Malaysia begins research into reducing HIV transmission in the prison communities

In the hope of stemming one of the biggest public health crises in Southeast Asia, Yale University is partnering with the University of Malaya to fight the spread of HIV among drug users in Malaysia who are completing prison terms and transitioning back into the community. The two universities recently signed a letter of intent expressing their continued commitment to this partnership, which is funded by a $4.1 million grant from the National Institutes of Health.

Malaysia suffers from one of the worst HIV epidemics among drug users in Southeast Asia. Seventy percent of HIV transmission is linked to injection drug use, primarily of opioids. Malaysia’s strict policy of incarceration for drug users has resulted in over 6 percent of its prisoners being HIV-infected, three times the rate in U.S. prisons.

Yale and the University of Malaya will share academic and research resources to find new ways to reduce HIV transmission in the prison community. Among other things, the study will examine the use of methadone, a treatment for heroin addiction, compared to an evidence-based behavioral intervention.

“The time just after release into the community is a vulnerable time period for prisoners. This study will examine pre-release interventions as a way to curb the HIV epidemic,” said Frederick L. Altice, M.D., a professor at the Yale School of Medicine and director of Clinical and Community Research at the Yale AIDS Program, who is the project’s principal investigator.

Altice, a pioneer in research and clinical care at the interface of infectious diseases and substance abuse, began several innovative health delivery programs in the U.S., including the HIV in Prison Program and the Community Health Care Van, in the early 1990s. Altice is the principal investigator on clinical and research activities that include more than nine active federal grants, including integrating buprenorphine into HIV treatment, community-based treatments for HIV, hepatitis C and tuberculosis infections, and HIV prevention. The current grant in Malaysia is the centerpiece of several prison re-entry research projects in the U.S. and Malaysia.

The Yale School of Medicine has been collaborating with the University of Malaya since 2005. The NIH grant will fund research activities, education and technical assistance, mentoring of students and junior faculty members, and community service.

“Both universities recognize that our scholars can create better synergy in research through greater collaboration, education and the exchange of information concerning HIV prevention and treatment and substance abuse,” Altice said.

Professor Adeeba Kamarulzaman, M.D., director of the Centre of Excellence for Research in AIDS (CERiA), serves as a co-investigator and site principal investigator on this project for the University of Malaya. “The outcomes of this study will provide policy-makers with firm data about how to stem the HIV epidemic in other settings where HIV transmission is fueled by injection drug use,” Kamarulzaman said.

Kamarulzaman is an internationally recognized leader in HIV prevention and treatment and has been involved in the implementation of syringe exchange and other harm reduction activities in Malaysia. She also serves as the president of the Malaysia AIDS Council, the largest HIV/AIDS non-governmental organization in the country. The research team is complemented by the contributions of Michael Copenhaver, Ph.D., a clinical psychologist at the University of Connecticut and Hussain Habil, M.D., head of psychiatry at the University of Malaya.