NSP AIDS 2011 2015

MALAYSIA

National Strategy Plan on HIV and AIDS 2011 – 2015

National Strategy Plan onHIV and AIDS2011 – 2015

MINISTRY OF HEALTH 2011

National Strategic Plan onHIV and AIDS

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MALAYSIA

National Strategy on HIV and AIDS 2011 – 2015

Acknowledgement: We acknowledge with gratitude and sincere thanks the significant inputs of MOH technical staff at Sector HIV/STI, State and District Level as well as to the UN family in Malaysia for their endless contribution. We are deeply indebted to officials of Government of Malaysia particularly the Ministry of Health, other government agencies such as Ministry of Women, Family and Community Development, Malaysia Department of Islamic Development (JAKIM), National Anti-Narcotic Agency, Royal Police of Malaysia, Legal Advisor, Ministry of Higher Learning, Ministry of Education, Ministry of Human Resource, Ministry of Defence, Ministry of Home Affairs and many others; and all Non-Government Organizations particularly Malaysia AIDS Council and its Partner Organizations, Academia and individuals for their views and valuable advice.

We greatly admire the dedication of all sectors, both government and non-government for their countless support.

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National Strategic Plan on HIV and AIDS

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Table of Contents Acknowledgement

Table of Contents

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Forward by the Director General of Health ………………………………………………………………………………… iii

List of Figures and Tables ………………………………………………………………………………………………………… iv

Acronyms and abbreviations ……………………………………………………………………………………………………….. v

Glossary of terms and definition used in this document …………………………………………………………. vi

Executive Summary ……………………………………………………………………………………………………………………… 1

Chapter 1: Introduction …………………………………………………………………………………………………………… 3

1.1 Background

1.2 Rationale

1.3 Developing the National Strategy on HIV and AIDS 2011 – 2015

Chapter 2: The Malaysian HIV Epidemic: Situation, response and challenges ………………….. 6

2.1 The HIV situation in the country

2.2 The national response

2.3 Issues and challenges

Chapter 3: The National Strategic Plan on HIV and AIDS 2011 – 2015 ………………………………. 17

3.1 Guiding principles

3.2 Goal and specific objectives

3.3 Strategic targets

3.4 Strategies

Chapter 4: Coordination and Implementation ………………………………………………………………………. 24

Chapter 5: Resource Mobilisation …………………………………………………………………………….…………… 28

Chapter 6: Monitoring and Evaluation …………………………………………………………………………………. 30

Annex 1: Framework of the National Strategic Plan on HIV and AIDS 2011 – 2015 ………. 37

Annex 2: National Action Plan on HIV and AIDS 2011 – 2015 ………………………………………….. 43

Annex 3: Target Proposal …………………………………………………………………………………………………… 54

Annex 4: Performance Indicators for the National Strategic Plan on HIV and AIDS 2011 – 2015

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Annex 5: Technical Team …………………………………………………………………………………………………… 64

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National Strategic Plan on HIV and AIDS2011 – 2015

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FFOREWORD

HIV/AIDS was first diagnosed in Malaysia in 1986. By the end of 2010, there was a cumulative figure of 91,362 HIV cases reported to the Ministry of Health out of which 77,064 people living with HIV. The epidemic peaked in 2002 with the rate of 28.5 per 100,000 population. Since then, there has been a steady decline and achieved at 12.8 per 100,000 population in 2010. The Government aims to reduce to 11.0 per 100,000 population by 2015.

With this NSP 2011-2015, we envisage that this target will be reached within the next couple of years and we aim to see a more significant decline by 2015. On reaching this target, it is important that comprehensive HIV prevention, treatment, care and support towards HIV/AIDS should be in place through strong political will, comprehensive policies and participation of the community.

The Government is confident that the new NSP 2011 – 2015 will be able to guide Malaysia towards fulfilling the objectives of the Millennium Development Goals (MDG), UNGASS and Universal Access (UA) targets. It is also intended to reflect the country’s participation in fulfilling these international commitments.

In spite of significant achievements over the years, yet there is even more critical work ahead for all of us and Malaysia is committed to the United Nations pledge ‘Getting to Zero’ - zero new HIV infections, zero discrimination and zero AIDS-related deaths. Indeed, there is an urgent and greater need for a more concerted and coordinated effort between the multiple sectors concerned.

Thank you.

DATO’ SRI DR. HASAN ABDUL RAHMAN

Director General of Health Malaysia

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List of Figures and Tables Figures

Figure 1: Reported AIDS-related deaths, Malaysia 1985 - 2010 16 Figure 2: Reported HIV cases in Malaysia 16 Figure 3: HIV Prevalence (%) among key at-risk populations 18 Figure 4: National HIV and AIDS Policy Framework 32 Figure 5: Stakeholders in the Malaysian HIV response 34 Figure 6: Monitoring and Evaluation Process 39 Figure 7: Monitoring and Evaluation Reporting Structure 41 Tables

Table 1: Overview of the Malaysian HIV Epidemic (as of Dec 2010) 15 Table 2: Findings from bio-behavioural studies conducted in 2009 18 Table 3: Estimates of the Malaysian HIV Epidemic 2010 19 Table 4: Source of approximate AIDS expenditure 2008 – 2010 37 Table 5: Programme coverage targets (2011 & 2015) 38

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Acronyms and abbreviations AIDS Acquired Immune Deficiency Syndrome ART Anti-Retroviral Therapy CBO Community-based Organisation DIC Drop-In Centre DRC Drug Rehabilitation Centre FBO Faith based organisation HAART Highly Active Anti-Retroviral Therapy HIV Human Immunodeficiency Virus IDU Injecting Drug Use/User IBBS Integrated Bio-Behavioural Surveillance MAC Malaysian AIDS Council MARPs Most At Risk Populations M&E Monitoring and Evaluation MDGs Millennium Development Goals MMT Methadone Maintenance Therapy MOH Ministry of Health MSM Men who have sex with men NGO Non-governmental organisation PTCT Parent-to-child transmission MWFCD Ministry of Women, Family and Community Development NADA National Anti Drug Agency NAP National AIDS Programme NGO Non-Government Organisation NSEP Needle and Syringe Exchange Programme NSP National Strategic Plan on HIV/AIDS PITC Provider Initiated Testing and Counselling PLHIV People Living With HIV PMTCT Prevention of Mother-to-Child Transmission SRH Sexual Reproductive Health STI Sexually Transmitted Infection SW Sex Worker TB Tuberculosis TG Transgender Person UA Universal Access UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session UNHCR United Nations High Commissioner for Refugees UNTG United Nations Theme Group on HIV VCT Voluntary Counselling and Testing WHO World Health Organisation

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Glossary of terms and definitions used in this document Civil society refers to NGOs and informal groups (may include People Living with HIV (PLHIV), MARPs, vulnerable populations, women’s organisations, faith-based organisations and advocacy groups) usually apolitical. Cost estimates are financial estimations of how much is envisaged to be spent for a particular programme, usually not be considered as detailed budgets. (Detailed budgets are prepared for usually for Annual Work Plans itemising details of the budget). Coverage is a measure of whether a programme is working in the right places and reaching its target population. For a programme to have a maximum impact on HIV prevention among most-at-risk populations, it must do both. Evaluation is a rigorous, scientifically-based collection of information about programme activities, characteristics, and outcomes that determine the merit or worth of a specific programme. Evaluation studies are used to improve programmes and inform decisions about future resource allocations. Impact evaluation looks at the rise and fall of disease incidence and prevalence as a function of HIV/AIDS programmes. The effects (impact) on entire populations can seldom be attributed to a single programme or even several programmes, therefore, evaluations of impact on populations usually entail a rigorous evaluation design that includes the combined effects of a number of programmes for at-risk populations. Input indicators are used to monitor the amount and level of resources made available to the implementation of the National Strategic Plan on HIV and AIDS. These can be sourced from public, private and international sources. This indicator is critical in evaluating the sustainability of programmes and interventions. Impact mitigation refers to programmes and activities which work towards decreasing the negative impact and direct consequences of HIV on MARPs, vulnerable persons and People Living with HIV such as illness, loss of employment, discrimination and death. Impact indicators are used to evaluate the impact of programmes and interventions to the overall epidemic. These are measured using HIV prevalence amongst MARPs as well as the general population. Incidence is defined as new infections per population at risk in a specified period of time. Injecting drug users (IDU) refers to drug users who inject drugs and use drug equipment. Intervention is a set of activities implemented by a project and that are often provided at the community level. Men who have Sex with Men (MSM). Many men who have sex with men (MSM) engage in anal sex and often have multiple sexual partners; male-to-male sexual transmission is an issue of great importance to HIV prevention. Monitoring is the routine tracking of key elements of a programme or project and its intended outcomes. It usually includes information from record keeping and surveys – both population and client-based.

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Outcome indicators are used to measure the effectiveness of implemented programmes in changing risk behaviours among most at risk populations, encourage prevention, treatment, care and support seeking behaviours. This indicator is critical to evaluate the effectiveness of programmes. Output indicators are linked closely to the coverage of programmes of MARPs. This is often measured by the coverage achieved through behavioural change communication programmes, harm reduction interventions such as access to needles, syringes and condoms, utilisation of VCT, treatment, care and support services. This indicator is critical to evaluate the development and implementation of programmes. Outreach services are those which take health information and services into the communities where most-at-risk populations live, or place where they congregate (such as back lanes where injecting drug use occurs or where pickups for transactional sex occur). Prevalence is defined as the total number of cases of HIV at a point in time per base population. Programme refers to an overarching national or subnational response to a disease and generally includes a number of projects. Project refers to a mix of interventions with activities supported by resources and that often operates at the community level. Transgender persons are refers to persons whose gender identity, expression, or behavior differs from the norms expected from their birth sex. The term “mak nyah” is commonly used within the Malaysian context to refer to persons of this category. Universal Access refers to the global commitment to scale up access to HIV treatment, prevention, care and support which all governments agreed to when they adopted the Political Declaration on HIV/AIDS at the UN General Assembly in 2006. This involves the setting up of ambitious national targets set against key outcome areas – such as ART coverage, prevention of mother to child transmission, coverage of prevention programmes for most at risk groups and testing coverage. Young person/ people refer to individuals within the ages of 15 – 24 years old.

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National Strategy on HIV and AIDS 2011 - 2015

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Executive Summary

The National Strategic Plan on HIV and AIDS 2011 – 2015 (NSP) runs parallel and is harmonised with the aims and objectives of the 10th Malaysian Plan (10MP) for 2011 – 2015. This NSP will continue to place strong emphasis on strengthening the multi-sectoral collaboration undertaken under the previous strategic plans. The HIV epidemic in Malaysia is driven by injecting drug use and sexual transmission occurring among most at risk populations such as drug users, sex workers, men who have sex with men and transgender persons. Operational research have shown that overlapping of injecting drug use and high risk sexual behaviour is occurring resulting in HIV infection between different segments of the populations. Studies and consensus discussions among experts have concluded that HIV in Malaysia is predicted to be increasingly spread through sexual transmission, though the infections acquired through injecting drug use (and other means e.g. vertical transmission) need to be monitored as well.

The review of the first National Strategic Plan on HIV and AIDS formulated in 1998 was done in 2001. The development of the National Strategic Plan on HIV/AIDS 2006 – 2010 in 2005 led to its implementation and use over the past five years, whilst this document (NSP 2011 – 2015) replaces the latter strategic document.

The lessons learnt and experience gained in the implementation and monitoring of the previous NSPs have shown that there are still a lot of opportunities to strengthen the commitment of all stakeholders. Various opportunities need to be enhanced to achieve greater harmonisation, coordination and alignment; maintain and sustain high levels of funding; achieve greater programme coverage, effectiveness, and efficiency; and to continue the provision of affordable treatment to those who need it. The NSP 2011–2015 intends to build upon the achievements and progress made during implementation of the previous strategic framework as well as address emerging issues and challenges. The National Strategy on HIV and AIDS 2011 – 2015 comprises three main components: 1. The National Strategic Plan on HIV and AIDS 2011 - 2015 2. The National Action Plan on HIV and AIDS 2011 – 2015 3. The national monitoring and evaluation framework

The goals of the Malaysian NSP 2011 - 2015, are:- 1. To prevent and reduce the risk and spread of HIV infection 2. Improve the quality of life of People Living with HIV 3. Reduce the social and economic impact resulting from HIV and AIDS on the individual, family and

society.

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The specific objectives of the NSP2011-2015 are:- 1. To further reduce by 50% the number of new HIV infections by scaling up, improving upon and

initiating new and current targeted and evidence based comprehensive prevention interventions

2. To increase coverage and quality of care, treatment and support for People Living with HIV and those affected

3. To alleviate the socioeconomic and human impact of AIDS on the individual, family, community and society.

4. To create and maintain a conducive and enabling environment for government and civil society to play meaningful and active roles in decreasing stigma and discrimination.

5. To further increase general awareness and knowledge of HIV, and reduce risk behaviour for at risk and vulnerable populations.

These objectives can only be meaningfully achieved and sustained under the commitments to UA and MDG after programmes worked towards achieving 80% service coverage among most at risk populations where 60% practice safe behaviours. To achieve these objectives, the NSP has adopted the following multisectoral strategies which provided an appropriate balance between prevention, treatment, care and support, namely:

Strategy 1 Improving the quality and coverage of prevention programmes among most at risk

and vulnerable populations

Strategy 2 Improving the quality and coverage of testing and treatment

Strategy 3 Increasing the access and availability of care, support and social impact mitigation programmes for People Living with HIV and those affected.

Strategy 4 Maintaining and improving an enabling environment for HIV prevention, treatment, care and support.

Strategy 5 Increasing the availability and quality of strategic information and its use by policy makers and programme planners through monitoring, evaluation and research.

The execution and fulfilment of the following strategies will require renewed and strengthened commitment and multisectoral partnership of government, civil society and private sector stakeholders to work together in the spirit of consultation and collaboration under the 1Malaysia initiative.

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CHAPTER 1 Introduction

1.1 Background It is estimated that 34 million people currently live with HIV globally, and each year, it is estimated that 2.7 million more people become infected with HIV and 2 million die of AIDS. The 2009 Commission on AIDS in Asia Report stated that more than 5 million Asians currently live with HIV, and approximately 440,000 become infected each year. Yearly, about 300,000 persons die of AIDS-related diseases. The report indicates that the pandemic in Asia is entering its second growth phase, which is expected to result in increasing HIV prevalence and nearly 10 million Asians infected if prevention efforts are not expanded or fully implemented. The Government of Malaysia is concerned by the continued spread of HIV in the country, particularly amongst most at risk populations (MARPs) identified mainly as injecting drug users (IDUs), sex workers (SW), transgender persons (TG) and men who have sex with men (MSM). The National Strategic Plan on HIV/AIDS (NSP) 2006-2010, which was developed by the Government and drafted with the involvement of key civil society representatives in 2005 / 2006, incorporated a multi-sectoral strategy covering issues from young people’s vulnerability to the delivery of healthcare services and antiretroviral treatment. Through this strategy, the Malaysia has made much progress in HIV prevention, particularly utilising the harm reduction approach which has begun to yield results in reducing the spread of the HIV epidemic. People living with HIV and in need of treatment are able to access first line treatment at no cost whilst the second line regimes at heavily subsidised as well. While NSP 2006 – 2010 has made the promotion and implementation of harm reduction and the intervention with injecting drug users as the focus of its HIV prevention interventions, the NSP 2011 - 2015 will need to deal with a variety of new challenges, among which are expected higher incidences of sexual transmission of HIV/AIDS to be detected and the focus of concentrated epidemic that Malaysia is being classified with the emergence of populations at risk. 1.2 Rationale Over the past five years, increased levels and additional sources of funding have made it possible to expand or upscale the support of HIV and AIDS interventions in the region, giving Malaysia avenues to accelerate the national response to the epidemic. Nevertheless, there remain gaps and opportunities for improvement in certain identified programmes. The 2008 and 2010 UNGASS Country Progress Reports identified certain challenges in the national response to HIV and AIDS. These reports have also recognised the significant progress and positive

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developments which have occurred in the last few years in Malaysia for example i.e. harm reduction interventions, the affordable treatment for PLHIVs, and the wide availability voluntary counselling and testing services. The government and the key stakeholders have agreed that the next National Strategy on HIV should be able to sustain and upscale the abovementioned achievements and commitments, while at the same time be able to address concerns and identified gaps as well as respond more effectively to the needs of its stakeholders, especially those of civil society and most at risk communities. The lessons learnt and experience gained in the implementation and monitoring of NSP 2006 – 2010 have also shown that there are opportunities could be tapped upon, namely to strengthen political commitment, to achieve greater harmonisation, coordination and alignment; maintain and sustain high levels of funding; and to continue the provision of affordable treatment to those who need it. The new strategic plan should achieve greater programme coverage amongst MARPs with high impact results, effectiveness, and efficiency. The NSP 2011–2015 intends to build upon the achievements and progress made during implementation of the previous strategic framework as well as address emerging issues and challenges which threaten the sustainability of the abovementioned gains. It is also intended to guide Malaysia towards achieving the Millennium Development Goals, UNGASS and Universal Access targets. 1.3 Developing the National Strategy on HIV and AIDS 2011 – 2015

1.3.1 The Ministry of Health initiated the process of multisectoral consultation in preparation of the NSP in May 2010. It was a matter of priority and concern for all key stakeholders that this National Strategy on HIV and AIDS would be able to capture as much of the issues, progress and challenges experienced by both Government and civil society stakeholders in the response to HIV in Malaysia.

1.3.2 An orientation and preparatory briefing on the NSP development process was organised by the Ministry of Health on 21 June 2010 for Government, civil society stakeholders and UN agencies. The intention was to ensure that all partners understood the process and were also able to participate and contribute to the substance and overall development of the National Strategy. The meeting also provided guidance for the consultations which would happen independently amongst the different MARPs communities.

1.3.3 Six technical working groups (TWG) consisting of government and NGO stakeholders, discussed and recommended key areas for response under the new National Strategy on HIV and AIDS; identified gaps in current interventions, technical skills, capacity building and financial requirements under the existing NSP; and provided input in identifying priority areas, programmes and targets for the next 5 years. Issue papers were submitted in the following areas: HIV prevention amongst IDUs; MSM, transgender persons, sex workers, intimate partners; prevention amongst other populations (at risk youth, migrants, refugees); Treatment and PLHIV; Impact mitigation through care and support; and enabling environment (advocacy, policy, strategic information, research and surveillance). The findings of the TWGs were presented, consolidated and integrated into the strategic framework at the first national consultative workshop with stakeholders.

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1.3.4 The first and second consultative meetings to develop the national strategic framework and the national action plan took place on 5-6 August and 20-21 September respectively and were attended by various government bodies and representative of MARPS.

1.3.5 A costing and budgeting workshop was organised as 11-12 October to ensure that the cost of the proposed interventions and activities contained within the national action framework was able to be properly estimated. A cost standardisation exercise was also conducted on 19 October. A monitoring and evaluation workshop was also convened on 1-2 November to develop a common understanding of monitoring and evaluation and to discuss the development of a common framework for use of government and civil society stakeholders to monitor, evaluate and manage AIDS programme, the results of which would be used for managing the AIDS response, improving performance and revising the national strategy and action plan.

1.3.6 The completed drafts of the individual components of the National Strategy on HIV and AIDS 2011 - 2015, consisting of the National Strategic Plan on HIV and AIDS, National Action Plan 2011 – 2015 and the national monitoring and evaluation framework were presented during a national workshop on 10 November.

The approach utilising information sharing, inclusivity and consensus building for the development of the National Strategy on HIV and AIDS has enabled many of the new developments in the Malaysian national AIDS programme to be properly reflected in the strategic document. The setting of clear, prioritized and evidence-driven national priorities which respond to the evolving dynamics of the Malaysian HIV epidemic was dependent on much of the strategic information and research data which became available over the past two years. Much of the research data utilised for priority originated from the efforts and work of civil society and community based organisations, working in partnership with Government agencies and academic institutions. Though obtaining data remains a continuing challenge, the inputs from government and civil society stakeholders have been critical in improving the understanding and response to the epidemic and form the backbone of the new strategy. The National Strategy on HIV and AIDS 2011 – 2015 was developed and prepared by the AIDS/STI Sector of the Disease Control Division, Ministry of Health. Technical support in the formulation and preparation of the consultation process, consolidation of inputs and drafting of the document was provided by the United Nations Theme Group on HIV and AIDS.

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CHAPTER 2 The Malaysian HIV Epidemic: Situation, response and challenges

2.1 The HIV situation in the country The present As of December 2010, an estimated 80,922 people (Estimation & Projection Model – EPP) are currently living with HIV. By the end of 2010, Malaysia had a cumulative figure of 91,362 of HIV cases, 16,352 AIDS cases and 14,298 deaths, thus giving reported people living with HIV (PLHIV) of 77,064.

The annual number of reported new HIV cases by the Ministry of Health has been on a steady decline from a peak of 6,978 in 2002. In 2010, there were 3,652 new cases reported to the Ministry of Health, approximately halve of what was reported in 2002. The notification rate of HIV also continues to experience a decrease from 27.0 in 2003 to 23.4 in 2005 and to 12.8 cases per 100,000 population in 2010. Currently, there are 10 new reported cases of HIV each day with a ratio of 2 females for every 8 males reported. In 2010, an average of 5 persons acquired HIV through injecting drugs while 5 others were infected sexually.

