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1.
Wellcome Open Res ; 6: 263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35111977

RESUMO

Background: Globally, vulnerable populations have been disproportionately affected by the COVID-19 pandemic and subsequent responses, such as lockdown measures and mass vaccinations. Numerous ethical challenges have arisen at different levels, be it at the policy-making level or on the ground. For example, policymakers have to contain a highly contagious disease with high morbidity using scarce resources, while minimizing the medium- to long-term social and economic impacts induced by containment measures. This study explores the impact of COVID-19 on vulnerable populations in Malaysia by using an intersectional framework that accounts for overlapping forms of marginalization.   Methods: This study utilizes in-depth qualitative data obtained from 34 individuals and organizations to understand the impact of the COVID-19 outbreak on vulnerable populations in Malaysia. We utilize four principles of ethics to guide our coding and interpretation of the data - namely beneficence, non-maleficence, justice and autonomy. We utilize a frequency analysis to roughly understand the types of ethical issues that emerged. Using hermeneutic content analysis (HCA), we then explore how the principles interact with each other. Results: Through the frequently analysis, we found that although beneficence was very prevalent in our dataset, so was a significant amount of harm - as perpetuated through injustice, the removal or lack of autonomy and maleficence. We also unearthed a worrying landscape of harm and deep systemic issues associated with a lack of support for vulnerable households - further exacerbated during the pandemic. Conclusions: Policy recommendations for aid organizations and society to mitigate these ethical problems are presented, such as long overdue institutional reforms and stronger ethical practices rooted in human rights principles, which government agencies and aid providers can then use in the provision of aid to vulnerable populations.

2.
Fam Process ; 60(3): 788-805, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32981083

RESUMO

Refugee families experience uncertainty and stress when residing in countries of first asylum, such as Malaysia, and may benefit from supportive parenting interventions. In the greater Kuala Lumpur, Malaysia area we piloted an eight-week parenting program with 79 Rohingya and Afghan mothers in nine separate groups. Participants were randomized to an intervention group or a waitlist control group and those in each arm completed a 3-month follow-up assessment. Program content addressed positive discipline, strengthening family relationships, adapting to a new environment, and improving health and emotional well-being. Measures assessed included child intensity and parenting self-efficacy from the Child Adjustment and Parent Efficacy Scale; positive parenting, inconsistent discipline, and poor supervision from the Alabama Parenting Questionnaire-Short Form; family intimacy and family conflict from the Family Functioning Scale, and emotional well-being from the Refugee Health Screening-15. Participating in the intervention led to beneficial changes in child intensity, parenting self-efficacy, family intimacy, family conflict, and emotional distress for the treatment group, and all changes except for emotional distress were maintained over time. However, the intervention did not lead to changes in positive parenting, inconsistent discipline, or poor supervision in the treatment group. Findings point to the potential benefits of parenting programs for refugee communities in transitory settings and contribute to the limited body of literature examining such programs.


Las familias refugiadas sienten incertidumbre y estrés cuando viven en países de primer asilo, como Malasia, por eso, pueden beneficiarse de intervenciones de apoyo para la crianza. En el área metropolitana de Kuala Lumpur, en la zona de Malasia, hicimos una prueba piloto de un programa de ocho semanas sobre la crianza de los niños con 79 madres afganas y rohinyás en nueve grupos distintos. Se asignó aleatoriamente a los participantes a un grupo de intervención o a un grupo de referencia en lista de espera, y las personas de cada división completaron una evaluación de seguimiento a los tres meses. El contenido del programa abordó la disciplina positiva, el fortalecimiento de las relaciones familiares, la adaptación a un entorno nuevo y la mejora del bienestar emocional y de la salud. Los criterios evaluados fueron la intensidad de los niños y la autoeficacia de los padres de la Escala de Adaptación de los Niños y Eficacia de los Padres (Child Adjustment and Parent Efficacy Scale); la crianza positiva; la disciplina inconstante y la mala supervisión del Cuestionario Breve de Alabama sobre la Crianza (Alabama Parenting Questionnaire-Short Form); la intimidad familiar y el conflicto familiar de la Escala de Funcionamiento Familiar (Family Functioning Scale), y el bienestar emocional de la Evaluación de Salud de los Refugiados-15 (Refugee Health Screening-15). La participación en la intervención condujo a cambios beneficiosos en la intensidad de los niños, la autoeficacia en la crianza, la intimidad familiar, el conflicto familiar y el distrés emocional para el grupo de tratamiento, y todos los cambios, salvo el distrés emocional, se mantuvieron con el tiempo. Sin embargo, la intervención no condujo a cambios en la crianza positiva, ni en la disciplina inconstante, ni en la mala supervisión en el grupo de tratamiento. Los resultados señalan los posibles beneficios de los programas de crianza para las comunidades de refugiados en entornos transitorios y contribuyen al escaso corpus de publicaciones que analizan dichos programas.


