Critical Analyses, Musings and General Observations on Malaysian and International Health Law. All views are mine unless expressly stated otherwise.

Friday, January 23, 2015

Tuberculosis, HIV and Hepatitis C in a Malaysian Prison

Sarah (MAC Policy Officer) and I went to Sungai Buloh prison today. We went up to the sick bay where the TB and HIV patients were segregated from the other patients by a thick glass wall. I tried to talk to a HIV positive prisoner but the glass was so thick I couldn’t hear a word he was saying. There were several Burmese prisoners in there for overstaying - one had a colostomy bag and would likely be transferred later to cramped immigration detention. 
Dato' Narander Singh, Director of Sungai Buloh prison, with our
Health, Safety, Public Order photo report on Swiss Drug
Policy. The Report is available at this link:
Exiting the sick bay area to where the psychiatric patients were held, we were greeted by the hollow wails of a man dressed in a green prison uniform (mid-length sentence). He sat while a guard and his friend comforted him, and he cried and cried, saying that he wished things were different and wondered out loud why he kept going in and out of prison. We earlier were told that psychiatrists only visited the prison an average of once a month. 
We moved on to the psychiatric cells, which were sparse, and had cement blocks for seats. They were painted an obnoxious pink, which I told the guard would probably induce mental illness in anyone, including me. He then hurriedly said that they’ve consulted someone to paint them in more conducive colours. Beige, or taupe, I don’t know. 
Earlier we'd been told that out of 4,027 individuals being held at the prison current at 21 January 2015, 2 individuals were triply diagnosed with HIV, TB and Hepatitis C, and 12 individuals were living with Hepatitis C alone. Because of the fact that 2,333 individuals out of the 4,027 prisoners were held under the Dangerous Drugs Act, we are concerned that this is an underdiagnosis.
The Director of the prison (Dato' Narander Singh) was very keen on improving health outcomes, which is a start for better conditions, I think. So we’ll keep working, and hopefully achieve something.

Wednesday, January 15, 2014

Abstinence-Based Sex Education: No Scientific Basis Whatsoever

This morning I recoiled in horror reading that the government had introduced abstinence-based sex education to be rolled out in September of this year. The program would also segregate students according to red, yellow and green colours based on their risk of sexual activity, which would constitute clear breaches of human rights. 

I immediately wrote an article in response which can be found at the Malay Mail Online and the Malaysian Insider. This blogpost is just to refer you all to the academic journal articles that I referred to in writing the article. 

The first article I referred to is available here, whereby a meta-analysis of different interventions in American schools was conducted over 15 years and found that there was a “very small overall effect of the interventions in abstinent behaviour”.

~ Mónica Silva, 'The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis' (2002) 17(4) Health Education Research 471-481

The second article showed that abstinence-only education ‘did not reduce the likelihood of engaging in vaginal intercourse’ and that adolescents who received comprehensive sex education (including safe sex education) were less likely to report teen pregnancy. 
~ Pamela K Kohler, Lisa E Manhart and William E Lafferty, 'Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy' (2008) 42 Journal of Adolescent Health 344-351

And the third article surveyed teachers in South Africa and found that although teachers were inclined to promote abstinence, they recognised the importance of the role that safe sex education played. The authors commented that these modalities: 'might be strategically combined to promote a comprehensive sexuality education that builds a sense of agency and responsibility without alienating young people through moralism.’ 
~ Dennis A Francis and Renée DePalma, 'Teacher Perspectives on Abstinence and Safe Sex Education in South Africa' (2014) 14(1) Sex Education: Sexuality, Society and Learning 

Drug Law Reform in Malaysia: Why Needed?

These are the slides I presented at the Drug Law Reform Parliamentary Roundtable, presented at the Banquet Hall of the Malaysian House of Parliament on 3 December 2013. The slides show that health and harm reduction-based drug policy is better at reducing crime, harms resulting from drug use, HIV, housing problems, and increasing overall health, than incarceration-based drug policy.

Saturday, December 28, 2013

Police Leadership in Public Health

On 12-13 December 2013, the Policy Team of the Malaysian AIDS Council in cooperation with the Royal Malaysian Police held a workshop on Police Leadership in Public Health. To some, the role of police and health staff in improving public health seems distinct. Immiscible. However, the 1967 Malaysian Police Act states that one of the key general duties of Police is to give assistance in the carrying out of any law related to sanitation and quarantine, and that police should give assistance in the protection of life and property. (Section 20) In our sessions with police, we emphasise that both police and public health NGOs have the same objective: creating safe and healthy communities. 