Table 1: Overview of the Malaysian HIV Epidemic (as of Dec 2010)

Cumulative number of reported HIV infections since 1986 91 362

Cumulative number of reported AIDS related deaths since 1986 14 298

Estimated number of people living with HIV (EPP & Spectrum model 2010) 80 922

Reported number of people living with HIV 77 064

Cumulative number of women reported with HIV 8 759

Cumulative number of children under 13 with HIV 909

New HIV infections detected in 2010 3 652

AIDS related deaths in 2010 904

Number of PLHIV currently on ART in 2010 13 981

Estimated PLHIV needing ART (CD4 <350) (EPP & Spectrum model 2010) 30 600

Estimated adult (aged 15-49 years) HIV prevalence (EPP & Spectrum model 2010)

0.42%

Notification rate of HIV (per 100 000) 12.6 Source: Ministry of Health, 2011

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The decline in the number of AIDS related deaths has been directly attributed to the introduction of more affordable and accessible first and second line antiretroviral (ARV) treatment. It has been estimated that by end of 2015, Malaysia will have an estimated 81,946 people living with HIV. Male continue to represent the majority (90%) of cumulative HIV cases in Malaysia. About 35% of reported infections are amongst young people between the ages 13-29 years old. Most reported infections occur among young heterosexual males, between the ages of 20 – 39 who inject drugs. However, in 2010 HIV infection through sexual transmission has exceeded the infection through injecting drug use. Children aged 13 years below consistently comprised 1% of cumulative total of HIV infections from 1986 to December 2010.

Figure 1: Reported HIV and AIDS-related deaths, Malaysia 1985 – 2010 Source: Ministry of Health, 2011

Figure 2: Reported new HIV cases in Malaysia, 1986 – 2010, disaggregated by sex, age group and transmission mode.

Source: Ministry of Health, 2011

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Amongst men, the main mode of HIV transmission continues to be via injecting drug use (IDU) with HIV prevalence estimated to be 22.1% (IBBS 2009). The Ministry of Health reported that most HIV infections amongst women have occurred mainly through heterosexual transmission (70%). Women and girls are increasingly getting infected with HIV and constitute around 20% of newly infected persons nationwide in 2010 compared to being barely 5% ten years ago. There are also very few reported cases amongst the indigenous population (Orang Asli) which was 36 cumulative cases (0.04%). The trends of HIV infection also appear to be geographically distinct. While the majority of states in Peninsular Malaysia have IDU driven epidemics, Sabah and Sarawak have more HIV resulting from heterosexual transmission (97.7% and 83.6% respectively) in 2010. The HIV prevalence in Malaysia continues to be less than 1%, but it (HIV prevalence) ranges from 3% to 20% among the MARPs. The World Health Organisation (WHO) currently classifies Malaysia as having a concentrated HIV epidemic.

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Most at risk populations The HIV epidemic in Malaysia was initially driven by transmission among injecting drug users in the 1990s. During that period, up to 83% of annual newly detected HIV cases were attributed to injecting drug use. Cumulative reported cases of HIV transmission was predominantly among injecting drug use (70.6%), followed by heterosexual intercourse (16.9%) and homosexual contact (2.0%)., However, 2010 data indicates that 47.6% of new reported HIV cases for that year were attributed to injecting drugs while 48.5% was through sexual transmission (heterosexual and homosexual).

In 2002, it was decided that the existing HIV surveillance system, based on notification of newly diagnosed HIV infection and screening in sub-populations, needed further strengthening, especially to predict the course of the epidemic. The Ministry of Health decided to incorporate the use of behavioural surveillance studies into the existing system. Through discussions and consensus meetings among local experts, it was recommended that monitoring HIV risk behaviour could play a vital role in determining the future direction in the spread of HIV within the different most-at-risk populations. Behavioural Surveillance Surveys were adapted for this purpose beginning in 2004 which was later followed by the use of Integrated Bio-Behavioural Surveillance (IBBS) studies.

Figure 3: HIV Prevalence (%) among key at-risk populations (EPP estimates 2011)

Most-At-Risk Populations (MARPs) refers to specific people or populations whose practices or behaviours put them at greater risk of HIV infection include high rates of unprotected sexual partnerships, unprotected anal sex with multiple partners, and injecting drugs with shared equipment. Thus in Malaysia, the population groups where these behaviours are concentrated include: injecting drug users (IDUs); female sex workers (FSWs), clients of FSWs; men who have sex with men (MSM); and transgender persons (TG). Included within this category, are partners, and spouses of the abovementioned populations as well as any group documented or projected to have HIV prevalence over 5%. Vulnerable populations refer to persons subject to factors or conditions which increase the possibility of them engaging in risky behaviours. A person vulnerable to HIV can be defined as one who is susceptible to, or unable to protect themselves from, significant harm or exploitation linked with HIV infection. Vulnerable populations include various categories of young people (e.g. out of school youth, children of sex workers and injecting drug users, street children, young people in incarcerated settings, foster care and other institutional settings), migrant workers and refugee populations, and other undocumented persons.

TG (8.3%)

IDU (23.2%)

MSM (3.6%)

FSW (10.3%)

Client (1.5%)

IBBS IDU (22.1%)

IBBS FSW (10.5%)

IBBS TG (9.7%)

IBBS MSM (3.9%)

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Table 2: Findings from bio-behavioural studies conducted in 2009

Source: Ministry of Health (2010). HIV Epidemic in Malaysia. Powerpoint presentation presented by Dr. Shaari Ngadiman, at 1st Consolidation and Consultation Workshop, 5-6 August 2010. Figure 4 above shows the HIV epidemic in Malaysia is driven by injecting drug use and sexual transmission occurring among MARPs. There is also clear evidence based on operational research that overlapping of injecting drug use and high risk sexual behaviour is occurring resulting in HIV infection between the different populations. Based on the evidence, the government has taken steps towards targeting increasing existing coverage of IDUs under the NSEP programmes. Relevant government healthcare facilities in recent years have also been upscaled the NSEP and MMT programmes thus eventually bringing down the costs of existing IDU related intervention programmes and activities. The future Based on recent HIV estimations and projections modelling conducted by the Ministry of Health, sexual transmission of HIV in Malaysia is predicted to be on the rise, while the newer cases of HIV infection through IDU are expected to plateau. The proportion of reported cases attributed to MSM and heterosexual route of transmission is slowly increasing which is consistent with the results of the HIV estimation and projections model for Malaysia, which was tabulated in 2011.

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Table 3: Estimates of the Malaysian HIV Epidemic (EPP 2010)

2010 2015

Total People Living With HIV 80,922 81,946 Male 65,669 (81.1%) 62,898 (76.8%) Female 14,739 (18.9%) 19,048 (23.2%)

Total new infections/ year 7,516 6,699 Male 5,751 4,692 Female 1,766 2,007

Total AIDS related deaths/ year 6,741 6,335 Male 5,698 5,137 Female 1,042 1,199

Source: National Consensus Workshop on Estimation and Projection of the Malaysian HIV Epidemic (2011) The key findings from the estimation and projection 2011 (EPP) workshops are as follows:- 1 Since 2008, the estimated number of new HIV infections among IDUs appears stabilized.

2 For every single male detected with HIV, there are two other male cases which would go undetected.

3 The number of AIDS related deaths is expected to decrease in the next 3-5 years, as accessibility to antiretroviral treatment and preventive activities increased.

4 The number of women living with HIV is higher than previously thought. It estimated that there is 1 female newly infected with HIV for every 3 males infected.

5 Revised needs and coverage estimates based on the adoption of WHO’s recommended criteria of CD4<350 for ARV treatment initiation, indicate a higher financial allocation is needed for the provision of ARV.

It is expected that the evolving phenomena of the HIV epidemic (particularly that of sexual transmission of the disease), will pose newer challenges for HIV programming taking into consideration Malaysia’s cultural and religious context and sensitivities. 2.2 The national policy and programmatic response The Malaysian HIV response over the past five years has been guided by the National Strategic Plan on HIV/AIDS 2006 – 2010 which was drafted via multi-sectoral approach incooperating issues ranging from young people’s vulnerability to the delivery of healthcare services and ARV treatment. This framework provided a common ground and emphasis on an integrated and comprehensive approach addressing the needs of prevention, treatment, care and support. As a result of many of the progress and accomplishments made by Malaysia in the duration of the NSP 2006-2010, the country is well on its mark to achieve the sixth goal of the MDG (Millennium Development Goals) within the next five years. There are however, still many challenges which lay ahead, thus maintaining the political support and further up-scaling financial resources are indeed crucial.

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2.2.1 Strengthening the national commitment and supporting the NSP 2006 – 2010.

The Cabinet Committee on AIDS (CCA) was restructured in 2009, and being replaced by the National Coordinating Committee on AIDS Intervention (NCCAI) chaired by the Minister of Health. Civil society is also being represented on this new committee.

The increase in proportion of female HIV cases in Malaysia over the past five years has made the government to revive the Taskforce on Women, Girls and HIV/AIDS. This taskforce is currently chaired by the Ministry of Women, Family and Community Development (MWFCD), mandated to guide the actions of the Government in its response to addressing the behavioural and socioeconomic factors on the sexual transmission of HIV. 2.2.2 Multi-sectoral engagement in the HIV response Malaysia has taken the multi-sectoral approach when addressing the issues and challenges on HIV/AIDS. Non-health sectors i.e. the Ministry of Women, Family and Community Development, National Anti Drug Agency (Home Affairs Ministry) Department of Orang Asli (Indigenous People) Affairs, the Department of Islamic Development (JAKIM), the Prison’s Department, and the Information Ministry now form part of the key stakeholders in the country involved in the national HIV prevention and control programmes. The Ministry of Women, Family and Community Development has been instrumental in improving the overall response especially on matters pertaining to care and support services for PLHIV and those affected. 2.2.3 ARV treatment, resource mobilisation and funding support The Government has provided an allocation of RM 500 million (USD 143 million) for a period of 5 years during the NSP 2006-2010. This translates to RM 100 million (approximately USD 28 million) yearly which goes towards funding of Government and non-government HIV prevention, care and support programmes. A bulk of the funds also provides for the provision of ARV treatment for almost 10,000 people living with HIV. During the NSP 2006-2010, two significant achievements have accomplished, firstly, the availability and provision of first line ARV treatment at no cost for those who need it and secondly, the availability of ARV treatment for incarcerated populations specifically for HIV+ prisoners as well as inmates in drug rehabilitation centres. Currently, the second line regime is also heavily subsidised by the government. 2.2.4 The harm reduction programme The harm reduction programme, comprising the Needle Syringe Exchange Programme (NSEP) and the Methadone Maintenance Therapy (MMT,) remains the cornerstone of the Malaysian Government’s HIV prevention strategy. This programme is currently being implemented in partnership with non-governmental organisations (NGOs), community based organisations (CBOs) and private health practitioners. Significant successes which have been attributed with increased sites and clients over the last few years have made this one of the programmes which has managed to get worldwide attention. A number of innovative strategies have been introduced lately i.e. the introduction of the

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MMT at National Anti Drug Agency service centres and incarcerated settings specifically prisons. More than 40,000 injecting drug users have been beneficiaries of this programme so far. 2.2.5 PMTCT programme The prevention of mother-to-child transmission (PMTCT) (prevention of vertical transmission) programme in Malaysia introduced in 1998 is based strongly around ARV prophylaxis for the child, safer delivery and infant feeding practices. It is also depended on detection of HIV infection during the mother’s antenatal period. The programme is implemented nationwide since 1998 at government health clinics and hospitals, and incorporates HIV screening utilising an opt-out approach. Although it covers only women receiving antenatal care at these government facilities, it is estimated that over 70% of total antenatal mothers nationwide utilise public antenatal facilities. Antenatal HIV cases from the private sector are also referred to the government medical system. 2.2.6 Mobilisation and involvement of MARPs and civil society Involvement of key civil society stakeholders in national level policy and programme development continues to be dependent on issues of capacity and relevance. Civil society is being represented at the National Coordinating Committee on AIDS Intervention and the Country Coordinating Mechanism. In the former, civil society is represented by the Malaysian AIDS Council while in the later several representatives (e.g. sex workers, PLHIV and transgender) have been elected onto the CCM by their respective communities. 2.2.7 Engagement with religious leaders The engagement with and involvement of religious leaders, especially Muslim religious leaders has increased significantly over the past few years. A lot of advocacy and investment in programming was done to mobilise and harness the support of Islamic religious leaders for HIV prevention and the provision of care and support. Muslim religious leaders have been actively involved in the implementation of HIV awareness programmes and also proactively established care and support facilities from financial and welfare assistance to shelters for Muslim PLHIV. The past 2 years in particular have seen the remarkable development of programmes by the Department of Islamic Development which involve a number of religious bodies engaging most-at-risk populations such as female sex workers and transgender persons through the availability of religious classes. 2.2.8 Increased availability and improvement of quality strategic information Much progress has been made in understanding the Malaysian HIV epidemic and most at risk populations (MARPs), particularly vulnerability to HIV and STI infection and the need for specific essential services. Much improvement has been achieved in the reporting of UNGASS country progress indicator data as a result of a number of surveys and research studies conducted in the past two years by a number of NGOs working with the Ministry of Health, such as the Malaysian AIDS Council (MAC), PT Foundation (PTF) and Federation of Reproductive Health Associations Malaysia (FRHAM) as well as the involvement of research bodies such as the Centre for Excellence on Research

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in AIDS (CERIA). The involvements of these NGOs have complemented the efforts made by the government bodies to produce quality data. Detailed gender disaggregated data has also recently become available as a result of a revision of the national HIV reporting system and the National AIDS Registry by the Ministry of Health. Analysis of this data is critical to ensure a better understanding of how men and women are vulnerable to HIV infection in Malaysia. 2.3 Key challenges As a result of the progress made in the NSP, expectations on both Government and civil society have become significantly higher. Much of the challenges are related to sustaining the results of existing HIV prevention, treatment, care and support programmes both financially and programmatically. 2.3.1 The rise in sexual transmission The rise in sexual transmission would require a further strengthening of commitment from the Government to undertake and improve upon programmes which specifically address the issue of sexual reproductive health, especially among young people. Policy-makers will need to be better informed about the importance of adolescent health and sexual reproductive health, particularly within the context of HIV. As issues relating to sexuality and young people are often contentious and linked to public morality, thus, making it more essential to further consult and engage religious leaders and other community leaders. The upholding of social and religious values and rulings should take into consideration the realities of an epidemic which is increasingly spread through sexual transmission. 2.3.2 Sustainability of human, financial and infrastructure resources Concern has been expressed as to whether many of the achievements made in the past few years are financially sustainable due to the sole reliance on public funding. Reaching out to these populations also remains a significant challenge. Over the last decade, the vast majority of prevention programmes involving MARPs by CBOs and NGOs have been heavily funded by the government. As a result, interventions programmes are sometimes confined to certain geographical locations and communities to get the maximum coverage and impact. Sustainability of funding, and human capacity enhancement in HIV/AIDS prevention programmes especially among the civil society therefore is one of the major concerns for Malaysia and NSP 2011-2015. 2.3.3 Financial cost of providing increased ARV treatment coverage Revised needs and coverage estimates based on the 2009 adoption of WHO’s recommended criteria of CD4<350 for ARV treatment initiation, indicate an increased burden in the provision of ART. This revision of treatment protocol has significantly increased the number of persons estimated to be in

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need of treatment. Of major concern for the Government on this issue, is the large financial cost of providing this increased coverage which is expected to cost an estimated RM 60 million annually. 2.3.4 Engaging religious leaders The engagement of religious leaders from all faiths is expected to play a continued, expanding and critical role over the years in providing complementary care and support services for PLHIV and those affected as well as prevention of sexual HIV transmission. The Government is currently making an effort to expand this engagement to those from non-Muslim faiths. Some of the religious departments e.g. Selangor and Pahang have provision in their enactment to provide deserving PLHIVs zakat (tithes). The next few years will probably see more shelter homes being built by the religious departments. 2.3.5 Mobilising MARPs and vulnerable populations to access public HIV healthcare services Mobilising MARPs, vulnerable populations and related civil society organisations to access and utilise the many available public HIV related healthcare facilities and service points remains an ongoing challenge. Perceived as well as actual occurrences of stigma and discrimination by these communities may act as deterrents and obstacles for them to utilise these facilities. There is also a need for NGOs to be able to work with these public facilities to provide services for vulnerable populations such as former prisoners and drug rehabilitation centres inmates who have been released from such institutions. One of the greatest challenges to date would definitely have to be adhering to ARV treatment. 2.3.6 Stigma and discrimination Stigma and discrimination continues to be an issue, however it has lessen now. Nevertheless, it not only affects PLHIV but to those around them, and also affect the progress and successful implementation of HIV prevention, treatment, care and support programmes. Vulnerable populations and MARPs may encounter incidences of discriminatory practices in public and private workspaces as well as during the implementation of HIV programmes, which inevitably might complicate the outcomes of impact of such programmes. 2.3.7 Structural challenges The Ministry of Health and its civil society partners face many challenges in responding to AIDS in the country, some of which are structural in nature. These may affect the implementation of the harm reduction programme as well as interventions with sex workers, transgender persons and MSM programmes. However, in dealing with these issues, government officials and their civil society counterparts have been encouraged to work together. Frequent dialogues and discussions have been held either at the local or national levels to address some of these challenges. A lot more needs to be done to overcome some of these challenges.

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2.3.8 More research and studies needed Strategic information such as behavioural data necessary to plan and implement a comprehensive response to HIV was previously quite limited. Data for these populations on HIV prevalence, profiles of risk behaviour and vulnerabilities were often anecdotal, limited or simply not available. The availability of relevant strategic information has improved tremendously since 2009. Though there continues to be limited research concerning most-at-risk populations and HIV, the past few years have seen the implementation of a number of behavioural studies and research with these communities. These are still limited in certain geographical locations and must be further expanded to other parts of Malaysia.

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CHAPTER 3 The National Strategic Plan on HIV and AIDS 2011 - 2015

The National Strategic Plan on HIV and AIDS 2011 – 2015 runs parallel and is harmonised with the aims and objectives of the 10th Malaysian Plan (10MP) for 2011 – 2015 which guides the development of Malaysia for the next five years as well as the policies outlined under the 1Malaysia initiative related to healthcare. 3.1 Guiding Principles for the National Strategic Plan on HIV and AIDS 2011 – 2015 Malaysia’s national multisectoral response to HIV and AIDS is built and guided by the following guiding principles: 3.1.1 The spread of HIV is a challenge to the national development of Malaysia and is a concern to

be addressed under the 10th Malaysian Plan and the 1Malaysia initiative.

3.1.2 The HIV and AIDS response will be based on evidence and prioritise interventions among most at risk populations (MARPs) and will also include other populations made vulnerable to HIV infection due to risk behaviours and environment.

3.1.3 The HIV and AIDS response will be comprehensive and focus on promoting healthy practices, disease prevention, as well as treatment, care and support for People Living with HIV and people affected by HIV and AIDS.

3.1.4 The response to HIV and AIDS should take into consideration cultural, religious and societal values.

3.1.5 Government, civil society and private sector stakeholders will work together in multisectoral partnership to respond to the spread of HIV and AIDS in the country. Working in consultation and collaboration with relevant stakeholders, the Government will provide policy direction, HIV treatment for those in need, and financial resources in support of this effort. Civil society, including non-government organisations, community groups, People Living With HIV and those affected by HIV and AIDS, will support and complement the Government in the prevention of HIV, as well as care and support for those living with HIV and those affected.

3.1.6 All stakeholders will work together to create a conducive and enabling environment to ensure the effectiveness of interventions under the HIV response which respect human dignity, gender and sexuality.

3.1.7 Active and meaningful participation of key populations including most at risk communities, People Living with HIV and those affected will be integral to the development, implementation, monitoring and evaluation of all interventions.

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3.2 Goal and Specific Objectives 3.2.1 Goal The National Strategic Plan on HIV and AIDS 2011 – 2015 aims to prevent and reduce the risk and spread of HIV infection, improve the quality of life of People Living with HIV, and reduce the social and economic impact resulting from HIV and AIDS on the individual, family and society. 3.2.2 Specific Objectives a) To further reduce by 50% the number of new HIV infections (i.e. notification rate of HIV) by scaling

up, improving upon and initiating new and current targeted and evidence based comprehensive prevention interventions

b) To increase coverage and quality of care, treatment and support for People Living with HIV and those affected

c) To alleviate the socioeconomic and human impact of AIDS on the individual, family, community and society.

d) To create and maintain a conducive and enabling environment for government and civil society to play meaningful and active roles in decreasing stigma and discrimination.

e) To further increase general awareness and knowledge of HIV, and reduce risk behaviour for at risk and vulnerable populations.

These objectives can only be meaningfully achieved and sustained under the commitments to Universal Access and the Millennium Development Goals after programmes have achieved 80% service coverage among MARPs where 60% of those covered practice safe behaviours. 3.3 Strategic Targets It is aimed that by the end of 2015, a 50% reduction of new infections able to be prevented and averted is achieved. Malaysia is currently able to provide Universal Access coverage on a number of limited services related to treatment of HIV and AIDS. However, the National Strategic Plan on HIV and AIDS 2011 – 2015 strives to sustain the progress and achievements made over the past National Strategic Plans on HIV and AIDS. To do so, this National Strategic Plan on HIV and AIDS targets to achieve the following: a) Comprehensive HIV prevention programmes are able to effectively cover 80% of most at risk

populations.

b) 60% of most at risk populations use condoms consistently.

c) 60% of most at risk populations, who are also injecting drug users, use clean injecting equipment.

d) All cases of vertical HIV transmission are able to be prevented with all HIV positive pregnant mothers receiving treatment and children born receive ARV prophylaxis.

e) Provision and access to comprehensive services for at least 80% of People Living with HIV who are eligible for ARV treatment, care and support which are non-discriminatory and professional.

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3.4 Strategies The National Strategic Plan on HIV and AIDS 2011 – 2015 is both a continuation and is as a result of the efforts of the previous National Strategic Plan 2006 – 2010. It is a response to the improved understanding and increase in behavioural and surveillance data availability amongst most at risk populations. This National Strategic Plan on HIV and AIDS is also a response to the increasing challenges and issues faced in the Malaysian HIV epidemic. It is intended to be a component within the 1Malaysia framework related to healthcare. There will be 5 main strategies to be undertaken under this plan, namely: a) Improving the quality and coverage of prevention programmes among most at risk and vulnerable

populations

b) Improving the quality and coverage of testing and treatment

c) Increasing the access and availability of care, support and social impact mitigation programmes for People Living with HIV and those affected.

d) Maintaining and improving an enabling environment for HIV prevention, treatment, care and support.

e) Increasing the availability and quality of strategic information and its use by policy makers and programme planners through monitoring, evaluation and research.

