HIV-INFECTION AMONG INJECTING DRUG-USERS IN NORTHEAST MALAYSIA, 1992

Human immunodeficiency virus (HIV) has spread widely among injecting d rug users (IDUs) in countries to the north and west of the 'Golden Tri angle' region of South-East Asia; it is likely to have spread southwar ds to Malaysia as well. In order to assess HIV seroprevalence among ID Us in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the Gene ral Hospital in the capital city of the north-eastern Malaysian state, Kelantan. subjects were sequential entrants to the detoxification war d, interviewed about HIV risk behaviour, and tested for antibody to HI V and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in t he preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contac t there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/2 10, 699%) among IDUs interviewed, as was unsafe injecting and unsafe s exual behaviour (20% had shared injecting equipment and 21% had had un protected intercourse) in other states. In every locale, rates of unsa fe injecting behaviour were high (55% sharing in last month), even amo ng those who knew they were HIV infected, and rates of condom usage we re low (93% of 160 sexually active IDUs had never used a condom). Syph ilis was not associated with HIV infection, but with contact with Thai prostitutes. On multivariate analysis, the major predictors of HIV se ropositivity in these ID Us were multiple sharing partners, low income and few years of education. HIV has spread widely among IDUs in north -east Malaysia, most likely fuelled by spread from the north, and is a ssociated with low socio-economic status. Endogenous spread is occurri ng among IDUs both within Kelantan and probably in other states, and r isk behaviour is so frequent in this high prevalence population that r ates of transmission are likely to remain high. Without large scale pr evention programmes, this epidemic among Malaysian IDUs could lead to a much larger and more general epidemic of HIV infection in Malaysia.