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FEATURE STORY November 29, 2018

World AIDS Day: A Story of Hope and Recovery for People Who Inject Drugs in Malaysia

World Bank Group


STORY HIGHLIGHTS

  • For 34 years, Ramli struggled with his drug addiction, during which he had undergone various forms of drug treatment but none were successful in preventing relapses.
  • In 2011, Ramli learned about a voluntary-based Cure & Care (C&C) center where he enrolled himself. For the next seven years, the treatment proved effective in keeping Ramli off drugs, resulting in him turning over a new leaf to rebuild his relationship with his family and become a counsellor for other drug users at the center.
  • In conjunction with World AIDS Day, we look at how voluntary-based and healthcare-oriented treatment centers are more effective than compulsory drug detention centers in preventing relapses for people who inject drugs in Malaysia.

Ramli was 15-years-old when he first began taking heroin. “I was in high school at the time, in Form 3. My friends and I were always the first to try new things.”

Since then, Ramli spent the next 34 years of his life battling his drug addiction. The consequences were devastating. He lost touch with his family and also lost his job as a Bahasa Malaysia literature teacher at a high school. “The change was so drastic that I went from having a car to go to work every day - to being forced to walk wherever I went.”

Ramli recounts his journey in battling his addiction. The various treatment methods he tried were ineffective as he would end up relapsing within months. “I felt close to giving up. I thought it was hopeless trying to look for treatment that could help me.”

In addition, compulsory treatment from Compulsory Detention Centers (CDDCs) were ineffective. “I ended up learning more about how to take drugs during compulsory treatment. Other patients would tell me how I can obtain drugs easily at an affordable price, for example. I relapsed soon after being released from the CDDC.”

“It was only in 2011 that I found out about voluntary methadone treatment from Cure & Care (C&C) centers under the National Anti-Drug Agency (NADA) from a friend. Initially, I was not very hopeful about the treatment but went on my own accord as I was tired of my drug addiction.”

This proved to be a turning point for Ramli as the methadone treatment was highly successful in helping Ramli fight his addiction for the past seven years. “When I’m on methadone, I don’t feel the need for drugs. Physically, it has been very effective but that’s only one factor of addiction. The C&C centers also have counselors who provide support for our mental health so that we do not relapse due to stress or anxiety when things get hard. This has been critical to my recovery,” Ramli said.

“The ratio of lesser patients to counsellor also means that I am in a more controlled setting. I find it convenient because methadone is provided in dosages that will last me for the week. This allows me to carry out my daily life without having to visit the center every day.”

Since then, Ramli says his life has been transformed. He has been elected to be a full-time peer guide at NADA to counsel drug users at the C&C center and in his community - especially the youth - and help them learn about methadone and get treated. In his free time, Ramli volunteers at a local NGO to help other drug users.

 “I’ve also managed to rebuild my relationship with my wife and children, 20 years after I left home. I am blessed to have this opportunity to rekindle our relationship.”


"The ratio of lesser patients to counselor also means that I am in a more controlled setting. I find it convenient because methadone is provided in dosages that will last me for the week. This allows me to carry out my daily life without having to visit the center every day."
Ramli

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Ramli at the University of Malaya where he works closely with the doctor to monitor his progress and also help other patients. (Photo: World Bank)


A key importance to this methadone treatment is that it is entirely voluntary. For people who inject drugs like Ramli, voluntary treatment has been far more effective in preventing relapses in drug users by six times, in comparison to compulsory treatment.  Further, 86% of patients from voluntary treatment centers like the C&C Centers do not experience a relapse after three months.

This has been posited in a report jointly conducted by the World Bank, the Centre of Excellence for Research in AIDS (CERIA) from  the University of Malaya, and with contribution from the University of Malaya Research Grant.

“Our findings show that this voluntary-based, healthcare-oriented C&C approach in Malaysia is 6 times more effective and 12 times more cost-effective than CDDCs in preventing drug relapses. Appropriate dosages of methadone treatment through this approach helps reduce injection drug use and HIV transmission. This is an immensely successful story from Malaysia that we want to share with the rest of the world.” said Sutayut Osornprasop, Senior Human Development Specialist at the World Bank.

In conjunction with World AIDS Day, helping people who inject drugs around the world receive effective treatment on a voluntary basis is of high importance, as drug users are particularly vulnerable to HIV infection through the sharing of needles.

Now Ramli lives in a dorm in Kuala Lumpur with other recovering addicts like himself, close to the C&C Center. His is a vivid story of hope, tenacity and turning over a new leaf. For many drug addicts without access to or information of effective treatment methods, they may not be so lucky.

 “I hope to stay clean from drugs for as long as I live. I want to live a normal life,” said Ramli. “I wish for my friends on the streets to come to seek help from C&C Centers so we can all recover together.”



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