The key stakeholders of the National Strategic Plan will continue to support the government, policy makes and the Ministry of Health in advocating the multisectoral approach on HIV and AIDS issues. For the execution and fulfilment of the strategies to be implemented fully, the commitment and partnership of government, civil society and private sector stakeholders working together in the spirit of consultation and collaboration are crucial. 3.4.1 Strategy 1: Improving the quality and coverage of prevention programmes among

most at risk and vulnerable populations HIV prevention efforts in 2011 – 2015 will focus on addressing the three primary prongs of HIV transmission in Malaysia, namely the sharing of needles and syringes through injecting drug use, unprotected sexual intercourse, amongst most at risk and vulnerable populations and advocacy amongst the most-at-risk youth populations Strategy 1.1: Prevention of HIV transmission through the sharing of needles and syringes The primary mode of transmission in Malaysia continues to be through injecting drug use. Sustaining and scaling up of existing comprehensive prevention interventions which includes the harm reduction (needle syringe exchange and methadone maintenance therapy) programme continues to be needed and their coverage increased to include other identified populations. Key Activities: a. Build an enabling environment for HIV prevention with IDUs and their partners by mobilizing key

stakeholders, including, health care providers, community networks, NGOs, local authorities, and law enforcement.

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b. Develop other innovative strategies to address challenges for the delivery of HIV prevention with IDUs.

c. Implement targeted behaviour change approaches for male and female IDUs which emphasize risk reduction and promote safer sexual and risk reduction behaviours.

d. Implement national scale up of HIV prevention with IDUs and their partners including needle and syringe exchange programmes and opioid substitution therapy.

e. Strengthen mechanisms to manage HIV prevention among drug users in prisons and other detention facilities and drug rehabilitation centres.

Strategy 1.2: Prevention of HIV transmission through unprotected sex Under this strategy addressing sexual transmission of HIV, coverage of interventions is improved upon to encourage barrier methods (e.g. condom use) among MARPs and vulnerable populations; provision of sexual reproductive health (SRH) education and other essential SRH services; encourage behavioural change among MARPs towards safer sexual practices; implementation of programmes which address intimate partner transmission of HIV; encouraging HIV testing through voluntary testing and counselling; and promotion of information and awareness of HIV and STIs through media. Key Activities: a. Review existing strategies including awareness programmes and activities to encourage and

facilitate behavioural change among MARPs.

b. Build an enabling environment for behavioural change through economic, welfare and religious aid.

c. Raise awareness and build knowledge and awareness on HIV and other diseases (e.g. TB and STIs), among MARPs, married and unmarried couples, and members of most at risk youth and their sexual partners.

d. Improve and strengthen VCT, STI and SRH services to all MARPs, including counselling for married and unmarried couples.

e. Raise awareness and understanding of HIV and STIs, support and promote the appropriate use of condoms and lubricants when engaged in sexual activities, particularly among MARPs, their partners and/or clients.

f. Develop and scale up services on sexual reproductive health, counselling and treatment related to STIs, HIV and AIDS to ensure universal coverage.

g. Expand and scale up HIV prevention programming incorporating a comprehensive package of services for men who have sex with men (MSM) and transgender persons.

h. Strengthen the participation of national and local partners in the provision of HIV prevention programmes targeting migrant workers and refugees.

i. Implement targeted behaviour change communication interventions to promote safer sexual behaviour, address negative gender values, and promote male responsibility for positive health.

j. Develop strategies to address barriers and challenges which prevent the efficient and effective delivery of HIV prevention services to MARPs especially MSM, SW and TGs

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Strategy 1.3: Prevention of mother to child transmission The Prevention of Mother To Child Transmission (PMTCT) programme in government healthcare facilities should be continued including screening, providing treatment, care and support for pregnant women with HIV and their partners/ spouses. More pregnant women will be screened for HIV through integration of PMTCT in antenatal services at public and private health facilities with improved linkages between existing SRH and HIV programmes. The goal would be to eliminate vertical transmission by 2015. Key Activities: a. Maintain the provision of quality, comprehensive national PPTCT services, in line with the WHO

recommended four pronged strategy, to reach pregnant women, their partners and their infants, including most at risk populations.

b. Strengthen community awareness of HIV to increase enrolment in the PMTCT programme and other related antenatal, family planning, sexual and reproductive health, voluntary confidential counselling and testing services, particularly among most at risk populations.

c. Ensure all HIV-infected pregnant women and their HIV-exposed infants under the PMTCT programme receive ARV treatment/ prophylaxis and breastfeeding education to reduce mother-to-child transmission of HIV.

d. Ensure the availability of PMTCT in all ANC facilities including private health care facilities 3.4.2 Strategy 2: Improving the quality and coverage of testing and treatment The Government continues to support a decentralised approach to health services which includes community-based and primary health care through to hospital-based care. It provides psychosocial support including voluntary, counselling and testing (VCT), nutritional support and treatment for common opportunistic infections. Malaysia already provides and is committed to affordable access to clinical care through the public health system, including free or subsidized access to ART. People Living with HIV (PLHIV) in closed settings and those living outside the major cities are of particularly concern and will need to be covered under existing programmes. Stronger linkages and referral systems between HIV and related services such as VCT, tuberculosis (TB), opportunistic infections (OIs), SRH, opioid substitution therapy (OST) and PMTCT will be encouraged. There is also a need to ensure and maintain the quality and sustainability of treatment, care and support services for PLHIV. Positive prevention should also be promoted among those living with HIV. Key Activities: a. Ensure adequate number and training of healthcare workers to deliver VCT and ARV and related

services.

b. Strengthen priority health services through increased integration of HIV service delivery.

c. Improve coverage and early access to and quality of HIV testing, care and treatment, sexual reproductive health and STI services for most at risk populations and their partners.

d. Increase access and quality of HIV testing and counselling services in the public and private sectors to identify those in need of HIV treatment.

e. Strengthen capacity of VCT related staff.

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f. Improve adherence to treatment and detection of treatment failure.

g. Expand routine PICT for pregnant women, TB and STI patients and strengthen linkages from prevention to care and treatment.

h. Develop and scale up care and treatment with anti-retroviral drugs and TB treatment for drug users in prisons and other detention centres.

3.4.3 Strategy 3: Increasing the access and availability of care, support and social impact mitigation programmes for People Living with HIV and those affected.

Increasing access and availability of care and support programmes for People Living with HIV (PLHIV) and those affected which address physical, mental, social, spiritual, religious and economical aspects. Key Activities: a. Improve coordination, linkages and referral among social, health and community based services at

the community level.

b. Strengthen the quality and impact of PLHIV and MARPs support groups and networks.

c. Link PLHIV and their families to existing social support programmes to ensure access to essential services.

d. Increase visibility and meaningful participation and decision making of PLHIV and MARPs in impact mitigation programmes.

e. Provide quality emotional, religious and spiritual support to PLHIV and their families.

3.4.5 Strategy 4: Maintaining and improving an enabling environment for HIV prevention, treatment, care and support.

Prevention and treatment programmes are more effective when operating in an enabling environment which does not stigmatise and discriminate against those most at risk and those affected. Creating and maintaining a better understanding of HIV to reduce risk taking as well as stigma and discrimination are therefore essential. It is necessary to establish and maintain an enabling public policy and structural environment which will help to reduce HIV stigma and discrimination, respects human dignity, gender and sexuality and is supportive to HIV programmes and interventions. Key Activities: a. Ensure HIV issues are mainstreamed into national social development plans and the necessary

financial and technical resources are mobilised to support development and implementation of HIV and AIDS plans and programmes.

b. Strengthen capacity of key ministries and other government and civil society stakeholders at the national and local levels to develop and implement targeted evidence-based interventions.

c. Engage law enforcement, healthcare service providers, relevant public officials and civil society stakeholders, to assess and mitigate complications to the national HIV response.

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d. Improve the representation, involvement and capacity of civil society, community based organizations and affected population networks in dialogue and decision-making, towards achieving Universal Access and strengthening the national response.

e. Strengthen the work of the private sector among local businesses to promote corporate social responsibility and to establish workplace-based HIV prevention programmes and to address stigma and discrimination in the private sector.

f. Intensify public understanding and awareness of HIV and AIDS through focused communications and integration into community-based HIV education messages.

3.4.6 Strategy 5: Increasing the availability and quality of strategic information and its use

by policy makers and programme planners through monitoring, evaluation and research.

There is a continuous need to improve upon the availability of research, surveillance and bio-behavioural data, and analysis of monitoring and evaluation of HIV programmes to guide and determine policy and programme frameworks for prevention, treatment, care and support. Key Activities: a. Develop and strengthen partnerships to plan, coordinate and manage the national monitoring and

evaluation, research and surveillance systems.

b. Produce and disseminate timely and high quality data from research, integrated biological behavioural surveillance (IBBS), population size estimations and other studies.

c. Promote the production, dissemination and effective use of strategic information to inform and guide programme and policy decision making.

d. Consolidate and streamline mechanism for data collection from both private and public HC facilities for future planning

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CHAPTER 4 Coordination and Implementation

It is necessary to ensure that the implementation of the National Strategic Plan on HIV and AIDS is structured and managed accordingly to facilitate the participation and involvement of relevant stakeholders from government, civil society, the private sector and development partners, and to ensure output of the intended results from the many interventions. Strong governance and coordination of the National AIDS Programme by the Ministry of Health will ensure harmonisation and alignment of all stakeholders involved in the Malaysian AIDS response. The overarching principle in management of the National Strategic Plan is the Three Ones Principle of one national multisectoral strategy, one national coordination platform with a multisectoral mandate and one monitoring and evaluation framework. 4.1 Coordination NCCAI and NATCA In 2009, the HIV policy and decision making structure was revised with the intention of streamlining the functions of the different entities involved in HIV policy development.

Under this new revision, the Cabinet Committee on AIDS was restructured and is now known as the National Coordinating Committee on AIDS Intervention (NCCAI) chaired by the Minister of Health. The NCCAI functions as the highest decision-making body on HIV and AIDS related policies. Its membership includes all the Secretary Generals of the relevant ministries and agencies listed in the NSP as well as civil society representatives, including the Malaysian AIDS Council.

Figure 4: National HIV and AIDS Policy Framework

Source: Ministry of Health (2009)

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The National Advisory and Technical Committee on AIDS (NATCA), is actually a merging of the two bodies present in the previous framework namely, the National Advisory Committee on AIDS and the Technical Committee on AIDS. This committee, which is chaired by the Director General of Health, acts as a high level advisory body to the NCCAI. It provides a forum for discussion of policy issues relevant to increasing the success of Malaysia’s response to the HIV epidemic as well as to review progress against the annual work plans and budgets. The membership of the NATCA is made up of key Ministry officials, subject matter experts, NGO and community representatives and the Director Generals and HIV Focal Points of the Ministries. It meets and reports to the NCCAI. National AIDS Programme Secretariat The responsibility for the overall coordination of Malaysia’s HIV and AIDS responses is currently tasked to the AIDS/STI Sector of the Disease Control Division, Ministry of Health located in Putrajaya, the Federal Administrative capital of Malaysia. The AIDS/STI Sector is currently functioning as the National AIDS Programme (NAP) Secretariat. The Secretariat interacts and engages the other institutions within the Federal Government (and the civil society) through HIV Focal Points who are present in each of the relevant Ministries. The NAP Secretariat will be strengthened with sufficient resources and capacity to the implementation of the National Strategy on HIV and AIDS 2011 – 2015. It will be responsible for overall coordination, monitoring, evaluation and reporting. This secretariat will continue to strengthen and maintain linkages with state and district authorities through the respective State AIDS Officers build capacity of ministerial AIDS focal points and facilitate information sharing among the different national level committees. The work of the National AIDS Programme Secretariat is supported by the State AIDS Officers whose tasks are to plan, coordinate, implement and evaluate HIV interventions. The AIDS Officers and the NAP Secretariat are also instrumental and critical in ensuring that HIV prevention, care and support programmes carried out by NGOs, who are recipients of public funds, are harmonised and in line with the identified priorities under the National Strategy on HIV and AIDS. Country Coordinating Mechanism (CCM) The Country Coordinating Mechanism, chaired by the Deputy Minister of Health, provides governance for all programmes and activities related to the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) in Malaysia. This mechanism operates concurrently and complements the work of the NATCA. Taskforce on Women, Girls and HIV/AIDS The Government established the Taskforce on Women, Girls and HIV/AIDS as a response to the increase in the number of female HIV cases and in incidences of sexual HIV transmission. This taskforce is spearheaded by the Ministry of Women, Family and Community Development and is tasked to guide the actions of the Government in its response to

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addressing the abovementioned situation as well as the behavioural and socioeconomic factors behind the sexual transmission of HIV.

Figure 5: Stakeholders in the Malaysian HIV response

Civil society The Malaysian AIDS Council (MAC) was initially established in 1992 by the Ministry of Health and serves as an umbrella organisation to support and coordinate the efforts of partner organisations working on HIV and AIDS issues in Malaysia. In partnership with government agencies, private sectors and international organisations, MAC works towards ensuring a committed and effective response by NGOs working on HIV and AIDS issues. Most of the public funds for use by non-governmental organisations working on HIV and AIDS projects are channelled through and coordinated by the MAC. The MAC facilitates the collaboration with civil society organisations in the implementation of the National Strategy on HIV and AIDS. Consultative mechanisms such as CSO stakeholder meetings at the national level will be established in an effort to seek a wide variety of viewpoints from the different at risk and vulnerable communities which would help streamline Malaysia’s response to HIV and provide input towards the implementation and evaluation of the National Strategy on HIV and AIDS.

4.2 Implementing the National Strategic Plan Priority Setting Priority setting is a key task in the management of the National Strategy on HIV and AIDS and will be guided by further improvements in the availability and use of strategic information. The priorities set in the National Strategy on HIV and AIDS will be reviewed regularly, as part of the monitoring and evaluation arrangements described in Chapter 6.

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Government Stakeholders Civil society stakeholders

National AIDS ProgrammeSecretariat

Ministry of Health (MOH)

Ministry of Health

State AIDS Officers

Ministry of Women,Family andCommunity

Development

Ministry ofEducation

Ministry of HigherEducation

Ministry of HumanResources

Ministry of HomeAffairs

Taskforce onWomen, Girls and

HIV

PLHIV and thoseaffected

VulnerablePopulations

Private Sectorclinics/ hospitals

Internationalorganisations

Local communitynetworks

Private laboratories

NCCAI

NATCAMalaysia AIDS Council (MAC)

Non-NSEP, NGOs

CBOs

MARPs

Academia

Universities

United Nations

Regional communitynetworks

NGOs FBOs

NSEP NGOs

CountryCoordinatingMechanism

Ministry of HomeAffairs

National Anti DrugAgency

Police

JAKIM


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Effective resource tracking system will be put in place to provide information and feedback concerning the alignment of resource allocations to agreed priorities. The collection, storage and sharing of strategic information and the need for a resource tracking system is addressed under Strategy 5. Development of the 2011 – 2012 and 2013 – 2015 workplans Two set of workplans based on clear and evidence driven national priorities will be developed to guide the implementation of the National Action Plan on HIV and AIDS 2011 – 2015 and will cover the periods of 2011 – 2012 and 2013 – 2015. These workplans will be used to detail the activities to be conducted and to guide decision making in resource allocation of public funds. These activities must be clear, action and results oriented, and targeted which will translate strategic priorities to operational realities. The development of the 2013 – 2015 workplan will also be guided by the outputs from the mid-term review of the NSP. The workplans of other individual stakeholders involved in the HIV response will be complementary to those mentioned above. Given its role in monitoring and evaluation as well as resource tracking, the National AIDS Programme Secretariat will play a central role in priority setting and the development of the workplans. The Secretariat will facilitate this process through the supporting of relevant partnership and stakeholder forums and technical working groups. It will collect, analyse and provide the strategic programmatic and financial information that is needed to inform the priority setting process. For specific components of the National Action Plan on HIV and AIDS, relevant Ministries and organisations will collaborate through technical working groups established for specific issues and population groups. The work of the individual Ministries and organisations will contribute towards the implementation of components of the National Strategic Plan and towards the achievement of agreed expected results and targets.

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CHAPTER 5 Resource Mobilisation

Over the next five years, it will be important to advocate for sustained domestic commitment to fund the national response to HIV and AIDS. Resource allocations will need to be aligned to the priority areas and programmes identified in the National Strategic Plan on HIV and AIDS and National Action Plan on HIV and AIDS. The National AIDS Programme Secretariat will track the variety and amount of resources allocated to the National Strategy which will provide crucial information on whether the existing allocation of funding is aligned with agreed national priorities. Such a system will highlight areas where insufficient resources are being allocated and experiencing gaps in funding. The provision of necessary and adequate resources and technical assistance will be needed for the next five years to further strengthen organisational and human capacity for HIV programmes to be sustained and to build upon the progress and results obtained from the previous National Strategic Plan. 5.1 Estimating the resources needed The resources required to achieve the NSP coverage and impact goals needs to be calculated from estimates of the number of people receiving each service and the cost per person. Service estimates are based on the population in need of the service or programme and the coverage level to be achieved. Coverage is assumed to increase from the baseline levels to the planned targets by 2015. The unit costs for these services are based on existing interventions currently being implemented by agencies and organisations. A number of assumptions have been made, which the cost estimates are based on i.e.:- a) Population sizes: The population sizes are estimated based on size estimation studies. Particular

populations such as MSM and clients of sex workers are extremely difficult to reach and therefore to estimate their sizes.

b) Target setting: Targets to be reached are based on perceived implementation capacity which varies according to the different implementing partners.

c) Unit costs: these are the main assumptions for calculation of total costs; As the same programme and interventions might have several unit costs depending on the geographical location, the unit costs indicated are the average value.

d) Overhead and management costs: these costs are not fully represented in the unit costs as they differ according to the programmes and activities involved.

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5.2 Sources of funding A bulk of the allocation from the previous NSPs was spent on the provision of HIV treatment and involved funding of HIV NGO prevention programmes which were small scale and with limited coverage. A three-fold increase in this allocation, now totalling RM 100 million (approximately USD 32 million) per annum, was made available to both government agencies and civil society organisations for the past five years (2006 – 2010) in support of implementation of the NSP. With an annual budget of RM 100 million allocated to it, the allocation provided by the Government utilising public funds to the national HIV programme currently translates to approximately RM 3.1 (USD 1) per capita. In 2008, total AIDS expenditure was approximately RM 86.6 million, 96.95% was financed by Government funding and 3.05% by the private sector and international sources. In 2009, expenditure increased by RM 8.6 million. Regarding sources of financing for HIV programmes, as indicated in the table below, in 2008 and 2009, the domestic public funding from the Government shouldered most of the AIDS related expenditure, whereas international and private sector contributions resources contributed to less than 3%.

Table 4: Source of approximate AIDS expenditure 2008 – 2009

Source of Funding Year 2008

(RM) %

Year 2009 (RM)

%

Domestic Public 83 993 000 96.95 92 661 000 96.71 Domestic Private 1 619 000 1.87 1 629 000 1.70 International 1 020 000 1.18 1 520 000 1.59

Total 86 632 000 100.0 95 810 000 100.0 Source: UNGASS Country Progress Report (Malaysia) 2008 & 2010

Government funding is channelled from the Ministry of Finance to the Ministry of Health which disburses the funds to other government ministries and departments. The other Ministries are also able to provide funding for their own HIV related programmes utilising their individual budgets. The government is committed to subsidise ARV for PLHIV either in institutionalised settings or otherwise, HIV screening programmes and activities either at the Primary Care Levels (VCT, PPCT, pre-marital HIV screening, STI patients) or secondary levels. In the case of NGO related programmes, the MOH uses the Malaysian AIDS Council as a conduit for channelling the necessary public funds to the individual NGOs. Currently, a lot of HIV prevention and control programmes and activities are channelled to MAC namely the NSEP for IDUs and intervention programmes for MARPs (sex workers, MSM, transgender).

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CHAPTER 6 Monitoring and Evaluation

In line with the Three Ones Principle, implementation of the National Strategic Plan will be monitored and evaluated through the national HIV monitoring and evaluation framework, which is coordinated by the National AIDS Programme Secretariat. Information gathered from national monitoring and evaluation of HIV and AIDS programmes will be used to: a) Ensure HIV and AIDS prevention programmes achieve high levels of accountability and efficiency

b) Inform and help determine whether programme up scaling or expansion is required

c) Allow corrective or remedial action to be taken

d) Provide information and data which is beneficial for the implementation of the programme and serve as input for the design of future programmes.

e) For the purpose of reporting on international commitments such as UNGASS reporting, Universal Access and the MDGs.

Partners involved in the implementation of the National Strategic Plan will continue to operate their own systems for programme monitoring and evaluation. The national monitoring and evaluation framework system (M&E), as outlined by the NSP 2011-2015 will consolidate information that is generated by the government and other key stakeholders. Expected results and targets will be monitored and evaluated periodically. 6.1 Programme Coverage It is aimed that by 2015, coverage of programmes reaching out to most at risk populations will be at 80%. To achieve the targets of Universal Access by that year, as shown in Table 5, the programme coverage targets are determined accordingly to ensure that MARPs and PLHIVs are able to access prevention, treatment, care and support services needed.

Therefore, in general by 2015, it is aimed that 80% of injecting drug users are able to be reached by the harm reduction programme (MMT and NSEP) of which 60% of them would consistently not be sharing needles; 60% of key most at risk populations would consistently be using condoms; 60% of all PLHIV in need of and eligible for treatment are able to access ARV.