Assuntos
Poder Familiar , Refugiados , Criança , Feminino , Humanos , Malásia , Mães , Pais
3.
Am J Orthopsychiatry ; 89(6): 665-674, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30035560

RESUMO

Forcibly displaced persons confront multiple stressors while awaiting permanent asylum or resettlement and often experience high levels of emotional distress. This study assessed an 8-week somatic-focused culturally adapted cognitive-behavioral therapy (CBT) group intervention with 39 female refugees from Afghanistan living in Kuala Lumpur, Malaysia. Twenty-nine participants were randomly assigned to treatment conditions, resulting in 20 participants in two separate treatment groups and 9 in a waitlist control group. An additional 10 participants were not randomly assigned and therefore were treated as an additional treatment group and analyzed separately. A three-group piecewise linear growth model was specified in Mplus using Bayesian estimation. Dependent variables included emotional distress, anxiety, depression, posttraumatic stress, and social support. From baseline to posttreatment assessments, initial intervention participants experienced significant declines in emotional distress (b = -16.90, p < .001), anxiety (b = -.80, p < .001), depression (b = -.59, p < .001), and posttraumatic stress (b = -.24, p < .05). Gains were maintained three months posttreatment, with similar trends observed among nonrandomized participants. Subsequent to receiving treatment, the waitlist control participants also showed significant declines in emotional distress (b = -20.88, p < .001), anxiety (b = -1.10, p < .001), depression (b = -.79, p < .001), and posttraumatic stress scores (b = -.82, p < .001). Comparing the treatment groups to the waitlist control group revealed large effect sizes: Cohen's d was 2.14 for emotional distress, 2.31 for anxiety, 2.42 for depression, and 2.07 for posttraumatic stress. Relevant public health findings include low drop out, group format, and facilitation by a trained community member. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental , Depressão/terapia , Refugiados/psicologia , Adulto , Afeganistão/etnologia , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Malásia , Estresse Psicológico/psicologia
4.
BMC Proc ; 12(Suppl 4): 4, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30044886

RESUMO

Migrants and refugees face challenges accessing both healthcare and good social determinants of health in Malaysia. Participants at the "Migrant and Refugee Health in Malaysia workshop, Kuala Lumpur, 9-10 November 2017" scoped these challenges within the regional ASEAN context, identifying gaps in knowledge and practical steps forward to improve the evidence base in the Malaysia.

5.
LGBT Health ; 5(1): 61-68, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29227183

RESUMO

PURPOSE: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. METHODS: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. RESULTS: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. CONCLUSIONS: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.


Assuntos
Atitude do Pessoal de Saúde , Intenção , Médicos/psicologia , Estigma Social , Pessoas Transgênero , Adulto , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Preconceito , Fatores Socioeconômicos , Transexualidade/psicologia
6.
J Int AIDS Soc ; 20(1): 21723, 2017 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-28782331