In the sessions, we spoke primarily about methadone and how there is a plethora of evidence that methadone enables persons dependent on opiates towards breaking the cycle of drug-seeking behaviour, meaning that the individual no longer needs to spend the entire day looking for money to purchase illicit drugs. When this occurs, 'fundraising' crime decreases. The individual can now focus on securing stable housing and employment, and has more time to focus on familial relationships. Currently in Malaysia, persons detained for drug use have no access to methadone in police holding cells, or lockups. As a result, persons previously on the methadone program will undergo severe withdrawal. When he is released, the doctor providing methadone substitution will have to start from scratch. This means he will need to start on a very low dose, managing the increase of the dose, which can take weeks to months. In the mean time, patients may still seek illicit drugs as the methadone dose given is insufficient. This increases the risk of HIV and other blood borne diseases, and increases likelihood of fundraising crime. As such, it is very important that the Royal Malaysia Police allow the continuation of methadone in police custody, as in the end, all parties benefit. 

The National Anti-Drugs Agency (known by its Malay acronym AADK) has methadone programs in its voluntary outpatient clinics. A key observation from the workshop was that police members stated that AADK Cure & Care voluntary programs were ineffective and did not produce results. Statistics from the Centre of Excellence for Research in AIDS (CERiA), however, show that out of 28,663 individuals attending these services from 2010-2013, 77.6% of individuals had improved family relations, 72.1% had obtained permanent homes, and 75.9% had been prevented from rearrest.

Methadone substitution has thus not only reduced spread of HIV via injection, but has also improved quality of life for persons who use drugs, persons around them, and the community at large. In order for these results to continue making positive changes, it is extremely important that police ensure that essential medical services including methadone and anti-retroviral therapy continue in the lockups.

*This workshop was funded by the European Union.

Tuesday, February 12, 2013

Government Trade Policy Shift: What has Changed?

 When I attended the 15th Round of Trans-Pacific Partnership Agreement (TPPA) negotiations in Auckland last December, it hit me that the campaign for access to medicines and fair trade really doesn’t have much time left. The rumours at that time were that negotiations would conclude in October 2013.

The TPPA, a US-led free trade agreement that has very little to do with trade, is a beefed-up version of previous US free trade agreements (FTAs) designed to maximise corporate power and profits, while ignoring and minimising patient rights, worker rights, internet user rights, and environmental rights. It is being negotiated between 11 countries: Australia, Brunei, Canada, Chile, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States, and Viet Nam.

In 2007-2008 when the Barisan National-led Malaysian government was negotiating the US-Malaysia FTA, there seemed to be no shortage of objections to TRIPS-plus and other provisions in the TPPA that would negatively impact access to medicines, farmer’s rights, and tobacco use in Malaysia. The then Agriculture Minister Tan Sri Muhyiddin Yassin (now Deputy Prime Minister) said that the Government would not compromise on the livelihood of local farmers, and excluded tobacco and rice from the ambit of the agreement.[1] Meanwhile, the Member of Parliament for the constituency of Rembau, Negeri Sembilan and UMNO Youth Chief wrote in his blog that the US-Malaysia FTA was ‘a serious test to our sovereignty’ and stringent patent protections in US demands were a ‘real danger’, denying access to more affordable generic medicines[2] for longer.

The negotiations for the US-FTA broke down, with the Malaysian Cabinet having over 50 ‘red lines’ or matters that the Malaysian government simply would not compromise.

Today, the TPPA negotiations seem to be proceeding without so much as a squeak from dissenting Barisan politicians. What has changed? The TPPA is a stronger trade agreement, not weaker. Have farmers’ and patients’ rights become acceptable to sacrifice for short-term economic gains? What (or who) has been the catalyst for all this change?

Prime Minister Najib Razak may just be it. On 29 and 30 May 2012, he received American Senators John McCain and Joseph Lieberman, notorious free trade advocates, at a meeting in Kuala Lumpur. Senator McCain later commented in a tweet that PM Najib was ‘improving US-Malaysia relations.’[3]  In September 2012, the PM said that the TPPA was a ‘promising pathway for free trade’.[4] On 20 November 2012, he attended a TPPA meeting in Phnom Penh with President Obama, PM Gillard, Sultan Hassanal Bolkiah, and other TPPA country leaders.[5] It may very well be that PM Najib’s keenness for the TPPA and Malaysia-EU FTA is being reflected throughout the party.