30



31

Table 5: Programme coverage targets (2010 & 2015)

Population Est. no. (as of 2010)

Baseline 2010 2011 2012 2013 2014 2015 Actual % No. % No. % No. % No. % No. %

IDU 170 0001 21 559 13% 34 000 20% 51 000 30% 85 000 50% 119 000 70% 136 000 80% Female sex workers 60 0002 18 000 30% 25 200 40% 31 500 50% 37 800 60% 44 100 70% 50 400 80% Transgender persons 5 0003 1 500 30% 2100 40% 2 625 50% 3 150 60% 3 675 70% 4 200 80% MSM 173 0004 6 000 3.5% 36 330 20% 54 495 30% 90 825 50% 127 155 70% 145 320 80% Clients of sex workers

845 0005 - - 17 745 2% 44 363 5% 88 725 10% 133 088 15% 177 450 20%

Intimate partners of at risk populations*

Data not available.

To be estimated

- - TBD 5% TBD 10% TBD 15% TBD 20% TBD 30%

Mothers needing PMTCT

4106 171 42% 450 100% 450 100% 460 100% 470 100% 490 100%

PLHIV (Eligible: CD4 <350 )

26 7227 9 962 37% 15 567 50% 21 794 70% 24 907 80% 28 021 90% 31 134 100%

*Estimation exercise to be conducted

6.2 Monitoring and Evaluation Process Monitoring and evaluation will be utilising a process which is able to capture and evaluate various levels of programme implementation, from input, activities, output to impact. All stakeholders involved in the response to HIV in Malaysia are contributors to the various indicators and are equally responsible to ensure that they are regularly monitored and utilised to measure progress. The National AIDS Programme Secretariat is given the responsibility to monitor and evaluate the overall HIV/AIDS framework. The NAP Secretariat is also empowered to ensure that all relevant stakeholders report to the Secretariat on specific indicators as necessary.

1 Malaysian AIDS Council (2010) Integrated Bio-Behavioural Surveillance (IBBS) survey with IDUs, SW, TG. Powerpoint presentation. Presented on 11 March 20102 Lim Hock Eam, Ang Chooi Leng and Teh Yik Koon (2010). Size Estimation for Local Responses in Malaysia for HIV Prevention in Sex Work. UNFPA Project3 Malaysian AIDS Council (2010) Integrated Bio-Behavioural Surveillance (IBBS) survey with IDUs, SW, TG. Powerpoint presentation. Presented on 11 March 20104 Kanter J, Koh C, Kiew R, Tai R, Izenberg J, Razali K and Kamarulzaman A (2009). Abstract: Risk Behaviour and HIV Prevalence among MSM in a Predominantly Muslim and Multi-Ethnic Society: A Venue-Based Study in Kuala Lumpur, Malaysia.5 Ministry of Health and World Health Organisation (2009). National Consensus Workshop on Estimation and Projection of the Malaysian HIV Epidemic. Revised version 20th March 2011.6 Ibid7 Ibid

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32

Figure 7: Monitoring and Evaluation Process

Adapted from ‘Rugg et al (2004). Global advances in HIV/AIDS monitoring and evaluation. New directions for Evaluation. Referenced within ‘UNAIDS (2007). A Framework for Monitoring and Evaluating HIV Prevention Programmes for Most-At-Risk Populations. ’, page 13

The overall monitoring and evaluation framework for the National Strategic Plan on HIV and AIDS can be found in Annex 3, and provides a detailed account of the various indicators, method of measurement and the stakeholder responsible for each individual indicator. This process of information and data gathering for monitoring and evaluation is best illustrated in Figure 7 above. 6.3 Data Collection The NAP Secretariat will work with Ministries in the Government and civil society organisations to conduct national monitoring and evaluation. Utilising strategic information gained from the framework, the NAP Secretariat will be able to evaluate the existing response as well as determine areas needing improvement or change. 6.3.1 Surveillance The responsibility of HIV surveillance is with the AIDS/STI Sector of the Ministry of Health. A number of surveillance related activities will be needed, namely:

(a) HIV sentinel surveillance The Ministry of Health conducts ongoing sentinel surveillance covering different populations including injecting drug users, sex workers, pregnant women, and many others.

(b) National AIDS Registry The Ministry of Health established the National AIDS Registry (NAR) in 2009. Intended to replace the existing surveillance system, the Internet-based registry is designed to function as a more streamlined and effective national HIV programme monitoring mechanism able to capture detailed disaggregated data systematically. The Registry captures data on each HIV

Situational assessment & planning

Situational and epidemiological analysis Response analysis Stakeholder needs

Input

Staff Financial resources Material Facilities

Activities

Behavioural change communication Trainings Prevention programmes Treatment, etc

Output

Trained personnel MARPs reached Clients served Needles distributed Condoms distributed Tests conducted

Results/ Outcome

Risk behaviour Users accessing services Clinical results Quality of life

Impact

HIV incidence & prevalence STI incidence & prevalence AIDS morbidity and mortality Economic impact

Programme Development Data

Programme Data Population-based biological, behavioural and social data

32



33

patient relating to their socioeconomic background, status of HIV treatment and background information

(c) Integrated bio-behavioural surveillance (IBBS)

Periodic IBBS will be conducted with most at risk populations in different states as needed.

(d) Other strategic information needed Other strategic information needed and currently being developed are the ARV resistance surveillance, estimation of MARPs, PLHIVs, etc. Such information will to be developed with the universities, institutions and international agencies to have a more meaningful data collection and future projections.

Other data sources:

Mapping of Most-At-Risk Populations Monitoring of programme coverage Monitoring of prevention services Monitoring of behavioural change communication programmes Monitoring of treatment services Monitoring of impact mitigation services Various researches, especially operational research needed to increase the effectiveness of prevention, treatment, care and support programmes.

6.4 Monitoring and Reporting Structure Horizontal working relationships between government and non-government agencies at the state level are critical to ensure that there is appropriate programme monitoring at both operational programme and national levels. The National HIV and AIDS Monitoring, Evaluation and Reporting Guidelines that will be produced and used as the basis for monitoring and evaluation in respect of the implementation of the National Strategic Plan on HIV and AIDS 2011 – 2015. These guidelines will kept as simple and practical as possible so as to allow monitoring, evaluation and reporting to be properly carried out. The dissemination of these guidelines, and the provision of training on how they should be used, will be initiated so that monitoring, evaluation and reporting will be optimized at all levels. A Technical Working Group on Monitoring and Evaluation (TWG-M&E) chaired by the Monitoring and Evaluation Unit of the National AIDS Programme Secretariat is proposed to lead on the HIV programme performance reviews conducted at the National level. This provides an opportunity for a strengthening of the Secretariat’s own technical capacity as well as those of the relevant and involved ministries and civil society organisations.

33



34

Figure 8: Monitoring and Evaluation Reporting Structure

6.5 Progress Monitoring and Evaluation Progress monitoring and evaluation are conducted utilising a joint government and civil society periodic performance review which should be conducted at both state and national levels. The intention of the performance reviews is to evaluate progress based on coverage, effectiveness and sustainability of programmes. 6.5.1 HIV programme performance review (State level) The frequency of the state level HIV programme review should be every 4 months with the State AIDS Officers and the State Health Department taking the lead. The review will be conducted with government and civil society organisations responding to HIV at the state level. 6.5.2 Annual Progress Report The National AIDS Programme Secretariat will coordinate and facilitate the preparation of annual progress reports and the Work Plans through the national HIV programme performance review, which will be discussed and finalised as part of the annual joint stakeholder meeting held in October. The inputs of the annual progress reports will also be based on the HIV programme performance review conducted at the State level.

34


Line Ministries andAgencies (MWFCD,NADA, JAKIM, etc)

National AIDS Programme SecretariatMinistry of Health (MOH)

TWG on Monitoring andEvaluation

State AIDS OfficersDistrict Health

Office

Malaysia AIDSCouncil (MAC)

MMTDrug Rehabilitation

CentresPrisons

Research/surveyNon-NSEP,

NGOs

NGO working on:- MSM- SW- TG- Vulnerable people

•IBBS•VDTS•Population based survey•Health facility survey•Sentinel surveillance

- PLHIVNGO working onIDU

NSEPNGOsGovt Healthcare

Facilities

Private HealthcareFacilities

National Monitoring and Evaluation Reporting Flow


35

The annual progress report will provide information on the progress made in implementing the Work Plan. Based on programme monitoring data that is routinely collected by the National AIDS Programme Secretariat and the Malaysian AIDS Council, an assessment is made whether planned activities have been implemented and whether planned outputs and expected results have been achieved. The annual progress report will also be based on the indicators and targets agreed in the M&E framework, which includes core indicators (see Annex 3). Based on data collected by the National AIDS Programme Secretariat and the Malaysian AIDS Council, and stored in a centralised database, an analysis will be made concerning the progress made in achieving the agreed targets for these core indicators. Finally, the annual progress report will include an analysis of most recent surveillance data as well as data from other recent surveys in order to assess changing and emerging epidemiological trends. Based on the results and findings of the assessments presented in the annual progress report, the National AIDS Programme Secretariat, in close consultation with its partners, will prepare or revise the Work Plan for the coming years. 6.5.3 Mid Term Review A mid-term review of the implementation of the National Strategic Plan is planned to take place in 2013. It will review progress made in the first two years of the NSP. The review will be discussed in a joint stakeholder meeting, with the aim of reaching consensus on: (a) Progress made in the implementation of the national response as agreed in the current National

Strategic Plan

(b) The direction and scope of future implementation of the response to HIV and AIDS. 6.5.4 Final Review and Impact Evaluation A final evaluation of the National Strategic Plan will take place in the second half of 2015. The final evaluation will assess whether expected results and targets have been achieved, through the analysis of available data to measure outcome and impact and a comparison with baselines values for these core indicators. The final evaluation will not only assess effectiveness of individual programmes and of the overall national response, but will also take into consideration the quality and efficiency of programmes and interventions. 6.5.5 HIV and AIDS Research Monitoring and evaluation of the National Strategic Plan will also require data collected through research, including regular surveys. Research, as indicated in Strategy 5 of the National Strategic Plan on HIV and AIDS, compliments monitoring and evaluation by building a knowledge base which will guide the national response. Thematic research will be needed in order to better understand

35



36

underlying causes, dynamics and impacts of the epidemic, such as epidemiological trends, new and emerging areas of concern and a better understanding of vulnerability and long-term consequences of the epidemic. It is therefore envisaged that:

(a) Appropriate research is conducted which is clear and current to support the broader picture of AIDS alleviation, amongst the various MARPs and vulnerable populations.

(b) There is better access to and resource mobilisation of funding for research.

(c) There is a systematic management and sharing of research data put into place to ensure that findings are used to improve the response to the HIV epidemic.

36


Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Ann

ex 1

:

Fr

amew

ork

for t

he N

atio

nal S

trat

egic

Pla

n on

HIV

and

AID

S 20

11 –

201

5

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

Stra

tegy

1:

Impr

ovin

g th

e qu

ality

and

cov

erag

e of

pre

vent

ion

prog

ram

mes

am

ong

mos

t at r

isk

and

vuln

erab

le

popu

latio

ns

Mos

t at r

isk

and

vuln

erab

le

popu

latio

ns

HIV

pre

vent

ion

effo

rts

in 2

011

– 20

15 w

ill fo

cus

on tw

o pr

imar

y pr

ongs

of H

IV tr

ansm

issi

on:

Shar

ing

of n

eedl

es a

nd s

yrin

ges

thro

ugh

inje

ctin

g dr

ug u

se

Unp

rote

cted

sex

ual i

nter

cour

se

1.1

Prev

entio

n of

HIV

tran

smis

sion

th

roug

h th

e sh

arin

g of

nee

dles

an

d sy

ringe

s

IDU

s Pr

imar

y m

ode

of tr

ansm

issi

on in

Mal

aysi

a co

ntin

ues

to b

e th

roug

h in

ject

ing

drug

use

. Su

stai

ning

and

sca

ling

up o

f a m

ore

com

preh

ensi

ve p

rogr

amm

e co

verin

g th

e ha

rm

redu

ctio

n (n

eedl

e sy

ringe

exc

hang

e an

d m

etha

done

mai

nten

ance

ther

apy)

pro

gram

me

cont

inue

s to

be

need

ed. I

ncre

ased

cov

erag

e to

in

clud

e:

Fish

erm

en a

nd o

ther

mob

ile p

opul

atio

ns

Popu

latio

ns in

clo

sed

sett

ings

At

risk

you

th

Wom

en a

nd tr

ansg

ende

r per

sons

Build

an

enab

ling

envi

ronm

ent f

or H

IV p

reve

ntio

n w

ith ID

Us

and

thei

r par

tner

s by

mob

ilizi

ng k

ey

stak

ehol

ders

, inc

ludi

ng, h

ealth

car

e pr

ovid

ers,

co

mm

unity

net

wor

ks, N

GO

s, lo

cal a

utho

ritie

s, a

nd

law

enf

orce

men

t

Dev

elop

str

ateg

ies

to a

ddre

ss b

arrie

rs a

nd c

halle

nges

w

hich

pre

vent

the

effic

ient

and

eff

ectiv

e de

liver

y of

H

IV p

reve

ntio

n w

ith ID

Us.

Impl

emen

t tar

gete

d be

havi

our c

hang

e ap

proa

ches

fo

r mal

e an

d fe

mal

e ID

Us

whi

ch e

mph

asiz

e ris

k re

duct

ion

and

prom

ote

safe

r sex

ual a

nd ri

sk

redu

ctio

n be

havi

ours

.

Impl

emen

t nat

iona

l sca

le u

p of

HIV

pre

vent

ion

with

ID

Us

and

thei

r par

tner

s in

clud

ing

need

le a

nd s

yrin

ge

exch

ange

pro

gram

mes

and

opi

oid

subs

titut

ion

ther

apy.

Stre

ngth

en m

echa

nism

s to

man

age

HIV

pre

vent

ion

amon

g dr

ug u

sers

in p

rison

s an

d ot

her d

eten

tion

cent

res.

37

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

1.2

Prev

entio

n of

HIV

tran

smis

sion

th

roug

h un

prot

ecte

d se

x

Sex

wor

kers

, at r

isk

yout

h, m

en w

ho

have

sex

with

men

, m

igra

nts,

refu

gees

, se

xual

par

tner

s of

ID

Us,

fem

ale

sexu

al

part

ners

of M

SM,

clie

nts

of s

ex

wor

kers

, tra

nsge

nder

pe

rson

s Se

xual

par

tner

s of

M

ARPs

Impr

ovin

g co

vera

ge o

f int

erve

ntio

ns w

hich

: En

cour

age

beha

viou

ral c

hang

e am

ong

MAR

Ps

enco

urag

e co

ndom

use

am

ong

MAR

Ps

prov

ide

sexu

al re

prod

uctiv

e he

alth

ed

ucat

ion

and

othe

r SRH

ser

vice

s

addr

ess

intim

ate

part

ner t

rans

mis

sion

of

HIV

enco

urag

e H

IV te

stin

g th

roug

h VC

T

prom

ote

info

rmat

ion

and

awar

enes

s of

HIV

an

d ST

I thr

ough

med

ia a

nd m

eans

whi

ch a

re

acce

ssib

le a

nd fr

iend

ly to

mos

t at r

isk

popu

latio

ns.

By 2

015,

ach

ieve

d 80

% s

ervi

ce c

over

age

amon

g m

ost a

t ris

k po

pula

tions

whe

re 6

0% o

f tho

se

cove

red

prac

tice

safe

beh

avio

urs.

Revi

ew e

xist

ing

stra

tegi

es in

clud

ing

awar

enes

s pr

ogra

mm

es a

nd a

ctiv

ities

to e

ncou

rage

and

fa

cilit

ate

beha

viou

ral c

hang

e am

ong

MAR

Ps.

Bu

ild a

n en

ablin

g en

viro

nmen

t for

beh

avio

ural

ch

ange

thro

ugh

econ

omic

, wel

fare

and

relig

ious

aid

.

Rais

e aw

aren

ess

and

build

kno

wle

dge

and

awar

enes

s on

HIV

and

oth

er d

isea

ses

(e.g

. TB

and

STIs

), am

ong

MAR

Ps, m

arrie

d an

d un

mar

ried

coup

les,

and

m

embe

rs o

f mos

t at r

isk

yout

h an

d th

eir s

exua

l pa

rtne

rs.

Impr

ove

and

stre

ngth

en V

CT, S

TI a

nd S

RH s

ervi

ces

to

all M

ARPs

, inc

ludi

ng c

ouns

ellin

g fo

r mar

ried

and

unm

arrie

d co

uple

s.

Rais

e aw

aren

ess

and

unde

rsta

ndin

g of

HIV

and

STI

s,

supp

ort a

nd p

rom

ote

the

appr

opria

te u

se o

f co

ndom

s an

d lu

bric

ants

whe

n en

gage

d in

sex

ual

activ

ities

, par

ticul

arly

am

ong

MAR

Ps, t

heir

part

ners

an

d/ o

r the

ir cl

ient

s.

Dev

elop

and

sca

le u

p se

rvic

es o

n se

xual

repr

oduc

tive

heal

th, c

ouns

ellin

g an

d tr

eatm

ent r

elat

ed to

STI

s, H

IV

and

AID

S to

ens

ure

univ

ersa

l cov

erag

e.

Expa

nd a

nd s

cale

up

HIV

pre

vent

ion

prog

ram

min

g in

corp

orat

ing

a co

mpr

ehen

sive

pac

kage

of s

ervi

ces

for m

en w

ho h

ave

sex

with

men

(MSM

) and

tr

ansg

ende

r per

sons

.

Stre

ngth

en th

e pa

rtic

ipat

ion

of n

atio

nal a

nd lo

cal

part

ners

in th

e pr

ovis

ion

of H

IV p

reve

ntio

n pr

ogra

mm

es ta

rget

ing

fore

ign

mig

rant

wor

kers

and

re

fuge

es.

Impl

emen

t tar

gete

d be

havi

our c

hang

e co

mm

unic

atio

n in

terv

entio

ns to

pro

mot

e sa

fer

38

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

sexu

al b

ehav

iour

, add

ress

neg

ativ

e ge

nder

val

ues,

an

d pr

omot

e m

ale

resp

onsi

bilit

y fo

r pos

itive

hea

lth.

Revi

ew e

xist

ing

polic

ies

and

deve

lop

stra

tegi

es to

ad

dres

s ba

rrie

rs a

nd c

halle

nges

whi

ch p

reve

nt th

e ef

ficie

nt a

nd e

ffec

tive

deliv

ery

of H

IV p

reve

ntio

n se

rvic

es to

MAR

Ps e

spec

ially

MSM

, SW

and

TG

s.

1.3

Prev

entio

n of

par

ent t

o ch

ild

tran

smis

sion

(PPT

CT)

Mar

ried

and

unm

arrie

d pr

egna

nt

mot

hers

, wom

en o

f re

prod

uctiv

e ag

e

The

PPTC

T pr

ogra

mm

e in

gov

ernm

ent

heal

thca

re fa

cilit

ies

cont

inue

s to

be

need

ed to

sc

reen

and

pro

vide

trea

tmen

t, ca

re a

nd s

uppo

rt

for p

regn

ant w

omen

with

HIV

and

thei

r pa

rtne

rs/

spou

ses.

Mor

e pr

egna

nt w

omen

will

be

scr

eene

d fo

r HIV

thro

ugh

inte

grat

ion

of

PPTC

T in

ant

enat

al s

ervi

ces

at p

ublic

and

priv

ate

heal

th fa

cilit

ies

with

impr

oved

link

ages

bet

wee

n ex

istin

g SR

H a

nd H

IV p

rogr

amm

es.

The

goal

wou

ld b

e to

elim

inat

e in

cide

nces

of

vert

ical

tran

smis

sion

by

2015

.

Mai

ntai

n th

e pr

ovis

ion

of q

ualit

y, c

ompr

ehen

sive

na

tiona

l PPT

CT s

ervi

ces,

in li

ne w

ith th

e W

HO

re

com

men

ded

four

pro

nged

str

ateg

y, to

reac

h pr

egna

nt w

omen

, the

ir pa

rtne

rs a

nd th

eir i

nfan

ts,

incl

udin

g m

ost a

t ris

k po

pula

tions

.

Stre

ngth

en c

omm

unity

aw

aren

ess

of H

IV to

incr

ease

en

rolm

ent i

n th

e PP

TCT

prog

ram

me

and

othe

r re

late

d an

tena

tal,

fam

ily p

lann

ing,

sex

ual a

nd

repr

oduc

tive

heal

th, v

olun

tary

con

fiden

tial

coun

selli

ng a

nd te

stin

g se

rvic

es, p

artic

ular

ly a

mon

g m

ost a

t ris

k po

pula

tions

.

Ensu

re a

ll H

IV-in

fect

ed p

regn

ant w

omen

and

thei

r H

IV-e

xpos

ed in

fant

s un

der t

he P

PTCT

pro

gram

me

rece

ive

ARV

trea

tmen

t/ p

roph

ylax

is a

nd

brea

stfe

edin

g ed

ucat

ion

to re

duce

mot

her-

to-c

hild

tr

ansm

issi

on o

f HIV

.

Ensu

re th

e av

aila

bilit

y of

PPT

CT in

all

ANC

faci

litie

s in

clud

ing

priv

ate

heal

th c

are

faci

litie

s

St

rate

gy 2

: Im

prov

ing

the

qual

ity a

nd c

over

age

of te

stin

g an

d tr

eatm

ent.

PLH

IV (a

dults

and

ch

ildre

n) a

nd th

ose

affe

cted

The

Gov

ernm

ent c

ontin

ues

to s

uppo

rt a

de

cent

ralis

ed a

ppro

ach

to h

ealth

ser

vice

s w

hich

in

clud

es c

omm

unity

-bas

ed a

nd p

rimar

y he

alth

ca

re th

roug

h to

hos

pita

l-bas

ed c

are.

It p

rovi

des

psyc

hoso

cial

sup

port

incl

udin

g VC

T, n

utrit

iona

l su

ppor

t and

trea

tmen

t for

com

mon

Ensu

re a

dequ

ate

num

ber a

nd tr

aini

ng o

f hea

lthca

re

wor

kers

to d

eliv

er V

CT a

nd A

RV a

nd re

late

d se

rvic

es

Stre

ngth

en p

riorit

y he

alth

ser

vice

s th

roug

h in

crea

sed

inte

grat

ion

of H

IV s

ervi

ce d

eliv

ery.