RESUMO

INTRODUCTION: Cisgender and transgender woman sex workers (CWSWs and TWSWs, respectively) are key populations in Malaysia with higher HIV-prevalence than that of the general population. Given the impact economic instability can have on HIV transmission in these populations, novel HIV prevention interventions that reduce poverty may reduce HIV incidence and improve linkage and retention to care for those already living with HIV. We examine the feasibility of a microfinance-based HIV prevention intervention among CWSW and TWSWs in Greater Kuala Lumpur, Malaysia. METHODS: We conducted 35 in-depth interviews to examine the acceptability of a microfinance-based HIV prevention intervention, focusing on: (1) participants' readiness to engage in other occupations and the types of jobs in which they were interested in; (2) their level of interest in the components of the potential intervention, including training on financial literacy and vocational education; and (3) possible barriers and facilitators to the successful completion of the intervention. Using grounded theory as a framework of analysis, transcripts were analysed through Nvivo 11. RESULTS: Participants were on average 41 years old, slightly less than half (48%) were married, and more than half (52%) identified as Muslim. Participants express high motivation to seek employment in other professions as they perceived sex work as not a "proper job" with opportunities for career growth but rather as a short-term option offering an unstable form of income. Participants wanted to develop their own small enterprise. Most participants expressed a high level of interest in microfinance intervention and training to enable them to enter a new profession. Possible barriers to intervention participation included time, stigma, and a lack of resources. CONCLUSION: Findings indicate that a microfinance intervention is acceptable and desirable for CWSWs and TWSWs in urban Malaysian contexts as participants reported that they were ready to engage in alternative forms of income generation.


Assuntos
Apoio Financeiro , Infecções por HIV/prevenção & controle , Profissionais do Sexo , Pessoas Transgênero , Adulto , Emprego , Feminino , Infecções por HIV/economia , Humanos , Incidência , Malásia , Pobreza , Prevalência , Comportamento Sexual , Estigma Social
7.
Sex Transm Dis ; 44(11): 663-670, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28708696

RESUMO

BACKGROUND: Sex workers face a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) worldwide. For cisgender women sex workers (CWSW), global HIV prevalence is over 10%, whereas transgender women sex workers (TWSW) face an HIV burden of 19% to 27%. METHODS: We used respondent-driven sampling to recruit 492 sex workers, including CWSW (n = 299) and TWSW (n = 193) in Greater Kuala Lumpur, Malaysia. Participants completed an in-depth survey and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Sample characteristics stratified by gender identity and interview site are presented. Bivariate analyses comparing CWSW and TWSW were conducted using independent samples t tests for continuous variables and χ tests for categorical variables. RESULTS: Pooled HIV prevalence was high (11.7%; 95% confidence interval [CI], 8.8-14.5), and was similar for CWSW (11.1%) and TWSW (12.4%). Rates of syphilis 25.5% (95% CI, 21.6-29.5), C. trachomatis (14.8%; 95% CI, 11.6-18.0) and N. gonorrhoeae (5.8%; 95% CI, 3.7-7.9) were also concerning. Both groups reported lifetime HIV testing (62.4%), but CWSW were less likely to have ever been HIV tested (54.5%) than TWSW (74.6%). Median time since last HIV test was 24 months. Previous screening for STI was low. Inconsistent condom use and drug use during sex work were not uncommon. CONCLUSIONS: High HIV and STI prevalence, coupled with infrequent HIV and STI screening, inconsistent condom use, and occupational drug use, underscore the need for expanded HIV and STI prevention, screening, and treatment efforts among CWSW and TWSW in Malaysia.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Adulto , Idoso , Preservativos/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malásia/epidemiologia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Estudos de Amostragem , Parceiros Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
8.
Int J Drug Policy ; 47: 144-152, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28652072

RESUMO

BACKGROUND: Approximately 40%-90% of people who inject drugs (PWID) in Malaysia have hepatitis C (HCV). PWID continue to be disproportionately affected by HCV due to their lack of knowledge, perceived risk and interest in HCV treatment. Education interventions may be an effective strategy for increasing HCV knowledge in PWID, and harm reduction services are uniquely positioned to implement and deploy such interventions. METHODS: We recruited 176 clients from methadone maintenance treatment (MMT: N=110) and needle/syringe programs (NSP: N=66) between November 2015 and August 2016. After baseline knowledge assessments, clients participated in a standardized, 45-min HCV education program and completed post-intervention knowledge assessments to measure change in knowledge and treatment interest. RESULTS: Participants were mostly male (96.3%), Malay (94.9%), and in their early 40s (mean=42.6years). Following the intervention, overall knowledge scores and treatment interest in MMT clients increased by 68% and 16%, respectively (p<0.001). In contrast, NSP clients showed no significant improvement in overall knowledge or treatment interest, and perceived greater treatment barriers. Multivariate linear regression to assess correlates of HCV knowledge post-intervention revealed that optimal dosage of MMT and having had an HIV test in the past year significantly increased HCV knowledge. Having received a hepatitis B vaccine, however, was not associated with increased HCV knowledge after participating in an education session. CONCLUSION: Generally, HCV knowledge and screening is low among clients engaged in MMT and NSP services in Malaysia. Integrating a brief, but comprehensive HCV education session within harm reduction services may be a low-cost and effective strategy in improving overall HCV knowledge and risk behaviors in resource-limited settings. In order to be an effective public health approach, however, education interventions must be paired with strategies that improve social, economic and political outcomes for PWID. Doing so may reduce HCV disparities by increasing screening and treatment interest.