The only Barisan politician who has spoken up, quite surprisingly, is the Minister of Health Liow Tiong Lai, who said in an interview after the Malaysian AIDS Council forum on the TPPA at the Bar Council on 4 August 2012, ‘We are against the patent extension.’[6] (Patent extensions are part and parcel of US free trade agreements, and they result in delays of entry of more affordable generic medicines into markets.) Also relevant is MP Khairy Jamaluddin’s response to me in regard to his 2008 blog post on twitter today:

What may have also changed is the level of tobacco industry interference in government policy. During my 6-month tenure as a Research Officer in the Ministry of Health from October 2010-March 2011, I noticed personally that Big Tobacco companies had direct access to the Minister when even MOH officers did not have access. This interference may be reflected in the decision not to raise tobacco taxes last year. It may also be reflected in trade negotiators’ very strong pro-tobacco stance in the TPPA, and their referring to statistics released by the tobacco industry in Malaysia, statistics usually only known by the tobacco industry themselves and tobacco control professionals. (Note: Tobacco industry interference in policymaking is specifically prohibited in Article 5.3 of the Framework Convention on Tobacco Control or FCTC, a Convention to which Malaysia is a party)

The reason I’ve written this article, really, is to implore Barisan politicians to speak up, or at the very least, meet with the Malaysian Chief Negotiator J. Jayasiri of MITI to express your concerns personally before it is too late.

Here is a short timeline of notable events that have occurred in recent years on TPPA:

October 2010
Malaysia announces that it has joined the TPPA negotiations
5-9 December 2011
Mini-round of negotiations held in Ritz-Carlton Kuala Lumpur, health groups protest outside negotiation venue and Tan Sri Mohd Zaman Khan, President of Malaysian AIDS Council hands petition to US negotiators.
29-30 May 2012
PM Najib meets with pro-free trade American senators John McCain and Joseph Lieberman in Kuala Lumpur
2-10 July 2012
San Diego round of negotiations held, Malaysian health coalition Joint Statement handed out to US and Malaysian negotiators. Joint Statement endorsed by Malaysian AIDS Council, MTAAG+ and National Cancer Society of Malaysia (NCSM)
4 August 2012
Public Forum on Medicines and the TPPA co-hosted by Malaysian AIDS Council and Breast Cancer Welfare Association
6 August 2012
Minister of Health Liow Tiong Lai states that MOH against patent extensions proposed by US in TPPA
September 2012
PM in Vladivostok for APEC meeting, comments that TPPA ‘promising pathway for free trade’.
20 November 2012
PM in Cambodia, meets with TPPA country leaders including President Obama and PM Gillard.
3-12 December 2012
15th Round of negotiations held in Auckland, New Zealand. At Stakeholder Briefing, I (Fifa Rahman) asked US Chief Negotiator Barbara Weisel: “We have been waiting 9 months for the new patent proposal that we understood was to be forthcoming, if it is coming, when can we expect it? Or will it be decided at the political level?” She answered that as it was a controversial issue, they will take their time and wait for congressional approval.
US Chief Negotiator Barbara Weisel at far right, Malaysian Chief Negotiator J Jayasiri fourth from left.

11 December 2012
My interview with Meera Sivasothy on BFM Radio on the Auckland Round of Negotiations. 

[1] Zulfakar, Mergawati. ‘Tobacco, rice excluded in FTA negotiations with US’ (January 15, 2007) The Star Online Accessed 12 February 2013.
[2] Jamaluddin, Khairy. ‘FTA must promote fair, not free trade’ (May 26, 2008) Accessed 12 February 2013
[3] New Straits Times ‘McCain: Najib an impressive reformer.’ (June 6, 2012) Accessed 12 February 2013
[4] Wong, Sai Wan. ‘PM: Msia, US want Trans-Pacific Partnerships talks to be wrapped up by end 2013’ The Star Online  (September 9, 2012) Accessed 12 February 2013
[5] ‘PMs visit abroad’ (November 20, 2012) Office of the Prime Minister of Malaysia, Official Portal Accessed 12 February 2013.
[6] Walton, Zach. ‘Malaysia Health Minister says TPP is no good.’ (August 9, 2012) WebPro News/Technology Accessed 12 February 2013.

Wednesday, December 5, 2012

15th Round TPPA Negotiations Update: Auckland, New Zealand

Reporting direct from Auckland on the TPPA negotiations. I have just met with some negotiators for the TPPA, and they said that negotiators from many different countries are united against American demands for greater monopolies of medicines. Malaysians will pay more for medicines and medical treatment if we aren't strong against the American demands. This is a huge trade agreement and Najib Razak wants it. Please voice out. YOU will be affected in the end.

Follow me on twitter at @fifarahman for live updates.

Thursday, June 7, 2012

Malaysian Police Views of Harm Reduction for Persons who Use Drugs

Last week, on 30-31 May 2012, I was in Canterbury for the International Society for the Study of Drug Policy conference and presented on Malaysian Police Views of Harm Reduction. 52.8% of respondents stated that they would seize state-provided needles-and-syringes. They also recommended that police change their KPIs from "persons arrested" to "persons arrested diverted to treatment." The full paper can be accessed here: