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A UNAIDS Initiative led by UNESCO

United Nations Towards A Comprehensive


Educational, Scientific and
Cultural Organization Education Sector Response

A Situation-Response Analysis of
the Education Sectors Response to

HIV, Drugs and


Sexual Health
in Malaysia
2012
A Situation-Response Analysis of the Education
Sector Response to HIV, Drugs and Sexual Health in
Malaysia

June 2012
Published by UNESCO Office, Jakarta
UNESCO Regional Science Bureau for Asia and the Pacific
UNESCO Custer Office to Brunei Darussalam, Indonesia, Malaysia, the Philippines, and Timor-
Leste
Galuh (II) Street, No. 5
Jakarta 12110, Indonesia

UNESCO 2012
All rights reserved

ISBN 978-602-9416-02-2 (Electronic version)

The designations employed and the presentation of material throughout this publication do not
imply the expression of any opinion whatsoever on the part of UNESCO concerning the legal
status of any country, territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries.

The authors are responsible for the choice and the presentation of the facts contained in this
book and for the opinions expressed therein, which are not necessarily those of UNESCO and do
not commit the Organization.

UNESCO Office, Jakarta is committed to widely disseminating information and to this end
welcomes enquiries for reprints, adaptations, republishing or translating this or other
publications. Please contact jakarta@unesco.org for further information.

Publication of this report was made possible with financial contribution from UNAIDS Unified
Budget and Workplan (UBW) funding and UNESCO Regular Programme Budget.

Cover Concept/Design: EPRD Ministry of Education, Malaysia


Digital Imaging/Cover Layout: Chaiyasook, Sirisak

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Table of Contents
Foreword (Ministry of Education, Malaysia) 3

Table of Contents 4

Acknowledgments 5

Acronyms 6

Executive Summary 8

Main Report: Introduction Background to the Study 11

Situation analysis 13

Structure and organisation of the education system 15

HIV and AIDS in Malaysia 17

Summary of Situation Issues 22

Response Analysis 23

Education, HIV, drugs and sexual health 23

The national response to HIV 24

The education sector response to HIV in Malaysia 34

Summary of response issues 42

Recommendations 44

Annex 1 Persons Interviewed 45

Annex 2 PEERS topics covered in the core school curriculum 46

Annex 3 References 50

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Acknowledgements
This review was commissioned and facilitated by the UNESCO Office, Jakarta through its
Education Unit funded under the UNAIDS Unified Budget and Work-Plan (UBW). UNESCO is the
lead agency of the UNAIDS for quality education for HIV prevention among young people/youths
in educational institutions. As the convener of EDUCAIDS, or the UNAIDS Global Initiative on
Education and HIV & AIDS, UNESCO supports comprehensive education sector responses to HIV
and AIDS, and works in collaboration with governments, national and local AIDS commissions,
UN partners and civil society organizations for that response.

This report was prepared by David J. Clarke, Independent Researcher Specializing in Education
Sector Response to HIV and AIDS, Former Senior Education Advisor for DFID on HIV and
Education and currently domiciled in Bangkok, Thailand. It was organized and edited by Ahmad
Afzal, the HIV & AIDS and School Health Coordinator of the Education Unit in UNESCO Office,
Jakarta. This report was prepared through data collected from interviews with key informants
and other relevant stakeholders on HIV and AIDS, drugs and sexuality in Malaysia. A special
acknowledgement is given to officials from the Curriculum Development Division, Ministry of
Education Malaysia (CDD-MOE), Ministry of Health, National Coordinating Committee on AIDS
Intervention, Malaysia AIDS Council, select UN agencies and NGOs in the Malaysia who had
made useful contributions and spent their valuable time to help complete this review. UNESCO
wishes to extend its gratitude and sincere thanks to all respondents who were involved in the
process of this assessment. Appreciation is directed also to Dr. Faridah Abu Hassan, Director,
Educational Planning & Research Division (EPRD) Ministry of Education Malaysia, and her team.
Special appreciation is allocated to those who helped make the workshop in Kuala Lumpur, 12-
13 April 2011 a great success. Finally, thank you to the CDD-MoE official who helped with the
coordination and facilitation of the interviews. Further gratitude goes to Justine Sass, the
UNESCO Bangkok Regional HIV and AIDS Adviser for Asia and the Pacific for her comprehensive
review and edits. Appreciation is also imparted to Nonthathorn Chaiphet in Bangkok, Thailand
for initial work on this report.

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Acronyms
AIDS Acquired Immunodeficiency Syndrome
ART Antiretroviral Therapy
ATS Amphetamine-Type Stimulants
CBO Community-Based Organizations
CCA Cabinet Committee on AIDS
EDP Education Development Plan
EPC Education Planning Committee
EPRD Educational Planning and Research Division, MoE, Malaysia
FGD Focus Group Discussion
FHE Family and Health Education
HAART Highly Active Antiretroviral Therapy
HIV Human Immunodeficiency Virus
ICT Information and Communications Technology
IEC Information, Education and Communication
MoE Ministry of Education
MoH Ministry of Health
MAC Malaysian AIDS Council
MDGs Millennium Development Goal
MSM Men Who Have Sex with Men
NACA National Advisory Committee on AIDS
NADA National Anti Drug Agency
NCCAI National Coordinating Committee on AIDS Intervention
NGO Non Governmental Organisation
NSP National Strategic Plan on HIV/AIDS 2006 - 2010
PEERS Pendidikan Kesihatan Reproduktif dan Sosial (Reproductive Health and
Social Education)
PITC Provider Initiated Testing and Counselling
PLHIV People Living With HIV
PROSTAR Program Remaja Sihat Tanpa AIDS (Healthy Life Style Program for Youth
Living Without AIDS)
PTA Parent-Teacher Association
SED State Education Department
SFS Supplementary Feeding Scheme
SHS School Health Services
SRA Situation-Response Analysis
SRH Sexual and Reproductive Health
STI Sexually Transmitted Infection
TCA Technical Committee on AIDS
UN United Nations
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNESCO United Nations Educational, Scientific and Cultural Organisation
UNGASS United Nations General Assembly Special Session on HIV/AIDS
UNICEF United Nations Childrens Fund
UNODC United Office on Drugs and Crime

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UBW Unified Budget and Workplan
VAW Violence Against Women
VCCT Voluntary, Confidential Counselling and Informed Consent Testing
WHO World Health Organization

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Executive Summary
1. The Situation

The education system in Malaysia has the potential to raise the levels of knowledge and life
skills required for better health, HIV and drug abuse prevention as well as reduced stigma and
discrimination for young people. This is very much in keeping with the emphasis within the
education sector on strengthening human capital for social and economic development.
Malaysia already has a school health framework in place, which offers opportunities for
addressing key issues facing young people on a large scale relating to HIV, drug abuse and sexual
health.

The HIV epidemic is concentrated among key populations and their families. National
prevalence is estimated at 0.5% of the adult population and some 100,000 people are living with
HIV. Data on the impact of HIV on children are limited. Addressing gender and sexual health
issues are critically important in preventing HIV transmission, with more males currently
infected. Sexually transmitted infections (STIs) are under-reported and constitute an important
public health issue. Drug abuse has ramifications beyond the spread of HIV; it is a major driver of
the epidemic in Peninsular Malaysia. Drug use is a significant social problem, associated with the
socially marginalized. Gender issues are important here too. Drugs are almost exclusively used
by males.

Adolescents face multiple challenges in growing up arising from the influences of rapid
economic development, access to globalised media and a perceived decrease in community
influence. Parenting practices are an issue, particularly with regard to sexuality education,
where parents are typically unprepared or unable to provide information and opportunities for
discussion on sexual and reproductive health issues.