Assuntos
Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/prevenção & controle , Metadona/uso terapêutico , Programas de Troca de Agulhas/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Adulto , Feminino , Humanos , Malásia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto Jovem
9.
Contemp Clin Trials ; 59: 1-12, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28479216

RESUMO

Incarcerated people living with HIV and opioid dependence face enormous challenges to accessing evidence-based treatment during incarceration and after release into the community, placing them at risk of poor HIV treatment outcomes, relapse to opioid use and accompanying HIV transmission risk behaviors. Here we describe in detail the design and implementation of Project Harapan, a prospective clinical trial conducted among people living with HIV and opioid dependence who transitioned from prison to the community in Malaysia from 2010 to 2014. This trial involved 2 interventions: within-prison initiation of methadone maintenance therapy and an evidence-based behavioral intervention adapted to the Malaysian context (the Holistic Health Recovery Program for Malaysia, HHRP-M). Individuals were recruited and received the interventions while incarcerated and were followed for 12months after release to assess post-release HIV transmission risk behaviors and a range of other health-related outcomes. Project Harapan was designed as a fully randomized 2×2 factorial trial where individuals would be allocated in equal proportions to methadone maintenance therapy and HHRP-M, methadone maintenance therapy alone, HHRP-M alone, or control. Partway through study implementation, allocation to methadone maintenance therapy was changed from randomization to participant choice; randomization to HHRP-M continued throughout. We describe the justification for this study; the development and implementation of these interventions; changes to the protocol; and screening, enrollment, treatment receipt, and retention of study participants. Logistical, ethical, and analytic issues associated with the implementation of this study are discussed.


Assuntos
Terapia Comportamental/métodos , Infecções por HIV , Metadona/farmacologia , Tratamento de Substituição de Opiáceos/métodos , Prisioneiros/psicologia , Abuso de Substâncias por Via Intravenosa , Adulto , Prática Clínica Baseada em Evidências , Feminino , Infecções por HIV/etiologia , Infecções por HIV/psicologia , Humanos , Malásia , Masculino , Entorpecentes/farmacologia , Avaliação de Resultados em Cuidados de Saúde , Prisões , Projetos de Pesquisa , Centros de Tratamento de Abuso de Substâncias/métodos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapia
10.
Int J Prison Health ; 12(4): 253-269, 2016 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-27921633

RESUMO

Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ µL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ µL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Infecções por HIV/epidemiologia , Prisioneiros/estatística & dados numéricos , Prisões/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Idoso , Estudos Transversais , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Hepatite C/epidemiologia , Hepatite C/terapia , Humanos , Malásia/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Abuso de Substâncias por Via Intravenosa/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sífilis/epidemiologia , Sífilis/terapia , Tuberculose/epidemiologia , Tuberculose/terapia , Adulto Jovem
11.
J Neuroimmune Pharmacol ; 11(3): 446-55, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27216260

RESUMO

Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs (PWID) and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the negative synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a 'perfect storm' of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent PWID. Although promoted by official policy, evidence-based addiction treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80 % of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, amplifying the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced morbidity and mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0 % and 75.7 %, respectively. We discuss the further deployment of these interventions in Malaysian prisons.