Impr

ove

cove

rage

and

ear

ly a

cces

s to

and

qua

lity

of

39

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

oppo

rtun

istic

infe

ctio

ns.

Mal

aysi

a al

read

y pr

ovid

es a

nd is

com

mitt

ed to

af

ford

able

acc

ess

to c

linic

al c

are

thro

ugh

the

publ

ic h

ealth

sys

tem

, inc

ludi

ng fr

ee o

r su

bsid

ized

acc

ess

to A

RT.

Peop

le L

ivin

g w

ith H

IV in

clo

sed

sett

ings

and

th

ose

livin

g ou

tsid

e th

e m

ajor

citi

es a

re o

f pa

rtic

ular

ly c

once

rn. S

tron

ger l

inka

ges

and

refe

rral

sys

tem

s be

twee

n H

IV a

nd re

late

d se

rvic

es s

uch

as V

CT, T

B, O

I, SR

H, O

ST a

nd P

PTCT

w

ill b

e ne

eded

. The

re is

als

o a

need

to e

nsur

e an

d m

aint

ain

the

qual

ity a

nd s

usta

inab

ility

of

trea

tmen

t, ca

re a

nd s

uppo

rt s

ervi

ces

for P

LHIV

. Po

sitiv

e pr

even

tion

shou

ld a

lso

be p

rom

oted

am

ong

thos

e liv

ing

with

HIV

Se

rvic

e co

vera

ge is

aim

ed to

be

80%

of t

hose

es

timat

ed to

be

elig

ible

for t

reat

men

t.

HIV

test

ing,

car

e an

d tr

eatm

ent,

sexu

al re

prod

uctiv

e he

alth

and

STI

ser

vice

s fo

r mos

t at r

isk

popu

latio

ns

and

thei

r par

tner

s.

Incr

ease

acc

ess

and

qual

ity o

f HIV

test

ing

and

coun

selli

ng s

ervi

ces

in th

e pu

blic

and

priv

ate

sect

ors

to id

entif

y th

ose

in n

eed

of H

IV tr

eatm

ent

Stre

ngth

en c

apac

ity o

f VCT

rela

ted

staf

f.

Impr

ove

adhe

renc

e to

trea

tmen

t and

det

ectio

n of

lin

e tr

eatm

ent f

ailu

re

Expa

nd ro

utin

e PI

CT fo

r pre

gnan

t wom

en, T

B an

d ST

I pa

tient

s an

d st

reng

then

link

ages

from

pre

vent

ion

to

care

and

trea

tmen

t.

Dev

elop

and

sca

le u

p ca

re a

nd tr

eatm

ent w

ith a

nti-

retr

ovira

l dru

gs a

nd T

B tr

eatm

ent f

or d

rug

user

s in

pr

ison

s an

d ot

her d

eten

tion

cent

res.

Stra

tegy

3:

Incr

easi

ng th

e ac

cess

and

ava

ilabi

lity

of c

are,

sup

port

and

soc

ial i

mpa

ct

miti

gati

on p

rogr

amm

es fo

r Peo

ple

Livi

ng w

ith H

IV a

nd th

ose

affe

cted

.

PLH

IV (a

dults

and

ch

ildre

n) a

nd th

ose

affe

cted

Incr

easi

ng a

cces

s an

d av

aila

bilit

y of

car

e an

d su

ppor

t pro

gram

mes

for P

eopl

e Li

ving

with

HIV

an

d th

ose

affe

cted

whi

ch a

ddre

ss p

hysi

cal,

men

tal,

soci

al, s

pirit

ual,

relig

ious

and

ec

onom

ical

asp

ects

.

Impr

ove

coor

dina

tion,

link

ages

and

refe

rral

am

ong

soci

al, h

ealth

and

com

mun

ity b

ased

ser

vice

s at

the

com

mun

ity le

vel.

Stre

ngth

en th

e qu

ality

and

impa

ct o

f PLH

IV a

nd

MAR

Ps s

uppo

rt g

roup

s an

d ne

twor

ks.

Link

PLH

IV a

nd th

eir f

amili

es to

exi

stin

g so

cial

pr

otec

tion

prog

ram

mes

to e

nsur

e ac

cess

to e

ssen

tial

serv

ices

.

Incr

ease

vis

ibili

ty a

nd m

eani

ngfu

l par

ticip

atio

n an

d de

cisi

on m

akin

g of

PLH

IV a

nd M

ARPs

in im

pact

m

itiga

tion

prog

ram

mes

.

40

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

Prov

ide

qual

ity e

mot

iona

l, re

ligio

us a

nd s

pirit

ual

supp

ort t

o PL

HIV

and

thei

r fam

ilies

.

Stre

ngth

en th

e ro

le o

f com

mun

ity a

nd h

ome

base

d ca

re to

sup

port

pos

itive

pre

vent

ion

and

linka

ges

to

TB a

nd S

RH s

ervi

ces.

Stra

tegy

4:

Mai

ntai

ning

and

impr

ovin

g an

en

ablin

g en

viro

nmen

t for

HIV

pr

even

tion,

trea

tmen

t, c

are

and

supp

ort.

All

Prev

entio

n an

d tr

eatm

ent p

rogr

amm

es a

re

mor

e ef

fect

ive

whe

n op

erat

ing

in a

n en

ablin

g en

viro

nmen

t tha

t doe

s no

t stig

mat

ise

and

disc

rimin

ate

agai

nst t

hose

mos

t at r

isk

and

thos

e af

fect

ed. C

reat

ing

and

mai

ntai

ning

a

bett

er u

nder

stan

ding

of H

IV to

redu

ce s

tigm

a an

d di

scrim

inat

ion.

Es

tabl

ish

and

mai

ntai

n an

ena

blin

g pu

blic

pol

icy

and

lega

l env

ironm

ent t

hat w

ill h

elp

to re

duce

H

IV s

tigm

a an

d di

scrim

inat

ion

and

is s

uppo

rtiv

e to

HIV

pro

gram

mes

and

inte

rven

tions

resp

ectin

g hu

man

dig

nity

, gen

der a

nd s

exua

lity

Ensu

re H

IV is

sues

are

mai

nstr

eam

ed in

to n

atio

nal

soci

al d

evel

opm

ent p

lans

and

the

nece

ssar

y fin

anci

al

and

tech

nica

l res

ourc

es a

re m

obili

sed

to s

uppo

rt

deve

lopm

ent a

nd im

plem

enta

tion

of H

IV a

nd A

IDS

plan

s an

d pr

ogra

mm

es.

Stre

ngth

en c

apac

ity o

f key

min

istr

ies

and

othe

r go

vern

men

t and

civ

il so

ciet

y st

akeh

olde

rs a

t the

na

tiona

l and

loca

l lev

els

to d

evel

op a

nd im

plem

ent

targ

eted

evi

denc

e-ba

sed

inte

rven

tions

.

Enga

ge la

w e

nfor

cem

ent,

heal

thca

re s

ervi

ce

prov

ider

s, re

leva

nt p

ublic

off

icia

ls a

nd c

ivil

soci

ety

stak

ehol

ders

, to

asse

ss a

nd m

itiga

te c

ompl

icat

ions

to

the

natio

nal H

IV re

spon

se.

Impr

ove

the

repr

esen

tatio

n, in

volv

emen

t and

ca

paci

ty o

f civ

il so

ciet

y, c

omm

unity

bas

ed

orga

niza

tions

and

aff

ecte

d po

pula

tion

netw

orks

in

dial

ogue

and

dec

isio

n-m

akin

g, to

war

ds a

chie

ving

U

nive

rsal

Acc

ess

and

stre

ngth

enin

g th

e na

tiona

l re

spon

se.

Stre

ngth

en th

e w

ork

of th

e pr

ivat

e se

ctor

am

ong

loca

l bus

ines

ses

to p

rom

ote

corp

orat

e so

cial

re

spon

sibi

lity

and

to e

stab

lish

wor

kpla

ce-b

ased

HIV

pr

even

tion

prog

ram

mes

and

to a

ddre

ss s

tigm

a an

d di

scrim

inat

ion

in th

e pr

ivat

e se

ctor

.

Inte

nsify

pub

lic u

nder

stan

ding

and

aw

aren

ess

of H

IV

and

AID

S th

roug

h fo

cuse

d co

mm

unic

atio

ns a

nd

41

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Stra

tegi

es

Targ

et P

opul

atio

ns

Ratio

nale

Ke

y A

ctiv

ity

inte

grat

ion

into

com

mun

ity-b

ased

HIV

edu

catio

n m

essa

ges.

Stra

tegy

5:

Incr

easi

ng th

e av

aila

bilit

y an

d qu

ality

of

str

ateg

ic in

form

atio

n an

d its

use

by

pol

icy

mak

ers

and

prog

ram

me

plan

ners

thro

ugh

mon

itori

ng,

eval

uatio

n an

d re

sear

ch.

All

The

avai

labi

lity

of re

sear

ch, s

urve

illan

ce a

nd b

io-

beha

viou

ral d

ata,

and

ana

lysi

s of

mon

itorin

g an

d ev

alua

tion

of H

IV p

rogr

amm

es is

impr

oved

upo

n an

d us

ed to

gui

de a

nd d

eter

min

e po

licy

and

prog

ram

me

fram

ewor

ks fo

r pre

vent

ion,

tr

eatm

ent,

care

and

sup

port

.

Dev

elop

and

str

engt

hen

part

ners

hips

to p

lan,

co

ordi

nate

and

man

age

the

natio

nal m

onito

ring

and

eval

uatio

n, re

sear

ch a

nd s

urve

illan

ce s

yste

ms.

Prod

uce

and

diss

emin

ate

timel

y an

d hi

gh q

ualit

y da

ta fr

om re

sear

ch, i

nteg

rate

d bi

olog

ical

be

havi

oura

l sur

veill

ance

(IBB

S), p

opul

atio

n si

ze

estim

atio

ns a

nd o

ther

stu

dies

.

Pr

omot

e th

e pr

oduc

tion,

dis

sem

inat

ion

and

effe

ctiv

e us

e of

str

ateg

ic in

form

atio

n to

info

rm a

nd

guid

e pr

ogra

mm

e an

d po

licy

deci

sion

mak

ing.

Cons

olid

ate

and

stre

amlin

e m

echa

nism

s fo

r dat

a co

llect

ion

from

bot

h pr

ivat

e an

d pu

blic

HC

faci

litie

s fo

r fut

ure

plan

ning

42

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Ann

ex 2

:

Nat

iona

l Act

ion

Plan

on

HIV

and

AID

S 20

11 –

201

5

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

Stra

tegy

1:

Impr

ovin

g th

e qu

ality

and

cov

erag

e of

pre

vent

ion

prog

ram

mes

am

ong

mos

t at r

isk

and

vuln

erab

le p

opul

atio

ns

1.1

Prev

entio

n of

HIV

tran

smis

sion

thro

ugh

the

shar

ing

of n

eedl

es a

nd s

yrin

ges

Build

an

enab

ling

envi

ronm

ent f

or H

IV

prev

entio

n w

ith ID

Us

and

thei

r par

tner

s by

mob

ilizi

ng k

ey s

take

hold

ers,

incl

udin

g,

heal

th c

are

prov

ider

s, c

omm

unity

ne

twor

ks, N

GO

s, lo

cal a

utho

ritie

s, a

nd

law

enf

orce

men

t

PDRM

, AAD

K, M

OH

, JAK

IM,

MAC

,

All d

istr

icts

whi

ch im

plem

ent h

arm

redu

ctio

n pr

ogra

mm

es w

ill h

ave

harm

redu

ctio

n co

mm

ittee

s in

volv

ing

law

enf

orce

men

t of

ficer

s.

Sust

ain

ongo

ing

advo

cacy

with

gov

ernm

ent b

odie

s an

d ci

vil s

ocie

ty o

rgan

isat

ions

at s

tate

and

nat

iona

l le

vels

Enga

gem

ent w

ith p

rint a

nd e

lect

roni

c m

ass

med

ia

on ID

U is

sues

.

Dev

elop

str

ateg

ies

to a

ddre

ss b

arrie

rs

and

chal

leng

es w

hich

pre

vent

the

effic

ient

and

eff

ectiv

e de

liver

y of

HIV

pr

even

tion

with

IDU

s.

PDRM

, AAD

K, M

OH

, JAK

IM,

MAC

Iden

tifie

d ba

rrie

rs a

nd c

halle

nges

hav

e be

en

sign

ifica

ntly

redu

ced

or re

mov

ed.

Enga

ge d

ecis

ion

and

polic

y m

aker

s, c

omm

unity

gr

oups

and

med

ia o

n ID

U re

late

d is

sues

incl

udin

g ne

edle

syr

inge

exc

hang

e, tr

eatm

ent,

reha

bilit

atio

n an

d co

mm

unity

sup

port

.

Im

plem

ent t

arge

ted

beha

viou

r cha

nge

appr

oach

es fo

r mal

e an

d fe

mal

e ID

Us

whi

ch e

mph

asiz

e ris

k re

duct

ion

and

prom

ote

safe

r sex

ual a

nd ri

sk re

duct

ion

beha

viou

rs.

AAD

K, D

istr

ict H

ealth

Off

ices

, Re

ligio

us D

epar

tmen

t

60%

of m

ale

and

fem

ale

IDU

s re

port

not

sh

arin

g in

ject

ing

equi

pmen

t.

60

% o

f sex

ually

act

ive

mal

e an

d fe

mal

e ID

Us

adop

t saf

er s

ex b

ehav

iour

(i.e

. usi

ng

cond

oms)

Ups

cale

cov

erag

e of

exi

stin

g ID

U a

nd S

RH

prog

ram

mes

to a

chie

ve im

prov

emen

t in

HIV

kn

owle

dge

and

unde

rsta

ndin

g, ri

sk a

sses

smen

t and

ab

ility

to a

cces

s se

rvic

es s

uch

as N

SEP,

MM

T,

cond

oms

and

lubr

ican

ts a

s w

ell a

s in

form

atio

n fo

r H

IV p

reve

ntio

n of

IDU

s an

d th

eir p

artn

ers.

Impl

emen

t nat

iona

l sca

le u

p of

HIV

pr

even

tion

with

IDU

s an

d th

eir p

artn

ers

incl

udin

g ne

edle

and

syr

inge

exc

hang

e pr

ogra

mm

es a

nd o

pioi

d su

bstit

utio

n th

erap

y.

MO

H, A

ADK,

MAC

, Priv

ate

Dru

g Re

hab

Cent

res

Each

dis

tric

t gov

ernm

ent h

ealth

clin

ic is

abl

e to

pro

vide

har

m re

duct

ion

serv

ices

.

Incr

ease

in th

e nu

mbe

r of N

GO

s ab

le to

pr

ovid

e N

SEP

serv

ices

.

Ups

cale

cov

erag

e of

exi

stin

g N

SEP

and

MM

T pr

ogra

mm

es w

ith g

over

nmen

t hea

lthca

re c

linic

s an

d N

GO

s.

In

crea

se th

e nu

mbe

r of a

cces

s po

ints

for M

MT

with

priv

ate

heal

thca

re s

ervi

ces.

.

43

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

Wai

ting

list s

houl

d no

t be

mor

e th

an o

ne

mon

th.

Stre

ngth

en m

echa

nism

s to

man

age

HIV

pr

even

tion

amon

g dr

ug u

sers

in p

rison

s an

d ot

her d

eten

tion

cent

res.

PUSP

EN,

Pris

ons

Dep

artm

ent,

PDRM

M

MT

is a

vaila

ble

in 1

8 pr

ison

s an

d 24

dru

g re

habi

litat

ion

cent

res

(PU

SPEN

).

Ups

cale

exi

stin

g M

MT

prog

ram

me

cove

ring

inca

rcer

ated

set

tings

.

Link

age

of fo

rmer

det

aine

es w

ith p

ost-

rele

ase

serv

ices

(cou

nsel

ling,

MM

T, tr

eatm

ent a

nd s

uppo

rt

grou

ps)

1.

2Pr

even

tion

of H

IV tr

ansm

issi

on th

roug

h un

prot

ecte

d se

x Re

view

exi

stin

g st

rate

gies

incl

udin

g aw

aren

ess

prog

ram

mes

and

act

iviti

es to

en

cour

age

and

faci

litat

e be

havi

oura

l ch

ange

am

ong

MAR

Ps.

MO

H, r

elev

ant M

inis

trie

s,

MAC

, NG

Os

Revi

ew a

nd re

form

s of

HIV

pro

gram

mes

and

ot

her r

elev

ant i

nter

vent

ions

hav

e be

en

cond

ucte

d.

Esta

blis

h na

tiona

l mul

ti st

akeh

olde

r Wor

king

G

roup

with

a m

anda

te to

revi

ew e

xist

ing

HIV

pr

ogra

mm

es a

nd p

rovi

de re

com

men

datio

ns fo

r re

form

.

Iden

tify

and

inte

grat

e be

st p

ract

ices

for H

IV

prev

entio

n pr

ogra

mm

es w

ith s

ex w

orke

rs, t

heir

part

ners

and

clie

nts.

Build

an

enab

ling

envi

ronm

ent f

or

beha

viou

ral c

hang

e th

roug

h ec

onom

ic,

wel

fare

and

relig

ious

ass

ista

nce.

KPW

KM, J

AKIM

, KKL

W, M

AC

Prog

ram

mes

are

ava

ilabl

e to

add

ress

vu

lner

abili

ties

linke

d to

soc

ioec

onom

ic

fact

ors

and

gend

er (e

.g. p

over

ty a

nd s

ingl

e m

othe

rs)

Esta

blis

h liv

elih

ood,

life

ski

lls a

nd w

elfa

re

com

mun

ity p

rogr

amm

es to

add

ress

pov

erty

and

th

e ne

eds

of lo

w in

com

e po

pula

tions

.

Esta

blis

h pa

rtne

rshi

p w

ith g

over

nmen

t and

civ

il so

ciet

y st

akeh

olde

rs o

n th

e is

sues

of

soci

oeco

nom

ic d

ispa

rity,

gen

der a

nd H

IV.

Ra

ise

awar

enes

s an

d bu

ild k

now

ledg

e of

H

IV a

nd o

ther

dis

ease

s (e

.g T

B an

d ST

Is),

amon

g M

ARPs

, mar

ried

and

unm

arrie

d co

uple

s, a

nd m

embe

rs o

f mos

t at r

isk

yout

h an

d th

eir s

exua

l par

tner

s.

MO

H, K

PWKM

, MAC

, NG

Os,

M

edia

Map

ping

, siz

e es

timat

e an

d so

ciob

ehav

iour

al

stud

ies

for e

ach

MAR

Ps h

ave

been

don

e at

le

ast o

nce.

Cond

uct m

appi

ng, s

ize

estim

atio

n an

d IB

BS

exer

cise

s w

ith e

ach

MAR

Ps a

nd id

entif

ied

vuln

erab

le p

opul

atio

ns.

D

isse

min

ate

findi

ngs

from

HIV

stu

dies

to re

leva

nt

gove

rnm

ent a

nd c

ivil

soci

ety

stak

ehol

ders

to a

ssis

t

44

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

in a

ddre

ssin

g is

sues

of s

ocio

econ

omic

dis

parit

y,

gend

er b

ased

vio

lenc

e an

d H

IV v

ulne

rabi

lity.

Impr

ove

and

stre

ngth

en V

CT, S

TI a

nd S

RH

serv

ices

to a

ll M

ARPs

, inc

ludi

ng

coun

selli

ng fo

r mar

ried

and

unm

arrie

d co

uple

s.

MO

H, K

PWKM

, MAC

, N

GO

s,

JAKI

M

50%

of p

ublic

hea

lthca

re fa

cilit

ies

have

a

pers

on tr

aine

d in

pos

t bas

ic c

ouns

ellin

g.

10

0 fa

cilit

ator

s tr

aine

d in

VCT

are

ava

ilabl

e ac

ross

the

coun

try

15 F

amily

Hea

lth C

linic

s (F

HC)

abl

e to

pro

vide

co

mpr

ehen

sive

VCT

, STI

and

SRH

ser

vice

s w

hich

are

MAR

P fr

iend

ly.

Co

mm

unity

run

faci

litie

s ba

sed

on th

e PB

KS

mod

el a

re e

stab

lishe

d in

3 s

tate

s w

ith th

e hi

ghes

t inc

iden

ce o

f HIV

.

Cond

uct

trai

ning

of V

CT fa

cilit

ator

s an

d ot

her

serv

ice

prov

ider

s fr

om N

GO

s an

d go

vern

men

t he

alth

care

faci

litie

s to

be

equi

pped

to in

tegr

ate

HIV

into

SRH

ser

vice

s an

d to

pro

vide

VCT

and

SRH

se

rvic

es b

ased

on

the

3C p

rinci

ples

(cou

nsel

ling,

co

nsen

t and

con

fiden

tial).

Iden

tify

and

enga

ge, a

t lea

st o

ne F

HC

in e

ach

stat

e to

col

labo

rate

with

a q

ualif

ied

NG

O to

pro

vide

co

mpr

ehen

sive

MAR

P fr

iend

ly V

CT, S

TI a

nd S

RH

serv

ices

.

Mai

ntai

n ex

istin

g N

GO

run

VCT

faci

litie

s to

co

mpl

emen

t the

Gov

ernm

ent’s

net

wor

k of

he

alth

care

faci

litie

s pr

ovid

ing

sim

ilar s

ervi

ces.

Rais

e aw

aren

ess

and

unde

rsta

ndin

g of

H

IV a

nd S

TIs,

sup

port

and

pro

mot

e th

e ap

prop

riate

use

of c

ondo

ms

and

lubr

ican

ts w

hen

enga

ged

in s

exua

l ac

tiviti

es, p

artic

ular

ly a

mon

g M

ARPs

, th

eir p

artn

ers

and/

or c

lient

s..

MO

H, K

PWKM

, MAC

, N

GO

s 80

% o

f MAR

Ps a

re re

ache

d by

a

com

preh

ensi

ve H

IV p

rogr

amm

e.

