Pang Joselyn, Danaee Mahmoud, Balasingam Kasinather Vicknasingam, Des Jarlais Don, Kamarulzaman Adeeba, Mohd Salleh N A
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
J Int AIDS Soc. 2025 May;28(5):e26420. doi: 10.1002/jia2.26420.
National surveillance data in Malaysia has observed a marked reduction in the number of new HIV cases among people who inject drugs (PWID) in the past decade. This study sought to estimate the current prevalence and associated risk factors of HIV and hepatitis C virus (HCV) among PWID in suburban areas of Klang Valley, Malaysia.
Between September 2021 and March 2022, a cross-sectional, respondent-driven sampling survey was conducted. Participants completed rapid HIV and HCV testing as well as social and behavioural assessments. Factors associated with HIV- and HCV-positive results were estimated using logistic regression.
Four-hundred individuals were recruited in the study, of whom 382 (94%) were men. The prevalence of HIV and HCV was 5.5% (95% confidence interval [95% CI]: 3.6-8.3) and 40.5% (95% CI: 35.7-45.5), respectively. Current heroin and amphetamine-type stimulant (ATS) use, regardless of injection or non-injection use, were reported by 340 (85.0%) and 328 (82.0%) individuals, respectively. Past exposure to the criminal justice system (lock-ups, prison and compulsory drug detention centres) was associated with both HIV (Adjusted odds ratio [aOR] = 3.47, 95% CI: 1.33-10.2) and HCV (aOR = 3.32, 95% CI: 2.06-5.39)-positive results. Additionally, HIV-positive results were associated with current ATS use (aOR = 0.31, 95% CI: 0.12-0.86). Meanwhile, HCV-positive results were associated with current heroin use (aOR = 2.44, 95% CI: 1.16-5.48), lifetime enrolment in methadone treatment (aOR = 2.30, 95% CI: 1.23-4.27), current methadone treatment (aOR = 0.46, 95% CI: 0.23-0.92) and current mixing of drugs through injection use (aOR = 1.80, 95% CI: 1.08-3.03).
This study observed low HIV prevalence among PWID, primarily associated with ATS use, while HCV prevalence, linked to heroin use, remained high. Higher odds of being HCV positive among PWID who reported to have ever but not currently enrolled in methadone programmes indicate that treatment may not be continuous once initiated, potentially due to exposure to the criminal justice system. These findings underscore the need for a dual approach: enhanced harm reduction programmes for PWID and a legal reform to address potential barriers posed by criminalization.
马来西亚的国家监测数据显示，在过去十年中，注射毒品者（PWID）中的新增艾滋病毒病例数显著减少。本研究旨在估计马来西亚巴生谷郊区PWID中艾滋病毒和丙型肝炎病毒（HCV）的当前流行率及相关危险因素。
在2021年9月至2022年3月期间，开展了一项横断面、应答驱动抽样调查。参与者完成了艾滋病毒和HCV快速检测以及社会和行为评估。使用逻辑回归估计与艾滋病毒和HCV阳性结果相关的因素。
该研究招募了400名个体，其中382名（94%）为男性。艾滋病毒和HCV的流行率分别为5.5%（95%置信区间[95%CI]：3.6 - 8.3）和40.5%（95%CI：35.7 - 45.5）。分别有340名（85.0%）和328名（82.0%）个体报告目前使用海洛因和苯丙胺类兴奋剂（ATS），无论是否注射使用。过去接触刑事司法系统（拘留所、监狱和强制戒毒中心）与艾滋病毒（调整后的优势比[aOR]=3.47，95%CI：1.33 - 10.2）和HCV（aOR = 3.32，95%CI：2.06 - 5.39）阳性结果相关。此外，艾滋病毒阳性结果与当前使用ATS相关（aOR = 0.31，95%CI：0.12 - 0.86）。同时，HCV阳性结果与当前使用海洛因相关（aOR = 2.44，95%CI：1.16 - 5.48）、美沙酮治疗的终身登记（aOR = 2.30，95%CI：1.23 - 4.27）、当前美沙酮治疗（aOR = 0.46，95%CI：0.23 - 0.92）以及当前通过注射混合使用毒品相关（aOR = 1.80，95%CI：1.08 - 3.03）。
本研究观察到PWID中艾滋病毒流行率较低，主要与使用ATS有关，而与使用海洛因相关的HCV流行率仍然很高。报告曾经但目前未参加美沙酮项目的PWID中HCV呈阳性的几率更高，这表明治疗一旦开始可能无法持续，这可能是由于接触刑事司法系统所致。这些发现强调了采取双重方法的必要性：加强针对PWID的减少伤害计划以及进行法律改革以解决刑事定罪带来的潜在障碍。
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