There is a strong need for age and culturally appropriate sexuality education to be provided to
young people in school. Young people lack information and skills relating to sexuality. Levels of
knowledge appear to be variable, but with significant gaps and misconceptions. HIV risks do not
appear to be well understood. There is evidence of sexual risk behaviours among some young
people, including unprotected sex and multiple partners. The age of sexual debut is relatively
late (19), however, the age of marriage is becoming later.

2. The Response

The National Strategic Plan on HIV/AIDS (2006-2010) included as an objective to reduce the
number of young people aged 1524 who are infected by HIV. It had 6 strategies, one of which
was to reduce vulnerability among women, young people and children. The main educational
thrust for children is to increase access by young people to life-skills based education. In
addition, access to youth friendly services and the creation of a supportive environment for HIV
prevention among youth would be pursued.

The education sector response has been rather weak. The 2010 UNGASS on HIV report for
Malaysia provides a coverage figure among schools that have implemented life-skills based HIV
education of 0.2%, one of the lowest reported rates in the world, with only 22 schools
participating in a pilot project. Gender issues around HIV and health appear to have been

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neglected, especially for adolescent girls.

There are no specific Ministry of Education (MoE) policies or plans in place to develop a
comprehensive approach to HIV, drugs, and sexual and reproductive health. The Ministry of
Health (MoH) has prepared a plan for adolescent health and essentially drives the HIV response.
There is ample scope for more concerted multi-sectoral action, with a much stronger
contribution from MoE. The approach to school health and nutrition appears to be fragmented
and in need of greater policy and institutional coherence, more in line with international best
practice.

The MoE has integrated HIV and reproductive health education across the curriculum in
secondary education and in Health Education at primary level. The approach to integration is
content-based and lacks inclusion of life-skills education. It has relied strongly on the
reinforcement of moral values. This may be necessary, but not sufficient in the context of a
rapidly changing Malaysia. The original Family Health Education has been revamped as
Pendidikan Kesihatan Reproduktif dan Sosial (PEERS) in 2006. It includes enhanced drugs and
sexuality education content at primary and secondary levels, with life-skills education
introduced. Co-curricular activities through the MoH-developed PROSTAR programme, which
includes peer education, is ongoing in schools, though coverage data are lacking.

The quality of PEERS and PROSTAR delivery are constrained by shortcomings in teacher/peer
educator training and support, school leadership and commitment, the lack of assessed learning
outcomes, and weak community involvement. Greater policy clarity is required on the
contribution of NGOs to HIV, drugs and sexuality education.

It is hard to discern a clear response to the impact of HIV on the education sector in relation to
the rights of children living with and affected by HIV. There is no specific HIV workplace policy in
place in the sector. There is no clear position on anti-discrimination education concerning
people living with HIV or any visible programming.

The response to date falls short of being comprehensive. Table 1 below summarises key
elements of the response. Key issues to be addressed by MoE are:

Policy development (School health/workplace);

Teacher education and support (Pre-service education and school based support);

Strengthening co-curricular activities; and

Strengthening coordination and M&E.

Table 1. Elements of a comprehensive response in HIV, drugs and sexuality education

Key elements of a comprehensive response Assessment of the Malaysian response

An education sector policy on HIV and AIDS that Not in place


addresses both HIV prevention and issues that arise
from their impact on the school such as stigma and
discrimination, and teachers and students living
with HIV;

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HIV/drugs training for MoE staff at all levels; No training plan.

Training appears to be ad hoc.

HIV/drugs prevention education curriculum Taught in primary and secondary education


development (sexuality education) and age- through PEERS components in Health Education
appropriate teaching and learning materials; subject under the new curriculum transformation

Pre- and in-service teacher training to implement Reliance on in-service teacher training
the sexuality education curriculum;
Co-curricular activities such as peer education In place, but there are issues of quality and
coverage

Monitoring arrangements to ensure programme Not in place


effectiveness.

3. Recommendations

There appears to be demand for sexuality education. It should start earlier than at present in
school and Government investment should increase in developing appropriate programmes,
including in the preparation of teaching and learning materials.

There remains a need to improve the policy environment for improved health of young people
through the education sector contributions to health promotion.

The following recommendations are made to MoE:

1. Convene a Task Force on HIV, drugs, health and sexuality education;

2. Develop a medium term action plan to strengthen programming across the


education sector through a participatory process involving key stakeholders;

3. Review current policies on school health, HIV and drugs education;

4. Put in place an appropriate M&E arrangements for PEERS/PROSTAR;

5. Consider developing parental education programming;

6. Strengthen the inclusion of gender issues in the curriculum and co-curricular


activities;

7. Develop appropriate content for the pre-service training curriculum and associated
materials and train trainers; and

8. Train school leaders/managers in HIV, drugs and sexuality education;

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9. Consider developing innovative methods to reach youth both in and out of school
including the use of social media.

A Situation-Response Analysis of the Education Sector Response to HIV,


Drugs and Sexual Health in Malaysia
1. Introduction
1.1 Background to the study

This situation-response analysis (SRA) was commissioned by UNESCO Office, Jakarta which
covers all of the cluster countries (Brunei Darussalam, Indonesia, Malaysia, the Philippines and
Timor Leste), through its HIV&AIDS/School Health Section of the Education Unit. It was funded
under the UNAIDS Unified Budget and Work-Plan (UBW) and UNESCO Regular Programme
Budget.

UNESCO is the lead for UNAIDS for ensuring quality education for an effective AIDS response. As
the convener of EDUCAIDS, or the UNAIDS Global Initiative on Education and HIV&AIDS,
UNESCO is working globally to support a comprehensive education sector response in
collaboration with Governments, National Coordinating Committee on AIDS Intervention,
Malaysia AIDS Council, UN partners and civil society organizations.

This review aims to describe and analyse the situation regarding the status and scope of the
education sector response to HIV, drugs and sexual health. The information collected and
reported is intended to provide an overall picture of the education section response to these
issues in Malaysia and inform how this can be further strengthened. The results of the study will
support strengthened coordination, implementation and scaling-up of education programmes.
This report can be used as a background document for the development of a medium-term
strategic plan involving different sub-sectors and institutions of the education sector, UN
agencies, NGOs and donor organizations.

1.2 Objectives of the study


The objectives of this SRA are to:

Provide an overview of the state of sexual health, drugs and HIV&AIDS activities in the
education sector in Malaysia;
Identify the policies, programmes and resources for sexual health, drugs and HIV
education that are missing or weak in the education sector;
Provide evidence-based information for future education sector sexual health, drugs
and HIV and AIDS planning and prioritization; and
Make recommendations on where to properly allocate resources to support the missing
or weak responses.

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1.3 Methods

The information for this review was collected through a combination of desk review, in-depth
interviews and focus group discussions (FGDs).

The desk review included the current situation in Malaysia concerning the thematic areas of HIV
and AIDS, drug use and unplanned pregnancy. Field visits for in-depth interviews and focus
group discussion were conducted on October 18-22, 2010 in Kuala Lumpur (KL), Malaysia, and
three other districts located on the outskirts of KL that were in the Selangor states jurisdiction.
The Ministry of Education (MoE) arranged the interviews with teachers and key informants. All
names and schools were kept confidential. UNICEF and NGO representatives were also
interviewed. A total of 36 people were interviewed (See Annex 1).

Individual and group interviews were conducted with a different set of questions that
corresponded to their roles and level of involvement in HIV and AIDS, drug use and sexual health
education activities. Common discussion topics for the interviews were: government and
education sector responses to HIV and AIDS, drug use and unplanned pregnancies; availability of
curricula addressing those issues; availability of HIV & AIDS and reproductive health-related
services for Malaysian youth; teaching methods at schools in addressing the issues; curriculum
development and teacher training sessions on HIV and AIDS, drug use and sexual health; length
of teaching sessions that carried out on these topics; problems and obstacles faced during
conducting of the sessions; policy and structure required to support implementation of the
education programme; current sexuality problems encountered by Malaysian youth; learning
formats and information learned about HIV and AIDS, drug use and sexual health; and topics
where more information is required in order for the students to protect themselves from
HIV/sexually transmitted infections and drug addiction.