60

% o

f MAR

Ps ,

thei

r par

tner

s or

clie

nts

of

sex

wor

kers

use

a c

ondo

m d

urin

g se

xual

in

terc

ours

e.

N

GO

s ar

e ca

pabl

e of

des

igni

ng a

nd

cond

uctin

g ev

iden

ced

base

d ou

trea

ch

prog

ram

mes

cov

erin

g Pe

nins

ular

and

Eas

t M

alay

sia.

Prom

ote

HIV

pre

vent

ion

and

beha

viou

r cha

nge,

su

ch a

s sa

fer c

ondo

m u

se th

roug

h an

tena

tal c

linic

s,

othe

r hea

lth s

ervi

ces

and

NG

O fa

cilit

ies

such

as

the

Pusa

t Ban

tuan

Khi

dmat

Sos

ial (

PBKS

) whi

ch a

re

mos

t oft

en u

sed

by m

ost a

t ris

k po

pula

tions

Iden

tify

and

deve

lop

the

capa

city

of r

elev

ant N

GO

s to

des

ign

and

cond

uct e

vide

nced

bas

ed o

utre

ach

prog

ram

mes

whi

ch in

clud

e ris

k as

sess

men

t, sa

fer

sex

kits

and

targ

eted

IEC

mat

eria

ls.

Dev

elop

and

sca

le u

p se

rvic

es o

n se

xual

re

prod

uctiv

e he

alth

, cou

nsel

ling

and

trea

tmen

t rel

ated

to S

TIs,

HIV

and

AID

S

MO

H, M

AC,

NG

Os

A co

mpr

ehen

sive

min

imum

pac

kage

of

serv

ices

for M

ARPs

has

bee

n de

velo

ped

and

depl

oyed

.

Ups

cale

cov

erag

e of

exi

stin

g H

IV a

nd S

RH s

ervi

ces

and

prog

ram

mes

in g

over

nmen

t hea

lthca

re c

entr

es

and

NG

Os.

45

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Act

iviti

esKe

y St

akeh

olde

rsPl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

to e

nsur

e un

iver

sal c

over

age.

80

% o

f MA

RPs

are

cove

red

by a

co

mpr

ehen

sive

HIV

pro

gram

me.

D

evel

op a

com

preh

ensi

ve m

inim

um p

acka

ge o

f se

rvic

es to

pro

vide

MA

RPS

wit

h th

e fo

llow

ing

com

pone

nts:

info

rmat

ion,

HIV

/STI

and

SRH

se

rvic

es, V

CT, c

ondo

ms

and

outr

each

ser

vice

s Ex

pand

and

sca

le u

p H

IV p

reve

ntio

n pr

ogra

mm

ing

inco

rpor

atin

g a

com

preh

ensi

ve p

acka

ge o

f ser

vice

s fo

r m

en w

ho h

ave

sex

with

men

(MSM

) and

tr

ansg

ende

r pe

rson

s

MO

H, M

AC,

NG

Os

80%

of M

SM a

nd T

G p

opul

atio

ns r

each

ed b

y H

IV p

reve

ntio

n pr

ogra

mm

es.

NG

Os

are

capa

ble

of d

eliv

erin

g a

com

preh

ensi

ve p

acka

ge o

f MSM

and

TG

HIV

pr

even

tion

serv

ices

cov

erin

g Pe

nins

ular

and

Ea

st M

alay

sia.

Dev

elop

a c

ompr

ehen

sive

pac

kage

of M

SM a

nd T

G

spec

ific

HIV

pre

vent

ion

serv

ices

bas

ed o

n be

st

prac

tices

.

Iden

tify

and

deve

lop

the

capa

city

of N

GO

s to

be

able

to d

eliv

er a

com

preh

ensi

ve p

acka

ge o

f HIV

pr

even

tion

serv

ices

focu

sing

MSM

and

TG

.

Stre

ngth

en th

e pa

rtic

ipat

ion

of n

atio

nal

and

loca

l par

tner

s in

the

prov

isio

n of

HIV

pr

even

tion

prog

ram

mes

targ

etin

g fo

reig

n m

igra

nt w

orke

rs a

nd r

efug

ees.

UN

HCR

H

IV p

reve

ntio

n pr

ogra

mm

es a

re a

vaila

ble

for

mig

rant

wor

kers

and

ref

ugee

s.

Redu

ctio

n of

60%

in th

e nu

mbe

r of

mig

rant

w

orke

rs fo

und

to b

e w

ith H

IV th

roug

h ro

utin

e an

nual

hea

lth s

cree

ning

.

80%

of r

efug

ees

reac

hed

by H

IV p

reve

ntio

n pr

ogra

mm

es a

nd 6

0% p

ract

ice

safe

r se

x be

havi

our.

Dev

elop

a m

inim

um s

tand

ard

pack

age

of H

IV

prev

entio

n se

rvic

es fo

r m

igra

nt w

orke

rs a

nd

refu

gees

.

Initi

ate

and

stre

ngth

en e

xist

ing

HIV

pro

gram

mes

fo

r m

igra

nt w

orke

rs a

nd r

efug

ees

utili

sing

the

min

imum

sta

ndar

d pa

ckag

e of

HIV

pre

vent

ion

serv

ices

.

Impl

emen

t tar

gete

d be

havi

our

chan

ge

com

mun

icat

ion

inte

rven

tions

to

prom

ote

safe

r se

xual

beh

avio

ur, a

ddre

ss n

egat

ive

gend

er v

alue

s, a

nd p

rom

ote

mal

e re

spon

sibi

lity

for

posi

tive

heal

th.

MO

H, M

AC,

NG

Os,

KPW

KM,

Min

istr

y of

Info

rmat

ion,

Co

mm

unic

atio

n an

d Cu

lture

, N

GO

s, M

edia

60%

of M

SM a

nd T

G r

each

ed b

y H

IV

prev

entio

n in

terv

entio

ns p

ract

ice

safe

r se

x be

havi

our

Dev

elop

a s

erie

s of

wor

ksho

ps fo

r yo

ung

MSM

and

TG

(18

– 24

yea

rs o

ld) w

hich

inte

grat

e liv

ing

skill

s,

gend

er a

nd s

exua

lity

with

saf

er s

ex k

now

ledg

e/

skill

s to

rei

nfor

ce s

afer

sex

beh

avio

ur.

Iden

tify

and

deve

lop

the

capa

city

of N

GO

s to

be

able

to c

ondu

ct th

ese

MSM

and

TG

wor

ksho

ps.

Dev

elop

str

ateg

ies

to a

ddre

ss b

arri

ers

and

chal

leng

es w

hich

pre

vent

the

MO

H, r

elev

ant g

over

nmen

t ag

enci

es, M

AC,

NG

Os.

Re

view

and

ref

orm

s of

str

ateg

ies

whi

ch h

ave

impa

ct o

n H

IV p

reve

ntio

n se

rvic

es h

ave

been

Es

tabl

ish

natio

nal m

ulti

stak

ehol

der

Wor

king

G

roup

with

a m

anda

te to

rev

iew

exi

stin

g po

licie

s to

46

Str

engt

hen

the

part

icip

atio

nof

natio

nal

and

loca

lpar

tner

sin

the

prov

isio

nof

HIV

prev

entio

npr

ogra

mm

esfo

rre

fuge

es.

UN

HCR

,MO

H

HIV

prev

entio

npr

ogra

mm

esar

eav

aila

ble

for

refu

gees

.

80

%of

refu

gees

reac

hed

byH

IVpr

even

tion

prog

ram

mes

and

60%

prac

tice

safe

rse

xbe

havi

our.

D

evel

opa

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

for

refu

gees

.

In

itiat

ean

dst

reng

then

exis

ting

HIV

prog

ram

mes

for

refu

gees

utili

sing

the

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

.

Str

engt

hen

the

part

icip

atio

nof

natio

nal

and

loca

lpar

tner

sin

the

prov

isio

nof

HIV

prev

entio

npr

ogra

mm

esfo

rre

fuge

es.

UN

HCR

,MO

H

HIV

prev

entio

npr

ogra

mm

esar

eav

aila

ble

for

refu

gees

.

80

%of

refu

gees

reac

hed

byH

IVpr

even

tion

prog

ram

mes

and

60%

prac

tice

safe

rse

xbe

havi

our.

D

evel

opa

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

for

refu

gees

.

In

itiat

ean

dst

reng

then

exis

ting

HIV

prog

ram

mes

for

refu

gees

utili

sing

the

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

.

Str

engt

hen

the

part

icip

atio

nof

natio

nal

and

loca

lpar

tner

sin

the

prov

isio

nof

HIV

prev

entio

npr

ogra

mm

esfo

rre

fuge

es.

UN

HCR

,MO

H

HIV

prev

entio

npr

ogra

mm

esar

eav

aila

ble

for

refu

gees

.

80

%of

refu

gees

reac

hed

byH

IVpr

even

tion

prog

ram

mes

and

60%

prac

tice

safe

rse

xbe

havi

our.

D

evel

opa

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

for

refu

gees

.

In

itiat

ean

dst

reng

then

exis

ting

HIV

prog

ram

mes

for

refu

gees

utili

sing

the

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

.

Str

engt

hen

the

part

icip

atio

nof

natio

nal

and

loca

lpar

tner

sin

the

prov

isio

nof

HIV

prev

entio

npr

ogra

mm

esfo

rre

fuge

es.

UN

HCR

,MO

H

HIV

prev

entio

npr

ogra

mm

esar

eav

aila

ble

for

refu

gees

.

80

%of

refu

gees

reac

hed

byH

IVpr

even

tion

prog

ram

mes

and

60%

prac

tice

safe

rse

xbe

havi

our.

D

evel

opa

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

for

refu

gees

.

In

itiat

ean

dst

reng

then

exis

ting

HIV

prog

ram

mes

for

refu

gees

utili

sing

the

min

imum

stan

dard

pack

age

ofH

IVpr

even

tion

serv

ices

.

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

effic

ient

and

eff

ectiv

e de

liver

y of

HIV

pr

even

tion

serv

ices

to M

ARPs

esp

ecia

lly

MSM

, SW

and

TG

s

cond

ucte

d.

addr

ess

barr

iers

and

cha

lleng

es a

nd p

rovi

de

reco

mm

enda

tions

for r

efor

m.

D

evel

op s

tand

ard

oper

atin

g pr

oced

ures

on

HIV

pr

even

tion

serv

ices

for m

ost-

at-r

isk

youn

g pe

ople

(1

8 –

24 y

ears

old

) and

on

the

test

ing

and

trea

tmen

t for

min

ors.

1.3

Prev

entio

n of

par

ent t

o ch

ild tr

ansm

issi

on (P

PTCT

) M

aint

ain

the

prov

isio

n of

qua

lity,

co

mpr

ehen

sive

nat

iona

l PPT

CT s

ervi

ces,

in

line

with

the

WH

O re

com

men

ded

four

pr

onge

d st

rate

gy to

reac

h pr

egna

nt

wom

en, t

heir

part

ners

and

thei

r inf

ants

, in

clud

ing

mos

t at r

isk

popu

latio

ns.

MO

H, A

ssoc

iatio

n of

Priv

ate

Hos

pita

l/

Fede

ratio

n of

Gen

eral

Pr

actit

ione

rs o

f Mal

aysi

a ,

Wom

en ‘s

NG

O, W

ABA,

LP

PKN

KP

WKM

0% o

f bab

ies

will

be

born

with

HIV

by

mot

hers

livi

ng w

ith H

IV

Initi

ate

new

PPT

CT p

rogr

amm

es a

nd s

tren

gthe

n ex

istin

g PP

TCT

inte

rven

tions

in th

e pr

ivat

e se

ctor

.

Impr

ove

pre-

preg

nanc

y an

d po

st n

atal

car

e b

y id

entif

ying

thos

e w

ho a

re a

t ris

k

Stre

ngth

en c

omm

unity

aw

aren

ess

of H

IV

to in

crea

se e

nrol

men

t in

the

PPTC

T pr

ogra

mm

e an

d ot

her r

elat

ed a

nten

atal

, fa

mily

pla

nnin

g, s

exua

l and

repr

oduc

tive

heal

th, v

olun

tary

con

fiden

tial c

ouns

ellin

g an

d te

stin

g se

rvic

es, p

artic

ular

ly a

mon

g m

ost a

t ris

k po

pula

tions

.

MO

H, A

ssoc

iatio

n of

Priv

ate

Hos

pita

l/

Fede

ratio

n of

Gen

eral

Pr

actit

ione

rs o

f Mal

aysi

a ,

Wom

en ‘s

NG

O, W

ABA,

LP

PKN

KP

WKM

80%

cov

erag

e of

repr

oduc

tive

age

grou

p (1

5-

49 y

ears

) W

ork

with

pha

rmac

eutic

al c

ompa

nies

, oth

er

corp

orat

e se

ctor

act

ors,

NG

Os

and

faith

bas

ed

orga

nisa

tions

to c

reat

e aw

aren

ess

and

IEC

mat

eria

ls w

hich

are

use

d in

road

sho

ws,

hea

lth

cam

ps/c

ampa

igns

and

cam

paig

ns u

sing

soc

ial

med

ia, w

eb s

ites

and

the

mas

s m

edia

..

Co

nduc

t com

mun

ity o

utre

ach

prog

ram

s w

hich

pr

ovid

e in

form

atio

n an

d re

ferr

al to

ant

enat

al,

fam

ily p

lann

ing,

SRH

, and

VCT

ser

vice

s.

En

sure

all

HIV

-infe

cted

pre

gnan

t wom

en

and

thei

r HIV

-exp

osed

infa

nts

unde

r the

PP

TCT

prog

ram

me

rece

ive

ARV

trea

tmen

t/ p

roph

ylax

is a

nd

brea

stfe

edin

g ed

ucat

ion

to re

duce

m

othe

r-to

-chi

ld tr

ansm

issi

on o

f HIV

.

MO

H, M

OE,

MO

HE,

N

GO

s

100

% m

othe

rs w

ith H

IV a

nd th

eir n

ewbo

rn

rece

ive

ARV

trea

tmen

t

100%

of A

NC

pers

onne

l in

gove

rnm

ent a

nd

priv

ate

heal

thca

re fa

cilit

ies

are

trai

ned

in

PPTC

T

Cond

uct c

lose

mon

itorin

g an

d su

perv

isio

n on

dru

g ad

here

nce

Cond

uct c

apac

ity b

uild

ing

thro

ugh

cont

inuo

us

trai

ning

of A

NC

pers

onne

l in

gove

rnm

ent

heal

thca

re fa

cilit

ies.

47

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

Ensu

re th

e av

aila

bilit

y of

PPT

CT in

all

ANC

faci

litie

s in

clud

ing

priv

ate

heal

th c

are

faci

litie

s.

Publ

ic a

nd P

rivat

e se

ctor

s

0% v

ertic

al tr

ansm

issi

on re

port

ed

Initi

ate

and

sust

ain

PPTC

T pr

ogra

mm

es a

nd

stre

ngth

en e

xist

ing

PPTC

T in

terv

entio

ns in

clud

ing

in th

e pr

ivat

e se

ctor

.

Stra

tegy

2:

Impr

ovin

g th

e qu

ality

and

cov

erag

e of

test

ing

and

trea

tmen

t. En

sure

ade

quat

e nu

mbe

r and

trai

ning

of

heal

thca

re w

orke

rs to

del

iver

ARV

and

re

late

d se

rvic

es

MO

H, M

AC, P

rivat

e M

edic

al

Prac

titio

ners

, civ

il so

ciet

y

Incr

ease

d nu

mbe

r of r

efer

rals

of A

RV/S

TI/

PLH

IV fr

om p

rivat

e he

alth

care

pra

ctiti

oner

s.

Furt

her d

evel

op, r

evis

e an

d en

sure

impl

emen

tatio

n of

trea

tmen

t rel

ated

pol

icie

s, s

trat

egie

s an

d gu

idel

ines

Trai

n ad

ditio

nal s

taff

and

furt

her s

tren

gthe

n ca

paci

ty o

f sta

ff in

volv

ed in

faci

lity

base

d ca

re

St

reng

then

prio

rity

heal

th s

ervi

ces

thro

ugh

incr

ease

d in

tegr

atio

n of

HIV

se

rvic

e de

liver

y.

MO

H, M

AC, c

ivil

soci

ety

Com

preh

ensi

ve a

nd C

SO in

tegr

ated

HIV

se

rvic

e su

ppor

t mod

el d

eplo

yed

in o

ne

desi

gnat

ed c

linic

per

sta

te

Dev

elop

com

preh

ensi

ve a

nd C

SO in

tegr

ated

HIV

re

late

d su

ppor

t ser

vice

s m

odel

Impr

ove

cove

rage

and

ear

ly a

cces

s to

and

qu

ality

of H

IV te

stin

g, c

are

and

trea

tmen

t, se

xual

repr

oduc

tive

heal

th

and

STI s

ervi

ces

for m

ost a

t ris

k po

pula

tions

and

thei

r par

tner

s.

MO

H, M

AC, c

ivil

soci

ety

60

% o

f MAR

Ps re

ache

d by

cur

rent

pr

ogra

mm

es re

port

kno

wle

dge

of o

r ac

cess

ing

a SR

H/S

TI/H

IV s

ervi

ce.

80

% o

f tho

se e

ligib

le fo

r tre

atm

ent r

ecei

ve

ARV

Stre

ngth

en li

nkag

es a

nd re

ferr

al b

etw

een

faci

lity

base

d pr

ivat

e an

d go

vern

men

t ser

vice

s (V

CT,

OI/

ART,

PPT

CT, T

B, S

TI, a

nd S

RH) a

nd N

GO

ser

vice

s.

M

aint

ain

the

avai

labi

lity

of A

RT fo

r adu

lt an

d pa

edia

tric

pat

ient

s in

all

maj

or g

over

nmen

t he

alth

care

faci

litie

s.

In

crea

se a

cces

s an

d qu

ality

of H

IV te

stin

g an

d co

unse

lling

ser

vice

s in

the

publ

ic a

nd

priv

ate

sect

ors

to id

entif

y th

ose

in n

eed

of H

IV tr

eatm

ent

MO

H, M

AC, c

ivil

soci

ety

60%

of M

ARPs

reac

hed

by c

urre

nt

prog

ram

mes

repo

rt k

now

ledg

e of

or

acce

ssin

g a

SRH

/STI

/HIV

ser

vice

.

Upd

ate

and

revi

sion

of S

tand

ard

Ope

ratin

g Pr

oced

ures

(SO

P) fo

r tes

ting.

Dep

loym

ent o

f rev

ised

SO

P th

roug

h tr

aini

ng o

f go

vern

men

t, pr

ivat

e an

d N

GO

hea

lthca

re w

orke

rs.

St

reng

then

cap

acity

of V

CT re

late

d st

aff.

M

OH

, MAC

, civ

il so

ciet

y 80

% o

f gov

ernm

ent h

ealth

care

wor

kers

and

N

GO

s in

volv

ed in

the

prov

isio

n of

VCT

hav

e un

derg

one

HIV

test

ing

rela

ted

trai

ning

Prov

ide

HIV

test

ing

rela

ted

trai

ning

for

gove

rnm

ent,

priv

ate

and

NG

O h

ealth

care

wor

kers

.

48

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

Impr

ove

adhe

renc

e to

trea

tmen

t and

de

tect

ion

of tr

eatm

ent f

ailu

re

MO

H, M

AC, c

ivil

soci

ety

50%

redu

ctio

n in

the

num

ber o

f cas

es o

f 1st

lin

e tr

eatm

ent f

ailu

re

Incr

ease

cap

acity

and

ava

ilabi

lity

of tr

aine

d re

leva

nt c

ouns

ello

rs a

nd p

eer s

uppo

rt s

ervi

ces,

and

of

rele

vant

hea

lthca

re p

ract

ition

ers

in th

e ar

ea o

f re

sist

ance

test

ing.

Prov

ide

sim

pler

opt

ions

for f

irst l

ine

trea

tmen

t re

gim

en (3

in 1

)

Expa

nd ro

utin

e PI

CT fo

r pre

gnan

t w

omen

, TB

and

STI p

atie

nts

and

stre

ngth

en li

nkag

es fr

om p

reve

ntio

n to

ca

re a

nd tr

eatm

ent.

MO

H, M

AC, p

rivat

e he

alth

care

faci

litie

s, c

ivil

soci

ety

80%

of

gove

rnm

ent a

nd p

rivat

e he

alth

care

fa

cilit

ies

are

able

to p

rovi

de P

ICT

to p

regn

ant

wom

en, T

B an

d ST

I pat

ient

s

Prov

ide

PICT

rela

ted

trai

ning

for r

elev

ant

gove

rnm

ent,

priv

ate

and

NG

O h

ealth

care

wor

kers

.

Dev

elop

and

sca

le u

p ca

re a

nd tr

eatm

ent

with

ant

i-ret

rovi

ral d

rugs

and

TB

trea

tmen

t for

dru

g us

ers

in p

rison

s an

d ot

her d

eten

tion

cent

res.

MO

H, M

inis

try

of H

ome

Affa

irs, P

rison

s D

epar

tmen

t, N

ADA,

MAC

, civ

il so

ciet

y

90%

of a

ll el

igib

le p

erso

ns in

clo

sed

sett

ings

ha

ve a

cces

s to

ART

and

/or T

B tr

eatm

ent.

Pr

ovid

e AR

T an

d TB

trea

tmen

t to

elig

ible

per

sons

in

pris

ons

and

drug

reha

bilit

atio

n ce

ntre

s.

Stra

tegy

3:

Incr

easi

ng th

e ac

cess

and

ava

ilabi

lity

of c

are,

sup

port

and

soc

ial i

mpa

ct m

itiga

tion

prog

ram

mes

for P

eopl

e Li

ving

with

HIV

and

thos

e af

fect

ed.

Impr

ove

coor

dina

tion,

link

ages

and

re

ferr

al a

mon

g so

cial

, hea

lth a

nd

com

mun

ity b

ased

ser

vice

s at

the

com

mun

ity le

vel.

