Needle exchange at the harbour: South-east coat of Malaysia

Yuseuf, 42, began fishing when he was 14 and began using heroin the same year. “When I first started fishing it was tough, it took quite a toll. I used to miss coming to land but now I’m used to it. It’s very different conditions out there. Even the air you breathe is different.”

He injects twice a day and says he needs to fish for eight hours to afford enough heroin to buy enough drugs for three day’s injecting. The rest of what he earns he spends on food and “saving for a rainy day”. Yuseuf has been in rehabilitation centres five times, each for a spell of two years. The longest he stayed clean after coming out was one month. “When you have money it’s very difficult to let the drugs go,” he says.

“Everybody on the boat does it. We become exhausted easily so it helps us concentrate and keep going.”

— Yo, 24, fisherman

Yuseuf has been living with HIV for 12 years but is not on antiretroviral treatment. “I have always been strong. Ever since I was young I have done physical labour. It’s better to keep going than to give in and mope, it will get you quicker that way.”

It is common for fishermen to inject heroin. Yo, 24, began fishing at the age of 13, and started injecting drugs when he was 19. “Everybody on the boat does it. We become exhausted easily so it helps us concentrate and keep going,” he says.

Zahari has injected heroin for the past 20 years and has had a steady job as a fisherman for the past ten. He can spend ten days at sea and three on land. During those three days he stocks up on clean needles at a drop-in centre at the fishing harbour, which is making a huge difference to the fishermen’s lives.

Community action

Yo, Yuseuf and Zahari are just three of the many people who benefit from the Drop in Centre (DiC) Pahang, supported by the Malaysian AIDS Council. DiC Pahang holds twice-weekly needle exchanges at the fishing harbour and village in Kuantan, on the south-east coast of Malaysia.

The outreach workers are former drug users, and are able to provide clean needles, counselling and condoms to those who are still injecting. Yuseuf says he likes getting clean needles from DiC Pahang outreach workers because they make him feel comfortable. “I am spoken to well. These are all my friends, there is no judgement.”

Although DiC Pahang has been running clean needle and syringe programmes since 2007, under Community Action on Harm Reduction (CAHR) programme, outreach workers now have money to buy cold drinks for clients. This simple intervention means they can sit down and talk to the fishermen coming for clean needles, allowing them to gain a deeper understanding of their lives and the risks they are taking.

Suharizal, 49, is an outreach worker for DiC Pahang points out that they can do a lot for the community because of the project. “There have been lots of differences that have come in because of CAHR. It’s not specific to just needle and syringe exchange and condoms, the scope is really wide. We are able to help those who are sick by making active referrals to clinics. We can also provide legal services, not just to drugs users but to their mothers, fathers, neighbours – to those connected to them.”

A large proportion of the work done in Pahang is with fishermen, many of whom cope with the harsh reality of a life spent six days at sea, two on land by using heroin. Their story is reflective of the country at large, where 90% of the 79,855 people living with HIV are men, the majority of whom have become infected with HIV by sharing needles.

In 2002, when HIV was at its peak in Malaysia, 18 people a day tested positive for HIV. Then, as now, the majority of people living with HIV were men who use heroin and had become infected by sharing needles. Now the number of new infections has halved, thanks for a large part to grassroot schemes such as this one.