1.4 Limitations

The SRA has the following limitations:

The principal, deputy principals, guidance counsellors, health education teachers and
students were all from government schools. Therefore, data on the HIV prevention
activities conducted at private schools are lacking in this review.

Executive officers for the Programme Sihat Tanpa AIDS Remaja (Healthy Programme
without AIDS for Youth - PROSTAR) and the National Anti Drug Agency (NADA) were not
available for interviews during the field visit.

Detailed information on HIV at the state-levels was lacking and could not be collected.

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2. Situation Analysis
2.1 Malaysia

Malaysia is located in one of the worlds fastest growing economic regions. Its neighbours are
Brunei Darussalam, Cambodia, China, Indonesia, Lao PDR, Myanmar, Philippines, Singapore,
Thailand and Viet Nam. The country has experienced rapid economic growth during the past
two decades. During the period 2001-2005 some 1.6 million new jobs were created. GDP per
capita is now US $14,700 and the country is number 57 in the 2010 Human Development
rankings, among countries with high human development.

Malaysia is a multi-ethnic, multi-cultural and multi-religious state. It is a parliamentary


constitutional monarchy, administered through a federal Government structure. It comprises
thirteen states and three federal territories spread across two regions separated by the South
China Sea. Peninsular Malaysia comprising the states of Perlis, Kedah, Kelantan, Terengganu,
Pulau Pinang, Perak, Selangor, Pahang, Negeri Sembilan, Melaka and Johor, and the Federal
Territories of Kuala Lumpur and Putrajaya. It is connected to mainland South-East Asia via the
long, narrow isthmus of Southern Thailand. East Malaysia comprises the states of Sabah and
Sarawak, on the island of Borneo, and the Federal Territory of Labuan, an island Southwest of
Sabah.

The population is estimated at 28,728,607 (July 2011). The population growth rate is 1.58 per
cent. Around 30% of the population is under 14 years of age. The median age is 26.8 years.

2.2 The Education Sector

2.2.1 Introduction

Education enjoys a high priority in Malaysias policy and planning frameworks for socio-
economic development. This is reflected in Government financial commitments. In 2009, 4.1 per
cent of GDP was allocated to education.1 This represented 17 per cent of Government
expenditure.

Participation rates in the early years of schooling are high by regional standards. The school life
expectancy is 12.6 years. At primary level the survival rate to grade 5 is 97 per cent (2009). The
transition rate from primary to secondary school is 99%. The net enrolment at secondary level
was last recorded at 86.2 per cent (2009). While primary education has been universalized,
there remains a long way to go at secondary level. At tertiary level, the Gross Enrolment Ratio is
28 per cent, which is the regional average.

2.2.2 Policy Framework

National Vision Policy 2001-2010

The National Vision Policy has aimed to establish a united, progressive and prosperous Malaysia.
It endeavoured to build a resilient and competitive nation, and equitable society with the
overriding objective of National Unity. It had seven critical thrusts, as follows:

1
Statistical data from UIS. Malaysia country profile.

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Building a resilient nation;
Promoting an equitable society;
Sustaining high economic growth;
Enhancing competitiveness;
Developing a knowledge-based economy;
Strengthening human resource development; and
Pursuing environmentally sustainable development.

In education, the policy was operationalised through the Education Development Plan (EDP)
2001-2010. The major thrusts were to increase access to education, increase equity in
education, increase quality of education, and improve the efficiency and effectiveness of
education management. Under the EDP, preschool education would be further developed by
institutionalising it and making compulsory the use of the National Preschool Curriculum at all
preschool institutions, providing training facilities for preschool teachers, and strengthening the
monitoring of preschool teachers, and strengthening the monitoring of preschool programmes
conducted by public and private agencies.

Strategies in the EDP to improve the quality of primary education included increasing basic
education infrastructure, revising the norms for teacher allocation, and ensuring 50 percent of
primary school teachers are university graduates by 2010. Other strategies include
strengthening the Integrated Primary School Curriculum (Kurikulum Bersepadu Sekolah Rendah,
KBSR) to further improve the 3R skills (reading, reading and arithmetic) among pupils, making
the curriculum more relevant to current and emerging needs of the country, and strengthening
all co-curriculum programmes to reinforce the development of intellectually, spiritually,
emotionally, and physically balanced individuals. In addition, the strategies included revising
school textbooks, improving integration of information and communications technology (ICT) in
teaching and learning, expanding the Smart School concept nationwide, increasing the role of
school administrators as curriculum leaders, strengthening monitoring and evaluation activities
on teaching and learning, strengthening evaluation mechanism of student performance,
increasing school and community collaborations, and reviewing the rate of per capita grant to
schools.

Strategies to further promote access to and equity in primary education included increasing the
participation rate particularly among the children of indigenous groups such as the Orang Asli in
Peninsular Malaysia and the ethnic groups in rural and remote areas of Sabah and Sarawak.

The EDP set out to review and strengthen the secondary school curriculum. Emphasis would be
given to the development of academic skills, especially in mastering skills of learning,
communication, critical and creative thinking, and self-management; acquiring basic industrial
skills; and possessing positive values. The secondary education curriculum development
included strengthening intervention programmes for students with learning problems,
integrating ICT in the curriculum and strengthening co-curriculum programmes.

The EDP contained no strategies for strengthening school health and nutrition (SHN), HIV and
drugs education or life-skills education.

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2.2.3 Structure and Organization of the Education System

Preschool education

Preschool education (kindergarten) is provided by several government agencies, private bodies


and voluntary organizations for children aged 4-6. All preschool centres are registered with the
Ministry of Education Malaysia. Generally, kindergartens charge fees.

Primary education

Primary education covers a period of six years and the admission age is 6. It is divided into two
three-year phases. At the end of primary school, pupils sit the Primary School Achievement Test.
Education at primary level is free and, according to the Education Amendment Act of 2002 (Act
A1152), is also compulsory.

Secondary education

Secondary education consists of two cycles. Lower secondary lasts three years. On completing
the three-year lower secondary programme, students sit the Lower Secondary Assessment
Examination. Upper secondary education lasts two years and is offered in academic, technical-
vocational and religious (Islamic studies) schools. On completing two years at this level, students
in academic and technical tracks sit the Malaysian Certificate of Education Examination, while
those in vocational tracks sit the Malaysian Certificate of Education (Vocational) Examination.

Post-secondary education prepares students for the Malaysian Higher School Certificate
Examination (Sijil Tinggi Persekolahan Malaysia) conducted by the Malaysian Examinations
Council, as well as matriculation examinations conducted by some local universities. Sixth Form
and matriculation courses are offered for the duration of two years. Matriculation courses
prepare students to meet specific entry requirements of certain universities, while the Sixth
Form is designed to meet the entry requirements of all universities.Institutes of higher
education include universities, colleges and polytechnics. A wide range of programmes is
offered at the certificate, diploma and degree levels. At the undergraduate level, the duration of
studies is three to four years.

Non-formal education

Skills training centres have been set up to accommodate unemployed and out-of-school youth
based on their needs. These centres, managed by various government agencies, provide formal
and non-formal trainings to youth and adults aged 15 to 40 years whose education ranges from
primary to tertiary level. The centres conduct training courses aiming to impart technical know-
how for the participants so that they may qualify for employment in various industries or begin
their own businesses.

2.2.4 Education Management

The Ministry of Education is responsible for the management of the education sector in the
country and run by the Minister of Education who is a member of the Cabinet and heads the
Ministry of Education. Two Deputy Ministers who are also political appointees and assists the

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Minister. Executive officials from the administrative and the education services carry out the
administration at the ministerial level.

