.
                                FSW             TG            MSM       PWID

                                         2012    2014     2017

                                                     Malaysia Global AIDS Reporting 2020
20

 Investing to End an Epidemic
                                                                               Since the beginning of the epidemic,
                      Figure 27: HIV Resources Availability, by Source,        more than 90% of the investment for
                                        2017-2019
                                                                               HIV responses is from domestic
                     250
                                                                               purse (Figure 27). The Global Fund
                     200                                                       to Fight against AIDS, Tuberculosis
                                                                               and Malaria (the Global Fund)
     RM (Millions)

                     150
                                                                               added some 2%-4% of total national
                     100
                                                                               responses for HIV since 2011.
                     50
                                                                               Compared to the year 2012 to 2016,
                      0
                           2010 2011 2012 2013 2014 2015 2016 2017 2018 2019   the total amount of expenditure for
                               Domestic (public)    Domestic (private)         HIV responses decreased by more
                               Global fund          International (other)      than 30% in 2017. This is due to the
                                                                               reduction in the price of ARV
                                                                               medication by more than half in
                      Figure 28: AIDS Spending by Category, 2016-2019          2017.

                                                                  Since the beginning of the
               100%
                                                                  implementation of National Strategic
     80%
                                                                  Plan For Ending AIDS (NSPEA
     60%
     40%
                                                                  2016-2030) in 2016, more than 70%
     20%
                                                                  of the total funding were spent on
      0%                                                          ‘test and treat’ strategy as knowing
               2016          2017       2018          2019        one’s status is the first step in
        Others
                                                                  preventing      infection    (through
        Elimination of MTCT
        Mitigating sexual transmission
                                                                  behavior       modification)      and
        Prevention of HIV transmission through injecting drug use treatment        reduce       onward
        Test and treat                                            transmission through sexual to
                                                                  uninfected partner by 96%. We
 aimed to first reduced the gap on the first and second 90 of HIV treatment cascade
 (Figure 28).

                                                   Malaysia Global AIDS Reporting 2020
21

 2019 galleries

                                       Multi-stakeholder Forum on National HCV
                                       Response 2019 – “Closing the gaps in HCV
                                       Response: Strategy on the Hard-to-Reach
                                       Populations”

 Training of Trainers (ToT): Stop the Stigma
 and Discrimination Towards PLHIV, PLHCV
 & Key Populations (HOPE) Module for
 Healthcare Worker, Cameron Highlands,
 Pahang

                       Malaysia Global AIDS Reporting 2020
22

                                               Stigma & Discrimination
                                               Among HCW Towards PLHIV
                                               Reduction Through Quality
                                               Improvement Initiatives
                                               Meeting with Stakeholders

 Site visit at Persatuan Cahaya
 Harapan Kedah/Perlis at Langkawi
 Island

                                                Community-based testing
                                                (CBT) by accredited
                                                personnel/NGO

                     Malaysia Global AIDS Reporting 2020
23

 Joint-visit MOH-MAC to
 Methadone Maintenance Therapy
 Clinic at Terengganu

                                                     Joint visit MOH-MAC to
                                                     NGO Baitul Cakna,
                                                     Terengganu

 AEM & Spectrum Workshop:
 Update on 2019 data for National
 and Subnational Analysis at
 Langkawi Island with MOH, MAC,
 Dr Wiwat Peerapatanapokin,
 Consultant from East-Centre
 Hawaii and Dr Khin Cho Win Thin,
 Data Specialist from UNAIDS

                      Malaysia Global AIDS Reporting 2020
24

                                                 Updates Medical Seminar for
                                                 Plantation Paramedics, Port
                                                 Dickson, Negeri Sembilan

 Development of Stop the Stigma
 and Discrimination Towards PLHIV,
 PLHCV & Key Populations (HOPE)
 Module for Healthcare Worker at
 Kuala Lumpur

                                                       Strengthening of
                                                       PROSTAR Program
                                                       Workshop, Fraser Hill,
                                                       Pahang

                     Malaysia Global AIDS Reporting 2020
25

                WORLD AIDS DAY 2019 ACTIVITIES

                                                           World AIDS Day in
                                                           Perak –

 World AIDS Day in Perak

                                                  World AIDS Day in Perak

                     Malaysia Global AIDS Reporting 2020
26

                                                   World AIDS Day in Pahang

 World AIDS Day in Johor

                                                   World AIDS Day in Melaka

                     Malaysia Global AIDS Reporting 2020
27

                                    HIV/STI/Hepatitis C Section
                                     Disease Control Division
                                    Ministry of Health Malaysia
                                       Tel: +60 3 8883 4387
                                      Fax: +60 3 8883 4285
                                        www.moh.gov.my

     Printed, reproduced, and/or distributed by Disease Control Division, Ministry of Health Malaysia.

                             Malaysia Global AIDS Reporting 2020
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