MO

H, K

PWKM

, MAC

, civ

il so

ciet

y Ea

ch d

esig

nate

d in

fect

ious

dis

ease

clin

ic p

er

stat

e w

ill h

ave

an a

ccre

dite

d pe

er s

uppo

rt

grou

p.

Al

l pee

r sup

port

per

sonn

el in

thes

e gr

oups

ar

e tr

aine

d in

refe

rral

and

link

ages

of H

IV

rela

ted

serv

ices

and

rele

vant

soc

ial s

uppo

rt

prog

ram

mes

.

Esta

blis

h an

acc

redi

tatio

n sy

stem

for H

IV p

eer

supp

ort g

roup

s w

hich

is s

tand

ardi

zed

thro

ugho

ut

the

coun

try

Br

ief p

eer e

duca

tors

and

hos

pita

l cou

nsel

lors

on

avai

labl

e go

vern

men

t and

NG

O w

elfa

re a

nd s

ocia

l su

ppor

t pro

gram

mes

.

Stre

ngth

en th

e qu

ality

and

impa

ct o

f PL

HIV

and

MAR

Ps s

uppo

rt g

roup

s an

d ne

twor

ks.

MO

H, M

AC, K

PWKM

A

PLH

IV s

uppo

rt g

roup

in e

ach

stat

e an

d lin

ked

to a

nat

iona

l net

wor

k.

A

MAR

Ps s

uppo

rt g

roup

s in

des

igna

ted

stat

es.

Trai

ning

of P

LHIV

faci

litat

ors

Es

tabl

ish

PLH

IV s

uppo

rt g

roup

s in

eac

h st

ate

and

stre

ngth

en a

n ex

istin

g na

tiona

l PLH

IV n

etw

ork.

49

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

Link

PLH

IV a

nd th

eir f

amili

es to

exi

stin

g so

cial

pro

tect

ion

prog

ram

mes

to e

nsur

e ac

cess

to e

ssen

tial s

ervi

ces.

MO

H, M

AC, K

PWKM

, Tas

k fo

rce

on W

oman

, Girl

s an

d H

IV, J

AKIM

A th

ird o

f all

PLH

IV s

uppo

rt g

roup

faci

litat

ors

(sta

te a

nd n

atio

nal)

are

wom

en.

In

crea

sed

refe

rral

cas

es b

y su

ppor

t gro

ups

to

soci

al p

rote

ctio

n (e

.g. w

elfa

re s

ervi

ces,

Ba

itulm

al, e

tc)

Trai

ning

of P

LHIV

wom

en fa

cilit

ator

s

Brie

f PLH

IV fa

cilit

ator

s on

ava

ilabl

e go

vern

men

t an

d N

GO

soc

ial p

rote

ctio

n pr

ogra

mm

es li

nked

to

gend

er b

ased

vio

lenc

e, s

ingl

e m

othe

rs a

s w

ell a

s w

elfa

re a

nd s

ocia

l sup

port

issu

es.

In

crea

se v

isib

ility

and

mea

ning

ful

part

icip

atio

n an

d de

cisi

on m

akin

g of

PL

HIV

and

MAR

Ps in

impa

ct m

itiga

tion

prog

ram

mes

.

MO

H, P

LHIV

org

aniz

atio

ns/

netw

orks

, rel

ated

gov

t or

gani

zatio

ns

PLH

IV a

nd M

ARPS

are

invo

lved

in th

e de

cisi

on m

akin

g pr

oces

s of

80%

of

prog

ram

mes

whi

ch in

volv

e th

em.

Incr

ease

cap

acity

and

cov

erag

e of

impa

ct

miti

gatio

n pr

ogra

mm

es to

cov

er a

ll PL

HIV

Incr

ease

opp

ortu

nity

for P

LHIV

and

MAR

PS t

o be

in

volv

ed in

the

plan

ning

, im

plem

enta

tion

and

eval

uatio

n of

impa

ct m

itiga

tion

prog

ram

mes

i.e.

tr

eatm

ent,

care

and

sup

port

pro

gram

mes

Prov

ide

qual

ity e

mot

iona

l, re

ligio

us a

nd

spiri

tual

sup

port

to P

LHIV

and

thei

r fa

mili

es.

Gov

ernm

ent a

nd N

GO

re

ligio

us b

odie

s, F

BOs,

JA

KIM

, MAC

, PLH

IV

orga

niza

tions

/net

wor

ks

Avai

labi

lity

of H

IV re

late

d pa

stor

al s

uppo

rt

by in

divi

dual

relig

ious

bel

iefs

in a

ll st

ates

and

w

ith a

ll re

ligio

ns.

Invo

lve

and

build

cap

acity

of f

aith

-bas

ed

orga

niza

tions

in p

rogr

amm

es in

volv

ing

PLH

IV/M

ARPs

Stre

ngth

en th

e ro

le o

f com

mun

ity a

nd

hom

e ba

sed

care

to s

uppo

rt p

ositi

ve

prev

entio

n an

d lin

kage

s to

TB

and

SRH

se

rvic

es

MO

H, M

AC, K

PWKM

, JAK

IM,

civi

l soc

iety

O

ne h

ome-

base

d ca

re p

rogr

amm

e es

tabl

ishe

d an

d pr

esen

t in

each

sta

te

Es

tabl

ishe

d re

ferr

al s

yste

m fo

r PLH

IV/M

ARPS

to

TB

and

SRH

ser

vice

s.

O

ne s

helte

r hom

e fo

r PLH

IV e

stab

lishe

d an

d op

erat

ing

in e

ach

stat

e.

Dev

elop

SO

P an

d pr

ovid

e tr

aini

ng fo

r hom

e-ba

sed

care

and

she

lter h

ome

prov

ider

s

Ensu

re th

at h

ome-

base

d ca

re a

nd s

helte

r hom

e pr

ovid

ers

are

know

ledg

eabl

e in

TB

and

SRH

re

ferr

als

Stra

tegy

4:

Mai

ntai

ning

and

impr

ovin

g an

ena

blin

g en

viro

nmen

t for

HIV

pre

vent

ion,

trea

tmen

t, c

are

and

supp

ort.

En

sure

HIV

issu

es a

re m

ains

trea

med

into

na

tiona

l soc

ial d

evel

opm

ent p

lans

and

th

e ne

cess

ary

finan

cial

and

tech

nica

l re

sour

ces

are

mob

ilise

d to

sup

port

NCC

AI, N

ATCA

, EPU

, MO

H,

MAC

, NG

Os

Incl

usio

n of

HIV

into

the

5 ye

ar M

alay

sian

Pl

an.

Th

e 5

year

Nat

iona

l Str

ateg

y on

HIV

and

AID

S

Stre

ngth

en th

e m

anag

emen

t and

cap

acity

of t

he

Nat

iona

l AID

S Pr

ogra

mm

e se

cret

aria

t (AI

DS/

STI

Sect

or a

nd th

e M

alay

sian

AID

S Co

unci

l) to

impr

ove

coor

dina

tion

and

man

agem

ent o

f the

nat

iona

l

50

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

deve

lopm

ent a

nd im

plem

enta

tion

of H

IV

and

AID

S pl

ans

and

prog

ram

mes

.

is fu

nded

and

sup

port

ed b

y ke

y st

akeh

olde

rs.

resp

onse

.

Cond

uct r

evie

w a

nd s

trea

mlin

ing

of e

xist

ing

polic

ies

and

stra

tegi

es.

St

reng

then

cap

acity

and

pla

ns o

f key

m

inis

trie

s, o

ther

gov

ernm

ent

stak

ehol

ders

and

civ

il so

ciet

y or

gani

satio

ns a

t the

nat

iona

l and

loca

l le

vels

to im

prov

e an

d st

reng

then

ta

rget

ed e

vide

nce-

base

d in

terv

entio

ns.

NCC

AI, N

ATCA

, MO

H, r

elev

ant

min

istr

ies,

MAC

Th

e N

atio

nal S

trat

egy

on H

IV a

nd A

IDS

2011

–

2015

is a

ble

to b

e ef

fect

ivel

y im

plem

ente

d,

mon

itore

d an

d ev

alua

ted

for i

mpa

ct.

Enga

ge k

ey m

inis

trie

s in

the

wor

k an

d de

cisi

on-

mak

ing

proc

esse

s of

the

Nat

iona

l Coo

rdin

atin

g Co

mm

ittee

on

AID

S In

terv

entio

n (N

CCAI

) and

N

atio

nal A

dvis

ory

and

Tech

nica

l Com

mitt

ee o

n AI

DS

(NAT

CA).

Bu

ild c

apac

ity o

f par

ticip

ants

who

rout

inel

y at

tend

Fe

dera

l, St

ate

and

Dis

tric

t lev

el H

IV p

rogr

amm

e m

eetin

gs.

Se

nsiti

se a

nd e

ngag

e la

w e

nfor

cem

ent,

heal

thca

re s

ervi

ce p

rovi

ders

, rel

evan

t pu

blic

off

icia

ls a

nd c

ivil

soci

ety

stak

ehol

ders

, to

asse

ss, p

reve

nt a

nd

miti

gate

any

neg

ativ

e co

nseq

uenc

es o

f la

ws

and

polic

ies

to th

e na

tiona

l HIV

re

spon

se

MO

H, M

embe

rs o

f Pa

rliam

ent,

law

enf

orce

men

t bo

dies

, MAC

, NG

Os.

Incr

ease

d ca

paci

ty o

f gov

ernm

ent a

nd c

ivil

stak

ehol

ders

to a

ddre

ss is

sues

of s

tigm

a an

d di

scrim

inat

ion

Build

cap

acity

of p

arlia

men

taria

ns, l

aw

enfo

rcem

ent o

ffic

ials

, and

key

pol

icy

and

deci

sion

m

aker

s on

HIV

rela

ted

issu

es.

Impr

ove

the

repr

esen

tatio

n, in

volv

emen

t an

d ca

paci

ty o

f civ

il so

ciet

y, c

omm

unity

ba

sed

orga

niza

tions

and

aff

ecte

d po

pula

tion

netw

orks

in p

olic

y di

alog

ue

and

deci

sion

-mak

ing,

tow

ards

ach

ievi

ng

Uni

vers

al A

cces

s an

d st

reng

then

ing

the

natio

nal r

espo

nse.

MAC

, NG

Os,

civ

il so

ciet

y ne

twor

ks

Incr

ease

d ca

paci

ty o

f civ

il so

ciet

y re

pres

enta

tives

in c

onsu

ltativ

e bo

dies

(e.g

. Co

untr

y Co

ordi

natin

g M

echa

nism

) and

pol

icy

disc

ussi

ons.

Build

cap

acity

of c

ivil

soci

ety

repr

esen

tativ

es to

en

able

them

to p

artic

ipat

e an

d co

ntrib

ute

in p

olic

y di

alog

ue a

nd d

ecis

ion

mak

ing.

Stre

ngth

en th

e w

ork

of th

e pr

ivat

e se

ctor

am

ong

loca

l bus

ines

ses

to p

rom

ote

corp

orat

e so

cial

resp

onsi

bilit

y an

d to

Min

istr

y of

Hum

an R

esou

rce,

M

AC, N

GO

s, p

rivat

e se

ctor

bo

dies

and

com

pani

es

30 p

rivat

e se

ctor

com

pani

es h

ave

adop

ted

eith

er th

e M

OH

R’s

HIV

in th

e W

orkp

lace

Po

licy,

the

Mal

aysi

an A

IDS

Char

ter o

r

Prom

ote

the

HIV

in th

e W

orkp

lace

Pol

icy

(MO

HR)

an

d th

e M

alay

sian

AID

S Ch

arte

r to

priv

ate

sect

or

com

pani

es a

nd o

rgan

isat

ions

.

51

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

esta

blis

h w

orkp

lace

-bas

ed H

IV

prev

entio

n pr

ogra

mm

es a

nd to

add

ress

st

igm

a an

d di

scrim

inat

ion

in th

e pr

ivat

e se

ctor

.

esta

blis

hed

som

e fo

rm o

f AID

S in

the

wor

kpla

ce p

olic

y.

Inte

nsify

pub

lic u

nder

stan

ding

and

aw

aren

ess

of H

IV a

nd A

IDS

thro

ugh

focu

sed

com

mun

icat

ions

and

inte

grat

ion

into

com

mun

ity-b

ased

HIV

edu

catio

n m

essa

ges.

MO

H, M

AC, N

GO

s, K

PWKM

, M

OE,

MO

HE,

Min

istr

y of

In

form

atio

n, C

omm

unic

atio

n an

d Cu

lture

, NG

Os,

Med

ia

60%

of y

oung

peo

ple

aged

15–

24 w

ho b

oth

corr

ectly

iden

tify

way

s of

pre

vent

ing

the

sexu

al tr

ansm

issi

on o

f HIV

and

who

reje

ct

maj

or m

isco

ncep

tions

abo

ut H

IV

tran

smis

sion

Prom

ote

com

preh

ensi

ve s

exua

l rep

rodu

ctiv

e he

alth

and

life

ski

lls b

ased

edu

catio

n an

d H

IV

awar

enes

s pr

ogra

mm

es a

mon

g yo

ung

peop

le a

ged

15-2

4.

Stra

tegy

5:

Incr

easi

ng th

e av

aila

bilit

y an

d qu

ality

of s

trat

egic

info

rmat

ion

and

its u

se b

y po

licy

mak

ers

and

prog

ram

me

plan

ners

thro

ugh

mon

itori

ng, e

valu

atio

n an

d re

sear

ch.

Dev

elop

and

str

engt

hen

part

ners

hips

to

plan

, coo

rdin

ate

and

man

age

the

natio

nal m

onito

ring

and

eval

uatio

n,

rese

arch

and

sur

veill

ance

sys

tem

s.

MO

H, M

AC,

Civi

l soc

iety

, rel

ated

go

vern

men

t age

ncie

s,

rese

arch

inst

itutio

ns

An in

tegr

ated

M&

E un

it ha

s be

en e

stab

lishe

d at

the

natio

nal l

evel

and

coo

rdin

ated

by

the

HIV

/STI

sec

tor.

Stre

ngth

en th

e ex

istin

g su

rvei

llanc

e sy

stem

by

deve

lopi

ng a

com

preh

ensi

ve n

atio

nal M

&E

fram

ewor

k

Prod

uce

and

diss

emin

ate

timel

y an

d hi

gh

qual

ity d

ata

from

rese

arch

, int

egra

ted

biol

ogic

al b

ehav

iour

al s

urve

illan

ce (I

BBS)

, po

pula

tion

size

est

imat

ions

and

oth

er

stud

ies.

MO

H, M

AC, M

ARPs

, res

earc

h in

stitu

tions

, re

gion

al &

inte

rnat

iona

l or

gani

satio

ns

Min

imum

of 1

rese

arch

per

MAR

P an

d ot

her

vuln

erab

le p

opul

atio

ns is

pro

duce

d an

d di

ssem

inat

ed w

ithin

6 m

onth

s of

rese

arch

All H

IV re

late

d re

sear

ch is

com

pile

d in

a

rese

arch

dire

ctor

y.

A

natio

nal M

&E

Fram

ewor

k an

d m

anua

l is

deve

lope

d an

d di

ssem

inat

ed to

all

stak

ehol

ders

Cond

uct s

ize

estim

atio

n an

d so

cial

rese

arch

on

MAR

PS/

othe

r det

erm

ined

vul

nera

ble

popu

latio

ns

with

indi

vidu

al re

sear

cher

s, in

stitu

tions

and

NG

Os.

at

nat

iona

l and

sta

te le

vel

Pr

oduc

e co

mpr

ehen

sive

and

hig

h qu

ality

rout

ine

prog

ram

me

mon

itorin

g da

ta b

y ha

rmon

izin

g an

d st

anda

rdis

ing

M&

E ef

fort

s in

clud

ing

alig

nmen

t of

mea

sure

able

indi

cato

rs w

hich

refle

ct a

ctua

l pr

ogra

mm

e ac

hiev

emen

t, in

dica

tor d

efin

ition

s,

data

col

lect

ion

tool

s, d

ata

man

agem

ent a

nd

repo

rtin

g pr

oced

ures

.

Prom

ote

the

prod

uctio

n, d

isse

min

atio

n an

d ef

fect

ive

use

of s

trat

egic

info

rmat

ion

to in

form

and

gui

de p

rogr

amm

e an

d

MO

H, r

elev

ant g

ovt a

genc

ies,

ci

vil s

ocie

ty, m

edia

A

min

imum

of 1

upd

ate

sess

ion

cond

ucte

d du

ring

NAT

CA.

Trai

n ex

pert

s in

writ

ing

evid

ence

bas

ed p

olic

y br

iefs

, ris

k co

mm

unic

atio

n m

ater

ial a

nd to

con

duct

m

edia

trai

ning

52

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Key

Activ

ities

Ke

y

Stak

ehol

ders

Pl

anne

d Ta

rget

Ach

ieve

men

ts b

y en

d of

20

15

Prio

rity

Prog

ram

mes

polic

y de

cisi

on m

akin

g.

60

% o

f new

s co

vera

ge o

n H

IV is

bas

ed o

n re

liabl

e da

ta a

nd fa

cts.

Dev

elop

sm

art p

artn

ersh

ip a

nd s

ensi

tisat

ion

prog

ram

mes

with

med

ia p

ract

ition

ers

on H

IV

rela

ted

issu

es.

D

evel

op m

echa

nism

for d

ata

colle

ctio

n fr

om b

oth

priv

ate

and

publ

ic h

ealth

care

fa

cilit

ies

for f

utur

e pl

anni

ng

MO

H, p

rivat

e he

alth

pr

actit

ione

rs, c

ivil

soci

ety

Fam

ily H

ealth

Div

isio

n an

d H

IV/S

TI e

stab

lish

an in

tegr

ated

and

con

solid

ated

dat

abas

e Es

tabl

ish

an a

gree

men

t bet

wee

n di

ffer

ent

stak

ehol

ders

(Gov

t, pr

ivat

e an

d BG

O) t

o sy

stem

atic

ally

and

con

sist

ently

con

trib

ute

rela

ted

HIV

dat

a

As

sess

and

upg

rade

exi

stin

g H

IV d

ata

colle

ctio

n sy

stem

s to

ena

ble

impr

oved

dat

a an

alys

is a

nd

acce

ssib

le to

MO

H a

nd N

GO

s.

53

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Ann

ex 3

:

Prop

osed

targ

et fo

r NSE

P un

der N

SP 2

011

– 20

15

STA

TE

TARG

ET O

F N

EW C

LIEN

T FO

R N

SEP

2011

20

12

2013

20

14

2015

Pe

rlis

248

392

494

530

587

Keda

h 1,

762

2,77

9 3,

502

3,76

3 4,

168

P. P

inan

g 2,

786

4,39

4 5,

538

5,94

9 6,

590

Pera

k 1,

583

2,49

7 3,

147

3,38

1 3,

745

W.P

. KL

3,69

0 5,

820

7,33

6 7,

882

8,73

0 Se

lang

or

3,14

1 4,

953

6,24

3 6,

708

7,43

0 N

. Sem

bila

n 1,

102

1,73

8 2,

190

2,35

4 2,

607

Mel

aka

603

950

1,19

9 1,

288

1,42

6 Jo

hor

2,55

0 4,

022

5,07

0 5,

447

6,03

3 Ke

lant

an

2,11

7 3,

339

4,20

8 4,

520

5,00

8 Te

reng

ganu

2,

208

3,48

2 4,

389

4,71

6 5,

223

Paha

ng

1,91

9 3,

027

3,81

5 4,

099

4,54

0 Sa

raw

ak

722

1,13

9 1,

436

1,54

3 1,

709

Saba

h 1,

438

2,26

8 2,

859

3,07

2 3,

403

TOTA

L 25

,869

40

,800

51

,425

55

,250

61

,200

54

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Pr

opos

ed ta

rget

for M

MT

unde

r NSP

201

1 –

2015

STA

TE

TARG

ET O

F N

EW C

LIEN

T FO

R M

MT

2011

20

12

2013

20

14

2015

Pe

rlis

202

270

438

548

742

Keda

h 1,

436

1,91

5 2,

963

3,89

1 5,

267

P. P

inan

g 2,

271

3,02

8 4,

685

6,15

1 8,

328

Pera

k 1,

291

1,72

1 2,

662

3,49

5 4,

744

W.P

. KL

3,00

9 3,

926

6,20

6 8,

149

11,0

33

Sela

ngor

2,

561

3,41

7 5,

282

6,93

5 9,

390

N. S

embi

lan

901

1,19

8 1,

854

2,53

4 3,

300

Mel

aka

492

655

1,03

5 1,

381

1,81

4 Jo

hor

2,07

8 2,

772

4,28

9 5,

632

7,62

5 Ke

lant

an

1,72

6 2,

301

3,56

0 4,

678

6,32

9 Te

reng

ganu

1,

800

2,40

0 3,

725

4,87

6 6,

329

Paha

ng

1,56

5 2,

086

3,22

7 4,

238

5,73

8 Sa

raw

ak

570

759

1,17

5 1,

543

2,08

9 Sa

bah

500

750

975

1,20

0 1,

800

TOTA

L 20

,400

27

,200

42

,075

55

,250

74

,800

55

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Pr

opos

ed ta

rget

for R

eage

nt a

nd A

RV u

nder

NSP

201

1 –

2015

STA

TE

TARG

ET O

F N

EW P

ATIE

NT

ON

ARV

20

11

2012

20

13

2014

20

15

Perli

s 12

4 14

0 15

7 17

4 19

0 Ke

dah

544

618

691

763

836

P. P

inan

g 1,

426

1,61

6 1,

806

1,99

7 2,

187

Pera

k 89

4 1,

013

1,13

2 1,

251

1,37

0 W

.P. K

L 16

18

20

23

25

Se

lang

or

4,14

1 4,

693

5,24

4 5,

797

6,34

8 N

. Sem

bila

n 1,

002

1,13

6 1,

269

1,40

3 1,

536

Mel

aka

278

315

352

389

426

Joho

r 3,

122

3,53

8 3,

954

4,37

0 4,

787

Kela

ntan

1,

258

1,42

6 1,

593

1,76

1 1,

929

Tere

ngga

nu

373

423

472

522

572

Paha

ng

444

503

563

622

681

Sara

wak

39

1 44

3 49

6 54

8 60

0 Sa

bah

728

825

922

1,01

9 1,

116

WPL

abua

n 3

4 4

5 6

HKL

25

5 29

0 32

4 35

8 39

2 TO

TAL

15,0

00

17,0

00

19,0

00

21,0

00

23,0

00

56

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Ann

ex 4

:

Perf

orm

ance

Indi

cato

rs fo

r the

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

2011

– 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

GEN

ERA

L IN

DIC

ATO

RS (I

MPA

CT)

1 H

IV p

reva

lenc

e am

ong

popu

latio

n ag

ed

15-4

9 ye

ars

MO

H-P

roje

ctio

n of

the

Mal

aysi

a H

IV e

pide

mic

Ev

ery

2 ye

ars

0.50

%

N

SP

2 Pe

rcen

tage

of y

oung

wom

en a

nd m

en

aged

15–

24 w

ho a

re H

IV in

fect

ed.