The administrative service is headed by the Secretary General, and the education service is
headed by the Director General. Both the Secretary General and Director General are directly
responsible to the Minister. The Secretary General is primarily responsible for administrative
affairs and is assisted by two deputies. The Director General of Education is responsible for
education matters and is assisted by three deputies. Decision-making at the MoE is made
through a system of committees. These committees are established to facilitate inter-division
and intra-division decision-making. The Education Planning Committee (EPC) chaired by the
Minister is the highest decision-making body at the federal level. Policy issues that have wider
ramifications are referred to the Cabinet before a final decision is made. However, the ultimate
authority on education is the Parliament. The Educational Planning and Research Division (EPRD)
serves as the Secretariat to the EPC.

Educational administration in Malaysia is centralised and organised into four distinct hierarchical
levels i.e., federal, state, district and school. The institutions representing these four levels are
the Ministry of Education, the State Education Departments, the District/Division Education
Offices and schools. At the ministry, education policies are formulated and translated into
programmes, projects and activities. The ministry is also responsible for developing education
development plans for the sector. Curricula design and syllabuses, and national public
examinations are also determined at this level.

The ministry is also responsible for coordinating and monitoring the progress and achievement
of the education policies and plans. The implementation of education policies and plans made at
the federal level are carried out at the state level through fourteen State Education
Departments (SEDs). The SEDs coordinate and monitor the implementation of national
education programmes, projects and activities at the state level as well as providing feedback to
the federal agencies. The administration of education at the state level is the responsibility of
the State Director of Education.

District Education Offices were set up in June 1982 to serve as an effective link between the
school and the SEDs. The administration of education at the school level is the responsibility of
the principal or headmaster who is both the administrative and instructional leader in the
school. The principal or headmaster is assisted by a Senior Assistant, a Head of Student Affairs
and a Head of Co-Curricular Activities. The Senior Assistant assists in administrative functions
such as the management of school funds, accounts and resources; and planning the timetable
and work scheme for teachers. The Head of Student Affairs assists in matters related to student
welfare, such as, textbooks loans, discipline, student health and nutrition. The Head of Co-
Curricular Activities assists in matters relating to co-curricular activities. Besides this, the
principal or headmaster attends to complaints and liaises with parents and the community on
matters relating to student well-being. For effective coordination of teaching and learning of the
various subjects taught in schools, a senior teacher is appointed as the head or key resource
teacher for the different subjects. Schools with two sessions have Afternoon Supervisors to
assist school heads in supervising the administrative and instructional activities of the schools.
All schools have a Parent-Teacher Association (PTA).

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2.2.5 School Health and Nutrition

The Nutrition and Health Programme aims to improve the standard of health of pupils through
proper nutrition education and good health practices. There are two main projects under this
programme, the Supplementary Feeding Scheme (SFS) and the School Health Services (SHS).

The aims of the SFS are to provide supplementary food to needy primary school children so as to
improve their general health and achieve normal physical growth, to put into practice health
education and nutrition, and to support the applied food and nutrition programmes as well as
activities and projects through active participation. It provides free meals (300 Kcal per child per
day) to 528,000 children from more than 5,000 primary schools throughout the country. The
SHS, which includes both health and dental care, is provided for by the school health teams of
the Ministry of Health and covers pupils in primary and secondary schools. Besides general
health appraisal and treatment follow-up, referral care is also provided for by the SHS.

The School Health Programme is implemented through Health Promoting Schools and aims to
improve the general health and nutritional status of pupils through good health practices and
health promotion activities. Six core areas, namely school health policies, the school physical
environment, the school social environment, community relationships, personal health skills and
health services are the building blocks of the Health Promoting Schools. Various supportive
activities carried out at the national, state and school levels help to develop knowledge, skills
and positive health experiences amongst the pupils.

2.3 HIV and AIDS in Malaysia

Malaysia is experiencing a concentrated HIV epidemic with HIV prevalence estimated at 0.5 per
cent of the adult population (15-49 years). On current trends, it unlikely that a generalized
epidemic (>1 per cent among women attending antenatal clinics) will develop.

The first case of HIV in Malaysia was detected in 1986. As of 2009, 87,710 cases have been
reported. It is estimated that in 2010, 105,471 people are currently living with HIV (MoH, 2010).
The majority (90.8 per cent) of cumulative HIV cases are reported among men while less than
9.2 per cent of this total is women and girls. Children aged 13 and below accounted for 1.0 per
cent of cumulative total of HIV infections. 35.9 per cent of reported infections are among youth
population aged between 20-39 years old who inject drugs. The annual number of reported new
HIV cases has declined from a peak of 7,000 in 2002. Data on children and HIV are weak or not
available (See Box 1).

Box 1. HIV and AIDS estimates (UNAIDS)

HIV AND AIDS ESTIMATES (UNAIDS 2009)

Number of people living with HIV: 100,000 [83,000 - 120,000]

Number of young people living with HIV:

Females aged 15-24: <1,000 [ <1,000 -1,200]


Males aged 15-24; 3,500 [2,800-4,300]

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Adults aged 15 to 49 prevalence rate: 0.5% [0.4% - 0.6%]

Young people aged 15-24 HIV prevalence rate 0.1%

Number of adults aged 15 and up living with HIV: 100,000 [83,000 - 120,000]

Number of women aged 15 and up living with HIV: 11,000 [8,600 - 15,000]

Number of children aged 0 to 14 living with HIV: Not available

Number of deaths due to AIDS: 5,800 [4,500 - 7,200]

Number of orphans due to AIDS aged 0 to 17: Not available

Sources: UNAIDS 2009 and UNICEF 2011

The HIV epidemic in Malaysia is being driven mainly through injecting drug use and heterosexual
transmission (See Figure 1). In 2009, the reported cases of HIV transmission were through
injecting drug use (70.6 per cent), followed by heterosexual intercourse (16.9 per cent) and
homosexual contact (2.0 per cent) with increasing infections among men who sex with men
(MSM). Injecting drug use is the main mode of HIV transmission among men while heterosexual
transmission is the main mode among women. Women and girls are increasingly becoming HIV
infected; 18 per cent of newly infected persons nationwide were female in 2009 compared to 5
% ten years ago.

There are two main regional patterns of HIV infections in Malaysia. In Peninsular Malaysia, the
majority of states have injecting drug use driven epidemics, with increasing rates of
heterosexual transmission. In Sabah and Sarawak (East Malaysia), heterosexual transmission
accounts for the overwhelming number of reported cases. In 2009, this amounted to 97.7 per
cent and 83.6 per cent of HIV cases, respectively.

Figure 1: Percentage of HIV cases by Risk Factors during 2000-2009

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Source: Ministry of Health (2010)

By ethnicity, the majority of cases are Malay men aged 20 to 39 (around 70 per cent). The main
route of HIV transmission is through injecting drug use and this seems predominant amongst
those of Malay and Indian ethnicity. Chinese Malaysians, on the other hand, appear to be
contracting HIV through heterosexual transmission. So far, these three ethnicities are the bulk of
people who have contracted the disease. (See Figure 2). However, the epidemic has been
spreading into Orang Asli and the indigenous population in East Malaysia The dynamics of the
epidemic in these communities are possibly different and require a better understanding of the
risk and vulnerability issues affecting them.

Figure 2: Proportion of reported HIV infections by Ethnicity in Malaysia as of 2007

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Source: Ministry of Health

HIV remains a notifiable disease under the Prevention and Control of Infectious Diseases Act of
1988 (Act 342). Screening for HIV is conducted throughout the country via a number of national
health programmes. As far as possible, the Ministry has tried to encourage the adoption of a
voluntary, ethical and internationally acceptable approach to HIV screening such as Provider
Initiated Testing and Counselling (PITC).