Assuntos
Comportamento Criminoso , Infecções por HIV/epidemiologia , Prisioneiros , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tuberculose/epidemiologia , Sudeste Asiático/epidemiologia , Direito Penal/métodos , Direito Penal/tendências , Infecções por HIV/terapia , Humanos , Malásia/epidemiologia , Prisioneiros/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/terapia , Tuberculose/terapia
12.
Drug Alcohol Depend ; 164: 120-127, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27207155

RESUMO

INTRODUCTION: Methadone maintenance therapy (MMT) is crucial for HIV prevention and treatment in people who inject opioids. In Malaysia, a large proportion of the prison population is affected by both HIV and opioid use disorders. This study assessed individual preferences and factors associated with interest in receiving MMT among male prisoners meeting criteria for opioid dependence in Malaysia. METHODS: A convenience sample of 96 HIV-positive and 104 HIV-negative incarcerated men who met pre-incarceration criteria for opioid dependence was interviewed using a structured questionnaire to examine participant characteristics and attitudes toward MMT. Factors associated with interest in prison-based MMT initiation were identified using logistic regression analysis. RESULTS: Among all participants, 85 (42.5%) were interested in receiving MMT within prison. Independent correlates of interest in prison-based MMT were being previously married (AOR=4.15, 95% CI: 1.15, 15.02), previously incarcerated (AOR=5.68, 95% CI: 1.54, 21.02), depression (AOR=3.66, 95% CI: 1.68, 7.98), daily heroin use in the 30days prior to incarceration (AOR=5.53, 95% CI: 1.65, 18.58), and more favorable attitudes toward MMT (AOR=19.82, 95% CI: 6.07, 64.74). CONCLUSIONS: Overall, interest in receiving prison-based MMT was low, and was associated with adverse social, mental health, and drug use consequences. Incarceration provides a unique opportunity to initiate MMT for those who need it, however, optimal scale-up efforts must be systemic and address modifiable factors like improving attitudes toward and motivation for MMT. Informed or shared decision-making tools may be useful in improving expectations and acceptability of MMT.


Assuntos
Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Prisioneiros/psicologia , Adulto , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Am J Drug Alcohol Abuse ; 42(1): 98-110, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26636885

RESUMO

BACKGROUND: While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. OBJECTIVES: To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. METHODS: A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. RESULTS: Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. CONCLUSION: Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.


Assuntos
Usuários de Drogas/psicologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Malásia/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
14.
Addict Behav ; 53: 31-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26436520

RESUMO

BACKGROUND: Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders. OBJECTIVES: To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia. METHODS: A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities. RESULTS: One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77). CONCLUSIONS/IMPORTANCE: Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.


Assuntos
Infecções por HIV/epidemiologia , Assunção de Riscos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Humanos , Malásia , Prevalência , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Trabalho Sexual/psicologia , Trabalho Sexual/estatística & dados numéricos , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Saúde da Mulher
15.
Int Tinnitus J ; 18(2): 129-33, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-25773104

RESUMO

INTRODUCTION: Tinnitus is defined as the perception of sound mainly due to the activity within the central nervous system without any mechanical, vibratory activity within the cochlea. Administration of tinnitus related questionnaires along with the audiological test battery is recommended in routine clinical practice. Tinnitus Handicap Inventory (THI) is one of the useful and widely recognized tools for quantifying the impact of tinnitus on daily life. India, being a multilingual country with a multicultural background, there is no such inventories available in many of the local Indian languages except in Tamil and Kannada. MATERIALS & METHODS: The English THI was translated to Malayalam by a faculty who is qualified and proficient in Malayalam language. Then the translated THI was given to 40 native Malayalam speakers for content validity. The final THI-M was administered on 50 tinnitus patient. Obtained data was then subjected for statistical analysis using SPSS Statistics 17.0. RESULTS: Reliability statistics revealed an alpha score of 0.855 for the overall inventory. Across the three subscales, i.e. emotional, functional and catastrophic, a global alpha score of 0.766, 0.693 and 0.630, respectively. The alpha score remained the same even after deleting any single item. CONCLUSION: The results of the current study conclude that, THI-M has a good reliability/internal consistency as per the Cronbach's alpha score. THI-M can be considered as a reliable tool that can be used across the State by Hearing Professionals in assessment and management.

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