Prog

ram

me

Mon

itorin

g (P

PTCT

Pro

gram

me)

Ev

ery

2 ye

ars

0.05

%

U

NG

ASS

22, M

DG

3 Pe

rcen

tage

of m

ost a

t- ri

sk p

opul

atio

ns

who

are

HIV

infe

cted

ID

U –

IBBS

Ev

ery

2 ye

ars

22.0

6% (2

009)

17

%

UN

GAS

S 23

SW –

IBBS

Ev

ery

2 ye

ars

10.5

3% (2

009)

7%

TG –

IBBS

Ev

ery

2 ye

ars

9.7%

(200

9)

6%

MSM

– V

DTS

Ev

ery

2 ye

ars

3.8

7% (2

009)

2%

4 Pe

rcen

tage

of a

dults

and

chi

ldre

n w

ith

HIV

kno

wn

to b

e on

trea

tmen

t 12

mon

ths

afte

r ini

tiatio

n of

ant

iretr

ovira

l th

erap

y

Nat

iona

l ART

Pro

gram

me

Mon

itorin

g Ev

ery

year

86

.9%

(200

9)

90%

U

NG

ASS

24, U

A

5 Pe

rcen

tage

of i

nfan

ts b

orn

to H

IV-

infe

cted

mot

hers

who

are

infe

cted

PMTC

T pr

ogra

m m

onito

ring

Ever

y ye

ar

2.67

% (2

009)

0%

U

NG

ASS

25

57

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

Stra

tegy

1: I

mpr

ovin

g th

e qu

ality

and

cov

erag

e of

pre

vent

ion

prog

ram

mes

am

ong

mos

t at r

isk

and

vuln

erab

le p

opul

atio

ns.

OU

TCO

ME

IND

ICA

TORS

6 Pe

rcen

tage

of y

oung

wom

en a

nd m

en

aged

15–

24 w

ho b

oth

corr

ectly

iden

tify

way

s of

pre

vent

ing

the

sexu

al

tran

smis

sion

of H

IV a

nd w

ho re

ject

m

ajor

mis

conc

eptio

ns a

bout

HIV

tr

ansm

issi

on

IBBS

Ev

ery

2 ye

ars

22.6

% (2

008)

50

%

UN

GAS

S 13

, UA

7 Pe

rcen

tage

of m

ost a

t- ri

sk p

opul

atio

ns

who

bot

h co

rrec

tly id

entif

y w

ays

of

prev

entin

g th

e se

xual

tran

smis

sion

of

HIV

and

who

reje

ct m

ajor

m

isco

ncep

tions

abo

ut H

IV tr

ansm

issi

on

IDU

– IB

BS (2

009)

Ev

ery

2 ye

ars

DU

: 49

.68%

60

%

UN

GAS

S 14

SW –

IBBS

(200

9)

Ever

y 2

year

s SW

: 38

.48%

60

%

TG –

IBBS

(200

9)

Ever

y 2

year

s TG

: 37%

60

%

MSM

– N

/A

Ever

y 2

year

s M

SM :

N/A

60

%

8 Pe

rcen

tage

of y

oung

wom

en a

nd m

en

who

hav

e ha

d se

xual

inte

rcou

rse

befo

re th

e ag

e of

15

Cros

s se

ctio

nal M

alay

sian

sc

hool

sur

vey

Ever

y 2

year

s 5.

38%

(200

6)

4%

UN

GAS

S 15

, UA

9 Pe

rcen

tage

of a

dults

age

d 15

–49

who

ha

ve h

ad s

exua

l int

erco

urse

with

mor

e th

an o

ne p

artn

er in

the

last

12

mon

ths

Popu

latio

n ba

sed

surv

ey

Ever

y 3-

5 ye

ars

N/A

UN

GAS

S 16

10

Perc

enta

ge o

f adu

lts a

ged

15–4

9 w

ho

had

mor

e th

an o

ne s

exua

l par

tner

in

the

past

12

mon

ths

who

repo

rt th

e us

e of

a c

ondo

m d

urin

g th

eir l

ast

inte

rcou

rse.

Popu

latio

n ba

sed

surv

ey

Ever

y 3-

5 ye

ars

N/A

UN

GAS

S 17

11

Perc

enta

ge o

f fem

ale

and

mal

e se

x w

orke

rs re

port

ing

the

use

of a

con

dom

w

ith th

eir m

ost r

ecen

t clie

nt

IBBS

Ev

ery

2 ye

ars

61.3

4%

(200

9-Fe

mal

e on

ly)

80%

U

NG

ASS

18

12

Perc

enta

ge o

f men

repo

rtin

g th

e us

e of

a

cond

om th

e la

st ti

me

they

had

ana

l se

x w

ith a

mal

e pa

rtne

r

MAC

Pro

gram

me

Mon

itorin

g

21

% (2

008)

60

%

UN

GAS

S 19

13

Perc

enta

ge o

f inj

ectin

g dr

ug u

sers

who

re

port

the

use

of a

con

dom

at l

ast

sexu

al in

terc

ours

e

IDU

– IB

BS

Ever

y 2

year

s 27

.8%

(200

9)

60%

U

NG

ASS

20

58

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

14

Perc

enta

ge o

f inj

ectin

g dr

ug u

sers

who

re

port

ed u

sing

ste

rile

inje

ctin

g eq

uipm

ent t

he la

st ti

me

they

inje

cted

IDU

– IB

BS

Ever

y 2

year

s 83

.49%

95

%

UN

GAS

S 21

OU

TPU

T IN

DIC

ATO

R

15

Perc

enta

ge o

f mos

t at-

risk

pop

ulat

ions

re

ache

d w

ith H

IV p

reve

ntio

n pr

ogra

mm

es d

isag

greg

ated

by

type

s of

M

ARPs

.

IDU

– IB

BS

Ever

y 2

year

s 27

% (2

009)

50

%

UN

GAS

S 9

SW –

IBBS

Ev

ery

2 ye

ars

12%

(200

9)

80%

TB –

IBBS

Ev

ery

2 ye

ars

65%

(200

9)

80%

MSM

– N

/A

Ever

y 2

year

s N

/A

80%

16

Num

ber o

f dis

tric

t gov

ernm

ent h

ealth

cl

inic

pro

vidi

ng N

SEP

serv

ices

MO

H

Ever

y ye

ar

73

800

NSP

17

Num

ber o

f NG

Os

prov

idin

g N

SEP

serv

ice

MO

H

Ever

y ye

ar

18

66

NSP

18

Perc

enta

ge o

f tar

gete

d cl

ient

s re

ceiv

ing

NSE

P ki

ts a

t NSE

P si

te

Prog

ram

mon

itorin

g (M

AC)

Ever

y ye

ar

N/A

10

0%

NSP

19

Num

ber o

f MM

T se

rvic

e av

aila

ble

disa

ggre

gate

d by

type

of c

entr

e.

MO

H

N

SP

Pris

on

Ever

y ye

ar

18 (2

010)

32

N

atio

nal A

nti-D

rug

Agen

cy

faci

litie

s Ev

ery

year

25

(201

0)

24

Gov

ernm

ent h

ealth

care

faci

lity

Ever

y ye

ar

174

(201

0)

800

20

Num

ber o

f com

preh

ensi

ve m

inim

um

pack

age

of s

ervi

ces

for M

ARPs

de

velo

ped

and

depl

oyed

.

MAC

Ev

ery

year

N

/A

5 N

SP

21

Num

ber o

f TW

G fo

r MAR

Ps to

mon

itor

com

preh

ensi

ve m

inim

um p

acka

ge o

f se

rvic

es e

stab

lishe

d

MAC

Ev

ery

year

N

/A

1

59

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

Stra

tegy

2:

Impr

ovin

g th

e qu

ality

and

cov

erag

e of

test

ing

and

trea

tmen

t.

OU

TCO

ME

IND

ICA

TORS

22

Perc

enta

ge o

f wom

en a

nd m

en a

ged

15-4

9 w

ho re

ceiv

ed a

n H

IV te

st in

the

last

12

mon

ths

and

who

kno

w th

e re

sults

(HIV

Pro

gram

me

Mon

itorin

g)

Ever

y ye

ar

98%

98

%

UN

GAS

S 7,

UA

23

Perc

enta

ge o

f MAR

Ps (M

ost a

t- ri

sk

popu

latio

ns) t

hat h

ave

rece

ived

an

HIV

te

st in

the

last

12

mon

ths

and

who

kn

ow th

e re

sults

.

IDU

– IB

BS

Ever

y 2

year

s ID

U :

33.0

%

(200

9)

60%

U

NG

ASS

8,

SW –

IBBS

Ev

ery

2 ye

ars

SW :

19.9

6%

(200

9)

90%

TG –

IBBS

Ev

ery

2 ye

ars

TG: 1

9%

(200

9)

90%

MSM

– N

/A

Ever

y 2

year

s M

SM :

N/A

60

%

OU

TPU

T ID

ICA

TORS

24

Perc

enta

ge o

f adu

lts a

nd c

hild

ren

with

ad

vanc

ed H

IV in

fect

ion

(CD

4 <3

50 o

r sh

owin

g si

gns

of A

IDS)

rece

ivin

g an

tiret

rovi

ral t

hera

py

Nat

iona

l AID

S Re

gist

ry

Ever

y ye

ar

37.3

%;

9,96

2 (2

009)

95

%

UN

GAS

S 4,

MD

G, U

A

25

Perc

enta

ge o

f hea

lth c

are

wor

ker

trai

ned

in H

IV re

late

d se

rvic

e de

liver

y di

sagg

rega

ted

by ty

pe o

f hea

lthca

re

wor

kers

:

MO

H /

MAC

NSP

Gov

ernm

ent h

ealth

care

wor

ker

Ever

y 2

year

s N

/A

85%

Priv

ate

heal

thca

re w

orke

r Ev

ery

2 ye

ars

N/A

85

%

26

Num

ber o

f des

igna

ted

clin

ic d

eplo

yed

com

preh

ensi

ve a

nd C

SO in

tegr

ated

H

IV s

ervi

ce s

uppo

rt m

odel

MO

H /

MAC

NSP

Gov

ernm

ent c

linic

Ev

ery

year

N

/A

14

Pr

ivat

e cl

inic

Ev

ery

year

N

/A

14

27

Perc

enta

ge o

f peo

ple

in e

nclo

sed

sett

ings

who

elig

ible

acc

essi

ng to

ART

an

d/or

TB

trea

tmen

t.

MO

H

Ever

y ye

ar

N/A

90

%

NSP

60

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

28

Perc

enta

ge o

f MAR

Ps re

ache

d by

cu

rren

t pro

gram

mes

repo

rt a

cces

sing

a

SRH

/STI

/HIV

ser

vice

s.

MAC

Ev

ery

2 ye

ars

IDU

: N

/A

60%

N

SP

Ever

y 2

year

s SW

: N

/A

60%

Ever

y 2

year

s M

SM :

N/A

60

%

Ever

y 2

year

s TG

: N/A

60

%

29

Perc

enta

ge o

f hea

lth c

are

faci

litie

s pr

ovid

ing

PICT

to p

regn

ant w

omen

, TB

and

STI p

atie

nts

disa

ggre

gate

d by

ty

pes

of h

ealth

car

e fa

cilit

ies.

MO

H

N

SP

Gov

ernm

ent h

ealth

faci

lity

Ever

y ye

ar

N/A

10

0%

Pr

ivat

e he

alth

faci

lity

Ever

y ye

ar

N/A

10

0%

Stra

tegy

3: I

ncre

asin

g th

e ac

cess

and

ava

ilabi

lity

of c

are,

sup

port

and

soc

ial i

mpa

ct m

itiga

tion

prog

ram

mes

for P

eopl

e Li

ving

with

HIV

and

thos

e af

fect

ed.

OU

TCO

ME

IND

ICA

TORS

30

Perc

enta

ge o

f pre

gnan

t wom

en w

ho

rece

ived

an

HIV

test

who

kno

w th

e re

sults

Prog

ram

mon

itorin

g (P

PTCT

) Ev

ery

year

N

/A

100%

N

SP

31

Perc

enta

ge o

f mal

e pa

rtne

rs o

f pos

itive

pr

egna

nt w

omen

att

endi

ng A

NC

who

kn

ow th

eir H

IV s

tatu

s

Prog

ram

mon

itorin

g (P

PTCT

) Ev

ery

year

N

/A

100%

N

SP

33

Perc

enta

ge o

f pos

itive

mal

e pa

rtne

rs o

f pr

egna

nt w

omen

use

con

dom

to

prot

ect P

PTCT

.

Prog

ram

mon

itorin

g (P

PTCT

) Ev

ery

year

N

/A

100%

N

SP

OU

TPU

T ID

ICA

TORS

33

Perc

enta

ge o

f HIV

pos

itive

pre

gnan

t w

omen

who

rece

ive

antir

etro

vira

l to

redu

ce th

e ris

k of

mot

her-

to-c

hild

tr

ansm

issi

on

Prog

ram

me

mon

itorin

g (P

PTCT

) Ev

ery

year

10

0% o

f 347

w

omen

rece

ived

AR

T ov

er th

e pa

st tw

o ye

ars

100%

U

NG

ASS

5, U

A

34

% o

f inf

ants

bor

n to

HIV

– In

fect

ed

wom

en re

ceiv

ing

any

ARV

prop

hyla

xis

for P

PTCT

Prog

ram

me

mon

itorin

g (P

PTCT

) Ev

ery

year

N

/A

100%

N

SP

61

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

35

Num

ber o

f des

igna

ted

clin

ic/h

ospi

tal

have

an

accr

edite

d pe

er s

uppo

rt g

roup

Pr

ogra

mm

e m

onito

ring

(MAC

) Ev

ery

year

5

14

NSP

36

Num

ber o

f PLH

IV s

uppo

rt g

roup

es

tabl

ishe

d lin

ked

to a

nat

iona

l ne

twor

k

Prog

ram

me

mon

itorin

g (M

AC)

Ever

y ye

ar

N/A

18

N

SP

37

Num

ber o

f hom

e-ba

sed

care

pr

ogra

mm

e fo

r PLH

IV e

stab

lishe

d an

d pr

esen

t

Prog

ram

me

mon

itorin

g (M

AC)

Ever

y ye

ar

1 18

N

SP

38

Num

ber o

f she

lter h

ome

for P

LHIV

es

tabl

ishe

d an

d op

erat

ing

Prog

ram

me

mon

itorin

g (M

AC)

Ever

y ye

ar

N/A

18

N

SP

Stra

tegy

4: M

aint

aini

ng a

nd im

prov

ing

an e

nabl

ing

envi

ronm

ent f

or H

IV p

reve

ntio

n, tr

eatm

ent,

car

e an

d su

ppor

t.

OU

TCO

ME

IND

ICA

TORS

39

Nat

iona

l Com

posi

te P

olic

y In

dex

(NCP

I)

UN

GAS

S

1.St

rate

gic

Plan

U

NG

ASS

Ev

ery

2 ye

ars

8 (2

009)

(A)

8

2.Po

litic

al s

uppo

rt

UN

GAS

S

Ever

y 2

year

s 9

(200

9) (A

) 9

3.H

uman

righ

ts

Prom

ote

and

prot

ect h

uman

rig

hts

UN

GAS

S

Ever

y 2

year

s 5

(200

9) (B

) 6

Law

enf

orce

men

t U

NG

ASS

Ev

ery

2 ye

ars

7 (2

009)

(B)

7

4.Ci

vil s

ocie

ty p

artic

ipat

ion

UN

GAS

S

Ever

y 2

year

s 8

(200

9) (B

) 8

5.Pr

even

tion

UN

GAS

S

Ever

y 2

year

s 7

(A);

5 (B

) 7

6.Tr

eatm

ent c

are

and

supp

ort

prog

ram

U

NG

ASS

Ev

ery

2 ye

ars

7 (A

); 6

(B)

7

7.Ef

fort

to m

eet H

IV-r

elat

ed n

eed

of

OVC

U

NG

ASS

Ev

ery

2 ye

ars

5 (A

); 1

(B)

1

8.M

onito

ring

and

eval

uatio

n U

NG

ASS

Ev

ery

2 ye

ars

5 (2

009)

(A)

5

62

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

No

Indi

cato

rs

Dat

a So

urce

Fr

eque

ncy

Base

line

Valu

e &

Yea

r Ta

rget

201

5 In

dica

tor r

efer

ence

Stra

tegy

5: I

ncre

asin

g th

e av

aila

bilit

y an

d qu

ality

of s

trat

egic

info

rmat

ion

and

its u

se b

y po

licy

mak

ers

and

prog

ram

me

plan

ners

thro

ugh

mon

itori

ng,

eval

uatio

n an

d re

sear

ch.

OU

TCO

ME

IND

ICA

TORS

40

Prog

ress

mad

e in

str

engt

heni

ng th

e M

&E

syst

em (a

sses

sed

thro

ugh

the

M

and

E Sy

stem

Str

engt

heni

ng to

ol)

1. A

n in

tegr

ated

M&

E U

nit h

as b

een

esta

blis

hed

at th

e na

tiona

l lev

el

coor

dina

ted

by H

IV/S

TI s

ecto

r

MO

H

Onc

e N

/A

Esta

blis

hed

2. A

ll H

IV re

late

d re

sear

ch is

com

pile

d in

a re

sear

ch d

irect

ory

MO

H

Ever

y 2

year

s N

/A

Com

plet

ed

3. M

inim

um o

f re

sear

ch p

er M

ARP

and

othe

r vul

nera

ble

popu

latio

ns is

co

nduc

ted

and

its re

port

is

diss

emin

ated

with

in 6

MO

H

Ever

y 2

year

s 4

(200

9)

Com

plet

ed

4. R

outin

e H

IV p

rogr

amm

e m

onito

ring

MO

H

Ever

y ye

ar

N/A

Co

mpl

eted

5. 6

0% o

f new

s co

vera

ge o

n H

IV is

ba

sed

on re

liabl

e da

ta a

nd fa

cts.

M

OH

Ev

ery

2 ye

ars

N/A

60

%

6. F

amily

Hea

lth D

ivis

ion

and

HIV

/STI

es

tabl

ish

an in

tegr

ated

and

co

nsol

idat

ed d

atab

ase

MO

H

Onc

e N

/A

Com

plet

ed

63

Nat

iona

l Str

ateg

ic P

lan

on H

IV a

nd A

IDS

201

1 - 2

015

Ann

ex 5

: Te

chni

cal T

eam

N

atio

nal A

dvis

or :

YB

hg. D

ato’

Sri

Dr H

asan

bin

Abd

ul R

ahm

an

Dire

ctor

Gen

eral

of H

ealth

Mal

aysi

a Te

chni

cal a

dvis

or :

D

r Lok

man

Hak

im b

in S

ulai

man

D

eput

y D

irect

or G

ener

al (P

ublic

Hea

lth)

Min

istr

y of

Hea

lth M

alay

sia

Dr C

hong

Che

e Kh

eong

D

irect

or o

f Dis

ease

Con

trol

Div

isio

n, M

inis

try

of H

ealth

Mal

aysi

a

Hea

d of

Tec

hnic

al T

eam

: D

r. Sh

a’ar

i Nga

dim

an,

Dep

uty

Dire

ctor

of D

isea

se C

ontr

ol a

nd H

ead

of A

IDS

Sect

ion,

M

inis

try

of H

ealth

Co

re M

embe

rs:

D

r. M

ohd

Nas

ir Ab

d Az

iz, A

IDS/

STI S

ecto

r, M

inis

try

of H

ealth

Dr.

Roha

ya A

bdul

Rah

man

, Pah

ang

Stat

e H

ealth

Dep

artm

ent

Dr.

Faz

idah

Yus

wan

, AID

S/ST

I Sec

tor,

Min

istr

y of

Hea

lth

Vass

undi

ra N

air,

Min

istr

y of

Wom

en, F

amily

and

Com

mun

ity D

evel

opm

ent

Prof

. Dr.

Teh

Yik

Koo

n, N

atio

nal D

efen

ce U

nive

rsity

of M

alay

sia

Prof

. Dr.

Ade

eba

Kam

aruz

aman

, Cen

tre

of E

xcel

lenc

e fo

r Res

earc

h in

AID

S (C

ERIA

), U

nive

rsiti

Mal

aya

Parim

elaz

haga

n El

lan,

Mal

aysi

an A

IDS

Coun

cil

Dr.

Zai

ton

Yahy

a, F

amily

Phy

sici

an, D

istr

ict H

ealth

Off

ice,

San

daka

n, S

abah

N

orle

la M

okht

ar, M

yPlu

s Az

rul M

ohd

Khal

ib, U

nite

d N

atio

ns M

alay

sia

64

HIV / STI SectionDisease Control Division

Level 4, Block E10, Complex E,Ministry of Health Malaysia,

Federal GovernmentAdministrative Centre

62590 Putrajaya, MALAYSIAwww.moh.gov.my

NSP AIDS 2011 2015

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