The HIV surveillance data compiled through the Governments system originates predominantly
from the public sector. Despite HIV being a notifiable disease under the current legislation, data
obtained and submitted from the private healthcare system such as from private hospitals,
clinics and screening laboratories is marginal as most detected cases in these facilities are not
reported. However, in the case of hospitals and clinics, these individuals found to be with HIV
are usually referred to the Government healthcare system for further treatment.

Various purposive sampled surveys have shown a relatively high level of knowledge on HIV and
its modes of transmission among Malaysians, but misconceptions and stigma remain pervasive
(UNESCAP, 2006). The fact that HIV is relatively confined to selected high-risk groups fosters a
widespread perception among Malaysians that they are not at risk as long as they and their
partners are not adopting high risk behaviours, even if they have multiple or casual partners.

2.4 Sexually transmitted infections

The scale of sexually transmitted infections (STIs) in Malaysia is considered to be very much
under-represented (MoH, 2010). This is due to under-reporting and under diagnosis,
asymptomatic manifestation of the disease as well as patients preferring to access the private
healthcare facilities to treat STIs as opposed to seeking treatment at public hospitals and clinics.
Some also prefer to self-treat through alternative medicine. Despite the existence of the
Prevention and Control of Infectious Diseases Act of 1988 which requires reporting of incidences
of syphilis, gonorrhoea, chancroid and HIV, most cases of STIs are not reported by private
practitioners.

2.5 Drug use in Malaysia

Globally, UNODC estimates that, in 2009, between 149 and 272 million people, or 3.3 per cent
to 6.1 per cent of the population aged 15-64, used illicit substances at least once in the previous
year (UNODC, 2011). About half that number are estimated to have been current drug users,
that is, having used illicit drugs at least once during the past month prior to the date of
assessment.

Cannabis is the most widely consumed drug in Asia. Despite national differences, overall
cannabis use is, however, rather low in Asia, clearly below the global average. The second most
widely consumed drug type in Asia is the amphetamines, that is, methamphetamine in East and
South-East Asia

Asia also plays a major role in the clandestine manufacture of amphetamine-type stimulants
(ATS), notably of methamphetamine. Methamphetamine manufacture is mainly concentrated in
East and South-East Asia, including China, Malaysia, Myanmar and the Philippines. In South-East

20
Asia, along with the use of ATS, the non-medical use of tranquillizers is widely reported from
various countries in the region, including Brunei Darussalam, Malaysia, Myanmar, the
Philippines and Singapore. Over the past five years, Malaysia has become a significant
methamphetamine manufacturing location. In 2009, 11 clandestine ATS manufacturing
laboratories were seized. Most of the laboratories were located in Kuala Lumpur and southern
Malaysia.

It is reported that the incidence of drug use in Malaysia continues to occur particularly amongst
the socio-economically marginalized sections of society and amongst students and youth. Drug
use further compounds this. The National Drug Agency (2010) reports that more than 300,000
drug users were detected in Malaysia between 1988 and 2008. 12,352 drug users were detected
between January and December 2008, 6,413 of whom were repeat offenders. The majority of
drug users are male (98%).

The age breakdown amongst teens and youth identified as in drug use in 2008 are: 13 18 years
old (accounting for 2% of all arrests); 19 24 years old (17%); 25 29 years old (20%). 55% of
users reported this as a result of peer influence, while 21% used drugs for fun. Another 15% of
users were curious about drugs. Heroin is the most used drug for users in Malaysia at 40%, while
users of Amphetamine-Type-Stimulants (ATS) account for 14% of total detected cases in 2008.
Injecting Drug use is also found in a transgender group. Among transgendered persons, 3.1%
reported having injected drugs in the previous year. Most HIV infections have been found
among those taking methadone maintenance therapy (MMT). ATS use is reported to be on the
increase. Methamphetamine is available in crystalline and tablet form. There is potential for
further spread of HIV if injecting of ATS is practised.

2.6 Adolescence and sexuality in Malaysia

The process of rapid economic development, which has seen growth in urbanisation and
industrialization, has increased the sexuality challenges facing adolescents. Social change has
occurred as result of increased affluence, erosion of community influence and globalization,
which has increased access to international media, including sexual and violent content. Stresses
have been experienced in the family with family breakdown possibly on the increase. Current
parenting practices have been identified as a social policy issue (MoH, 2007). Peer pressure on
adolescents is a social factor, associated with risk behaviours, that needs to be harnessed for
positive development outcomes.

There has been very little research on adolescence and sexuality in Malaysia. This represents a
critical gap in social policy data and analytic work. The literature in this field is very limited. A
few surveys have been carried on youth such as the Malaysian Youth Index. A situation
assessment of youth in was carried out in 2002 (UNESCAP, 2002). The main findings were:

Most youth are not provided with information, counselling or support when they
experience stress owing to biological changes that affect their behaviour, attitude,
personality and lifestyle;
Parents are often unprepared or unable to give sufficient advice and reassurance to their
children or are reluctant to discuss the issues. Therefore, youth often share experiences
of biological changes and sexual relationships with each other;
Over two-thirds of youth aged 13 to 19 years have had at least some exposure to

21
materials such as magazines, films and videos containing explicit or implied sexual
connotations;
Dating is an accepted norm among teenagers;
Only 1 per cent of those surveyed admitted to ever having sexual intercourse.
Almost all the adolescents surveyed, or 98 per cent, had heard of AIDS. Some 78 per cent
had heard of AIDS through the television and the radio while 11 per cent had heard of it
through the newspaper.
About 14 per cent of the adolescents interviewed, said they practiced masturbation.
Most boys began masturbation at the age of 15 years, while girls did so at an earlier age;
Substance abuse in various forms like smoking, glue-sniffing and ingesting cough
medicines were reported by respondents as common;
Loitering or lepak was reported by adolescents to occur when the home environment
was dull or unhappy, or if there is parental neglect or bad relations between the parents
and the children.

Gender based violence among adolescents, particularly girls has been neglected as a policy
issue. Data are weak. National prevalence data on violence against women (VAW) are
unavailable (MoH, 2007).

2.7 Summary of Situation Issues

The education system in Malaysia has the potential to raise the levels of knowledge, attitudes
and life-skills required for better health, HIV and drug use prevention as well as reduced stigma
and discrimination among young people. This is very much in keeping with the emphasis in
education sector development on strengthening human capital for social and economic
development. There is already a school health framework in place, which offers opportunities
for addressing key health issues on a large scale.

The HIV epidemic is concentrated among key populations. Data on children and HIV are weak.
Addressing gender and sexual health are critically important in preventing HIV transmission.
Drug abuse is a major driver of the epidemic in Peninsular Malaysia. Drugs are almost exclusively
used by males. STIs are believed to be under-reported and constitute an important public health
issue.

Adolescents face multiple challenges in growing up from the influences of rapid economic
development, access to globalised media and a perceived decrease in community influence.
Parenting practices are a concern, particularly with regard to sexuality education, where parents
are typically unprepared or unable to provide information and opportunities for discussion.

There is a strong need for age and culturally appropriate sexuality education to be provided to
young people in school. Young people lack information and skills in this area. Levels of
knowledge appear to be variable, but with significant gaps and misconceptions. HIV risks do not
appear to be well understood. There is evidence of sexual risk behaviours among some young
people, including unprotected sex and multiple partners. The age of sexual debut is relatively
late (19), however, the age of marriage is becoming later.

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3. Response Analysis
3.1 Education, HIV, drugs and sexual health

It is widely acknowledged that schools are uniquely well-placed to avert HIV infections among
young people, especially where school participation is high. Schools can provide fundamental
information and life-skills related to HIV prevention to students who have not yet had sexual
intercourse (WHO, 2007). Not all HIV education programmes are optimally effective, however,
and Ministries of Education need to design and implement programmes that incorporate the
characteristics that have been shown through research to be related to effectiveness in
developed and developing countries (UNESCO, 2009).

There is a growing body of evidence indicating that school-based sexual health education
programmes, if well-designed and implemented, are valuable and have a positive impact on
young peoples sexual health by improving preventive behaviour and thereby reducing the risks
of unintended pregnancy and STIs, including HIV.

In late 2007, UNESCO began a programme of work on sexuality education, primarily as a


platform for strengthening HIV prevention efforts with children and young people but also to
address broader sexual and reproductive health objectives, such as the prevention of other STIs
and unintended pregnancies. This has resulted in the publication of International Technical
Guidance on Sexuality Education (Volumes I & II), which were published in December 2009.
These have set international standards formulated by UNESCO in partnership with UNICEF,
UNFPA, WHO and UNAIDS.

The primary goal of sexuality education is that children and young people become equipped
with the knowledge, skills and values to make responsible choices about their sexual and social
relationships in a world affected by HIV (UNESCO, 2009). Sexuality education programmes
usually have several mutually reinforcing objectives:

To increase knowledge and understanding;

To explain and clarify feelings, values and attitudes;

To develop or strengthen skills; and

To promote and sustain risk-reducing behaviour and their professional staff, including
curriculum.

UNESCO has also identified key elements of the education sector response to HIV (UNESCO,
2008). These are:

An education sector policy on HIV and AIDS that addresses both HIV prevention and issues
that arise from their impact on the school such stigma and discrimination, and teachers
and students living with HIV;

HIV training for MoE staff at all levels;

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HIV preventive education curriculum development (sexuality education) and age specific
teaching and learning materials;

Pre and in-service teacher training to implement the sexuality education curriculum;

Co-curricular activities such as peer education; and

Monitoring arrangements to ensure programme effectiveness.

These elements provide simple benchmarks with to assess the Malaysian response.

3.2 School health and nutrition

A major step forward in international coordination and cohesion on school health was achieved
when the FRESH2 framework was launched at the World Education Forum in Dakar in April 2000.
The FRESH framework provides a consensus approach or the effective implementation of health
and nutrition services within school health programs. The framework proposes four core
components that should be considered in designing an effective school health and nutrition
program and suggests that the program will be most equitable and cost-effective if all of these
components are made available, together in all schools:

Policy: health-and nutrition-related school policies that are non-discriminatory,


protective, inclusive, and gender sensitive and that promote the nutrition and physical
and psychosocial health of staff, teachers and children;
School environment: access to safe water and provision of separate sanitation facilities
for girls, boys and teachers;
Education: skills-based education, including life-skills, that addresses health, nutrition, HIV
prevention, and hygiene issues and that promotes positive behaviors;
Services: simple, safe and familiar health and nutrition services that can be delivered cost-
effectively in schools (such as deworming services, micronutrient supplements, and
nutritious snacks that counter hunger)and increased access to youth-friendly clinics.

The FRESH framework further proposes that these four core components can be implemented
effectively only if they are supported by strategic partnerships between the following groups:

Health and education sectors, especially teachers and health workers


Schools and the community
Children and others responsible for implementation.

3.3 The national response to HIV

UNAIDS has prescribed a set of guiding principles for the national response to HIV. These are
termed the Three Ones (UNAIDS, 2004). These three key principles are now widely in place. They
are briefly described below as they are fundamental to HIV interventions in all sectors.

2
Focusing resources for effective school health

24
KEY PRINCIPLE 1: One agreed HIV/AIDS Action Framework that forms the basis for
coordinating the work of all partners

An agreed, common HIV and AIDS Action Framework is a basic element for coordination across
partnerships and funding mechanisms, and for the effective functioning of a National AIDS
Coordinating Authority. Such a framework calls for clear priorities for resource allocation and
accountability, making it possible to link priorities, resource flows and outcomes/results. The
education sector response needs to be included within the National Action Framework, which is
usually the HIV National Strategic Plan (NSP).

KEY PRINCIPLE 2: One National AIDS Coordinating Authority with a broad based multi-sector
mandate.

A National AIDS Coordinating (NAC) Authority requires legal status and a formal mandate that
will:

Define the degree of autonomy;


Specify formal reporting lines (information and policy instruction) to Government authorities
at ministerial and administrative levels; and
Spell out areas of accountability in terms of policy implementation, partner inclusion
and programme/development outcomes.

The education sector response needs to be formally linked with the NAC and involved in multi-
sectoral coordination.

KEY PRINCIPLE 3. One agreed M&E framework for overall national monitoring and evaluation

The absence of an operational common M&E framework in most countries has hampered
efforts to increase capacity for quality assurance, national oversight and adequate use of M&E
for policy adaptation. As a result of a lack of M&E capacity, data has often been lacking or of
poor quality, which constrains the monitoring of performance and formulation of evidence-
based policies. Thus, each National HIV/AIDS Action Framework should be accompanied by a
core system for monitoring progress towards controlling the epidemic under the leadership of
the National AIDS Coordinating Authority. The education sector response needs to be included
within the National M&E framework. Indictors 11 (life skills education) and 12 (school
attendance of orphans) of the UNGASS on HIV and AIDS core indicators are education sector
specific.

3.4 The strategic response to HIV and AIDS

3.4.1 The National Strategic Plan (NSP) on HIV/AIDS

The National Strategic Plan (NSP) on HIV/AIDS 2006 2010 (MoH, 2006) superseded the
previous HIV/AIDS National Strategic Plan. The NSP provided a general framework for a
nationally driven and expanded HIV and AIDS response over the five-year period from year 2006
to 2010. Its development involved a range of consultative processes, including a multi-sectoral
consultation. It also provided the basis for coordinating the work of all partners with a view to

25
successfully achieving UNGASS on HIV and AIDS targets and the Millennium Development Goals
(MDGs), including MDG 6 to halt and reverse the spread of HIV and AIDS.

Goals

The goals of Malaysias response to HIV/AIDS (MoH, 2011) are to:

Prevent and reduce the risk and spread of HIV infection;


Improve the quality of life of people living with HIV;
Reduce the social and economic impact resulting from HIV and AIDS on the individual,
family and society.

Objectives

The objectives of the 2006-2010 NSP were to achieve the following principles of the UNGASS on
HIV and AIDS and the MDG targets and also complement approaches outlined in the National
Drug Strategy:

To reduce the number of young people aged 1524 who are HIV-infected;
To reduce the number of adults aged 2549 who are HIV-infected;
To reduce the number of HIV infections in injecting drug users;
To reduce each year the number of HIV-infected infants born to HIV-infected mothers;
To reduce the number of marginalised populations (sex workers, transgenders and men
who have sex with men) who are HIV infected; and
To increase the survival and quality of life among people living with HIV.

Strategies (NSP 2006-2010)

i) Strengthening Leadership and Advocacy

Leadership at the highest level is critical for a successful response to HIV and AIDS. Leadership,
at national and state government and community level, is needed to mobilise and co-ordinate
actions across sectors and to direct resources and activities to the most urgent priorities.

ii) Training and Capacity Enhancement

There was an identified need to upgrade the capacity of the health system and NGOs to increase
the coverage and quality of prevention, care and support services as well as using HIV
surveillance data to shape policies and programmes. This would determine the quality of the
national response to HIV and AIDS. The NSP priorities include:

The HIV and AIDS surveillance system;


Primary health service delivery, home and community-based care and training for
healthcare workers.

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Voluntary confidential Counselling and informed consent Testing (VCCT) services. Malaysia has
a range of HIV counselling and testing services. There is a wide coverage of VCT services in the
districts and community. These services are accessible to the general and vulnerable population.
The increasing rates of HIV infection and AIDS and expansion of ART bring with them the
potential for demand to overwhelm the capacity of the existing VCT services.

The strategy sought to scale up a combination of new VCT services and integration of VCT in
health and community services. An increase in coverage of VCT services would help overcome
stigma and denial and will lead to better management of illnesses and opportunistic infections.

Delivery and monitoring the Highly Active Anti-Retroviral Therapy (HAART) programmes. It
was estimated by MoH that approximately 10,000 people were living with HIV (PLHIV) required
anti-retroviral therapy (ART) in the country in 2010. The three main approaches would be to
increase:

Accessibility to treatment;
Availability to ARV drugs; and
Capacity enhancement support services.

HIV and AIDS workplace policies and programmes. This intervention would include
strengthening and expanding HIV and AIDS workplace policies and programmes. Malaysia has a
Code of Practice on Prevention and Management of HIV/AIDS at the Workplace and a
programme of seminars and workshops had been initiated jointly by the Ministries of Health
and Human Resources to encourage companies to adopt the Code. However, there remained a
nation-wide need to develop and implement HIV and AIDS prevention and care workplace plans,
and to strengthen measures to provide a supportive workplace environment for people living
with HIV/AIDS.

iii) Reducing HIV vulnerability among people injecting drugs and their partners

The NSP aimed to reduce HIV infection among people injecting drugs and to prevent
transmission to their partners by expanding access to harm reduction programs. Reusing and
sharing needles and syringes or other equipment for preparing and injecting drugs is the most
efficient mode of HIV and Hepatitis C transmission.

iv) Reducing HIV vulnerability among women, young people and children

For the majority of young people in Malaysia, barriers to access to HIV prevention appear to
stem more from cultural and religious values than from limited resources or capacity. Young
people, particularly those in marginalised populations, are also deterred from accessing services
by concerns about confidentiality and the lack of youth-friendly sexual and reproductive health
services. Stigma and discrimination are also issues for PLHIV and youth in marginalised
populations.

The peer education program for youth (PROSTAR) is to be implemented and include more
effective ways to educate young people about HIV. In order to reduce the HIV vulnerability of

27
young people and children, the NSP aims to:

Increase access by young people to life-skills based education;


Increase access by young people to youth-friendly health and social services; and
Create a supportive environment for HIV prevention for youth.

v) Reducing HIV vulnerability among marginalised and vulnerable groups

The NSP focuses on key populations who are at higher exposure to HIV. This includes: sex
workers; men who have sex with men; transgender people; and mobile populations (legal and
illegal migrants, displaced persons, refugees, and migrant labourers). The NSP aimed to
implement a series of comprehensive campaigns targeting these key population groups in order
to:

Increase their access to accurate HIV and AIDS, sexual and reproductive health
information, education and communication;
Encourage condom use, provide education in correct use and disposal of condoms among
high risk groups;
Increase their access to community-based, user-friendly VCT, by increasing the number
and geographical coverage of VCT services (including mobile units);
Increase the coverage and quality of outreach programmes, by establishing new
programmes, training of staff (including volunteers) and involving target populations in
the design, delivery and evaluation of programmes.

vi) Improving access to treatment, care and support

The Government will continue to support a decentralised approach to health services that
includes community-based and primary health care through to hospital-based care. It provides
psychosocial support including VCT, palliative care, nutritional support and treatment for
common opportunistic infections. Malaysia provides affordable access to clinical care through
the public health system, including free or subsidized access to ART.

However, service coverage had been falling short of needs and demand. The increasing
numbers of AIDS cases has the potential to overwhelm the capacity of the health system and
available resources. PLHIV in closed settings and those living outside the major cities were
particularly affected. The NSP would also improve support to infected and affected children,
including orphans.

To address the specific needs of HIV-infected and -affected children the NSP emphasised the
need for:

The provision of appropriate counselling and psycho-social support to orphans and other
vulnerable children, and to their carers;
The provision of HIV treatment and care for HIV-infected children;
Their enrolment in school; ensuring their access to shelter, good nutrition, health and
social services on an equal basis with other children;

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Non-discrimination through the promotion of an active and visible policy of
destigmatisation of children orphaned and made vulnerable by HIV and AIDS.

Strategies (NSP 2011-2015)

The current NSP is working to the following strategies:

Strategy 1: Improving the quality and coverage of prevention programmes among most at risk
and vulnerable populations

Strategy 2: Improving the quality and coverage of testing and treatment

Strategy 3: Increasing the access and availability of care, support and social impact mitigation
programmes for People Living with HIV and those affected.

Strategy 4: Maintaining and improving an enabling environment for HIV prevention,


treatment, care and support.

Strategy 5 Increasing the availability and quality of strategic information and its use by policy
makers and programme planners through monitoring, evaluation and research.

The current NSP builds on the previous NSP. It acknowledges that the rise in sexual transmission
of HIV will require a further strengthening of commitment from the Government to undertake
and improve on programmes which specifically address the issue of sexual reproductive health,
especially among young people. Policy-makers will need to be better informed about the
importance of adolescent health and sexual reproductive health, particularly within the context
of HIV. It observes that as issues relating to sexuality and young people are often contentious
and linked to public morality, it is essential to further consult and engage religious leaders and
other community leaders. There is a need to take into consideration the realities of an epidemic
which is being increasingly spread through sexual transmission.

3.4.2 Key results of the NSP 2006-2010

Strategy 1: Strengthening leadership and advocacy

Under the National Strategic Plan on HIV/AIDS 2006-2010, the Cabinet Committee on HIV/AIDS
(CCA) was established and chaired by the Deputy Prime Minister. It functioned as a forum for
discourse and decision-making at the highest level on HIV and AIDS related policies. It
represented a strong commitment on the issue of HIV and AIDS, and also provided a strong
political platform for advocacy at the highest levels of Government. In late 2009, the CCA was
restructured and known as the National Coordinating Committee on AIDS Intervention (NCCAI)
chaired by the Minister of Health. The NCCAI functions as the highest decision-making body on
HIV and AIDS related policies. Its membership includes all the Chief Secretaries of the 16
Ministries and government agencies listed in the NSP as well as civil society representatives,
including the Malaysian AIDS Council. The NCCAI has been made responsible for ensuring the
development and implementation of policies.

29
A Taskforce on Women, Girls and HIV/AIDS was set up in 2009, and is chaired by the Ministry of
Women, Family and Community Development (MWFCD). The Taskforce is tasked to guide the
actions of the Government in its response to addressing the behavioural and socioeconomic
factors behind the sexual transmission of HIV. It is also tasked to bring together actors beyond
the health and medical sphere and include bodies such as the Social Welfare Department,
National Population, Family Development Board (NPFDB), Department of Islamic Development,
Ministry of Information and other bodies which address issues such as teenage pregnancies,
sexual violence and gender inequality. MoE is conspicuous by its absence in the list of
stakeholders represented on the Taskforce, despite its important role in the development and
preparation for adult life of girls.

There is no evidence of any concerted action in the education sector to strengthen leadership
and advocacy during the NSP period of implementation. No Taskforce on education has been
established. There is no evidence of any policy development, including education sector-specific
HIV and AIDS workplace policy.

Strategy 2: Training and capacity enhancement

A great deal of progress has been made both in understanding the situation of key populations ,
particularly regarding vulnerability to HIV and STI infection and the need for specific essential
services. The evidence base includes the following studies:

Impact of HIV on People Living With HIV, Their Families and Community in Malaysia
(2007);
Integrated Bio-Behavioural Surveillance (IBBS) with injecting drug users, female sex
workers and transgender persons (2009);
Venue-Day-Time-Sampling (VDTS) survey with men who have sex with men (2009);
Estimation and Projection of the Malaysian HIV Epidemic (2009);
Size Estimation for Local Responses in Malaysia for HIV Prevention in Sex Work (2010).

There still exist concerns of the limited availability of technical expertise to conduct research
and data collection. Scientific researchers in social science, epidemiology, medical treatment
and other areas who are interested to conduct HIV related research are still scarce. There is still
a high level of dependence on external resource persons and consultants.

Detailed sex-disaggregated data has also recently become available as a result of a revision of
the national HIV reporting system by the Ministry of Health. Analysis of this data is critical to
ensure a better understanding of how men and women are vulnerable to HIV infection in
Malaysia. The responses, experiences and the burden of disease appear to be different for men
and women. Therefore it is necessary to emphasize the need for gender to be mainstreamed
into any analysis of the epidemic to better understand how and why HIV affects women and
men differently.

It is difficult to discern where technical capacity has been strengthened in the education sector
to respond to HIV, drugs and sexual health. There has been no capacity needs assessment,
neither has there been any plan to improve capacity at any of the levels of the sector.

30
Strategy 3: Reducing HIV vulnerability among people who inject drugs and their partners

Initiated in February 2006 and now entering its fourth year of operation, the Needle and Syringe
Exchange Programme (NSEP), with its current target of servicing 15,000 drug users by 2010 with
free syringes and condoms, is a priority HIV prevention programme. It also provides access to
and education on sterile injection equipment and safer injecting techniques as well as
methadone and HIV treatment related services. However, by end 2009, 18,377 people injecting
drugs were enrolled in this programme.

The implementation of the NSEP takes place in drop-in centres, outreach points and health
clinics which supply sterile needles and syringes to injecting drug users. These facilities are also
intended to act as a depository for the disposal of used injecting equipment. Many of the
outreach workers employed by the NGOs which are implementers of the NSEP are also
recovering drug users.

Strategy 4: Reducing HIV vulnerability among women, young people and children

Despite this strategy indicating the need to address the issue of HIV amongst women, there are
generally no general women-specific HIV prevention programmes available in Malaysia.

The prevention of mother-to-child transmission (PMTCT) programme in Malaysia introduced in


1998 is based strongly around ARV prophylaxis for the child, safer delivery and infant feeding
practices. It is also dependent on the detection of HIV infection during the mothers antenatal
period. The programme is implemented nationwide since 1998 at government health clinics and
hospitals, and incorporates HIV screening utilising an opt-out approach. Although it covers only
women receiving antenatal care at these government facilities, it is estimated that over 70 per
cent of total pregnant women nationwide were found to utilise government antenatal facilities.
Coverage of these mothers through the public facilities improved from 49.7 per cent in 1998 to
99 per cent in 2009. Antenatal HIV cases from the private sector are also referred to the
government medical system. With a coverage of 98.1 per cent for 2009, the programme has
been able to successfully reduce the incidence of MTCT to 4 per cent among women enrolled in
the programme.

To address the ongoing issue of the lack of sexual reproductive health education, the Ministry of
Women, Family and Community Development has recently announced the formation of the
National Reproductive Health and Social Education Policy. The policy is intended to assist in the
delivery of reproductive health education, particularly to young people.

Since September 2007, HIV and AIDS lectures aimed at inculcating awareness and behavioural
change have been integrated for the first time into the syllabus of the annual National Service
exercise. The National Service which involves almost 100,000 young people (aged 17-19 years)
nationwide annually represents a unique opportunity to ensure that students are equipped with
the necessary information, awareness and ability to make informed decisions, particularly on
issues related to HIV and AIDS. A survey taken with 6,000 trainees of this programme indicated
that 22.6 per cent correctly identified ways of preventing the sexual transmission of HIV and
rejected major misconceptions about HIV transmission.

MoH UNGASS on HIV and AIDS data for the 2010 report on school based life skills education for

31
HIV prevention (Indicator 11 - Percentage of schools that provided life skills-based HIV
education within the last academic year) concerned the UNICEF and Ministry of Education LSBE
Pilot Project. Only 0.2 per cent of schools were implementing HIV prevention, one of the lowest
coverage rates in the world. The UNGASS report stated that current life skills-based HIV
education initiatives exist only at the pilot stage, involving only 20 schools. No relevant data
exist beyond the pilot programme.

There is a need to include specific services for children living with HIV, which will require
different types of activities and responses. At the moment, this area of concern is very much
unaddressed. Children living with HIV face problems of stigma and discrimination from their
peers and school authorities, and of treatment adherence. There is a need for programmes to
address the needs of adolescents living with HIV in dealing with regular teenage problems such
as boy-girl relationships and family issues in the context of their status. The Ministry of Women,
Family and Community Development currently run several programmes which address these
issues; however, they do not as yet provide for children living with HIV. To date, there are also
inadequate shelter homes for children infected and/or affected by HIV. As such, those who are
without a home are usually put together in adult shelters.

Strategy 5: Reducing HIV vulnerability among marginalised and vulnerable groups

Reaching out to key affected populations remains a significant and formidable challenge. The
role of NGOs and CBOs (Community Based Organizations) in implementing programmes with
groups such as those identified under this strategy (i.e. sex workers, MSM, transgender people,
migrants, displaced persons and refugees) remains critical.

Prevention programmes for key affected populations have increased over the last 2 years due to
the greater availability of funding from the Government. For example, the Sex
worker/Transgender outreach programme has expanded to 4 new states from the previous 2;
the NSEP programme have increased their coverage to 12 new sites and the outreach
programme to MSM has expanded to 1 new state.

Despite having a series of ambitious objectives under the NSP aimed at increasing access to HIV
and AIDS related information, promoting condom use, increasing access to VCT, and increasing
coverage and quality of outreach programmes, significant challenges and barriers remain. The
vast majority of prevention programmes involving key affected populations such as people who
inject drugs, MSM and sex workers are mainly dependent on CBOs and NGOs.

Strategy 6: Improving access to prevention, treatment, care and support

The Governments achievements in the area of HIV treatment have been particularly impressive.
Health services in the hospital and primary healthcare systems are of high standard, especially
those relating to clinical management of HIV. Strong measures are in place to ensure blood
supply safety whereupon testing of blood products is consistently conducted. Since 2006, first
line therapies involving nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside
reverse transcriptase inhibitors (NNRTIs) were accessible for all patients at no charge at
government hospitals and clinics.

32
A challenging area of concern has been the need to increase treatment literacy and education
among PLHIV. MTAAG+ (Positive Malaysian Treatment Access and Advocacy Group) has been
working in addressing this issue through treatment education programmes which have included
illiterate PLHIV in rural areas. They have also played a role in dialogues with government on the
issue of access and affordability of ART.

Stigma and discrimination continues to be an issue that not only affects the lives of PLHIV and
those around them, but also present themselves as obstacles to the progress and
implementation of HIV prevention, treatment, care and support programmes. The education
sector has yet to play a strong role in addressing stigma and discrimination among young
people.

3.4.3 The Malaysian AIDS Council

The Malaysian AIDS Council (MAC) was established in 1992 to serve as an umbrella organisation
to support and coordinate the efforts of organisations working on HIV and AIDS issues in
Malaysia. MAC, in partnership with government agencies, private sector and international
organisations, ensures a committed and effective response by NGOs working on HIV and AIDS
issues in Malaysia.

MAC, comprising the Secretariat and its Partner Organisations, work together as a team to
provide nationwide coverage and serve as the common voice for the community. Besides
coordinating and streamlining programmes with its Partner Organisations, the MAC Secretariat
also provides these organisations with the necessary training, funds and other resources to
implement effective HIV AND AIDS programmes within various communities in Malaysia.

The primary objectives of MAC are to:

Increase awareness of HIV and AIDS;


Prevent the spread of HIV;
Eliminate discrimination, stigma and prejudice associated with HIV and AIDS;
Promote and protect the rights of those made vulnerable by HIV and AIDS;
Ensure the highest possible quality of life for those with HIV and AIDS; and
Provide care and support to individuals living with HIV.
3.4.4 The MAC Strategic Plan 2008-2010

The Malaysian AIDS Council has developed its own strategic plan for the period 2008-2010. It
has adopted the 6 NSP strategies and added two of its own. These are:

Strategy 7: Reducing HIV vulnerability among sex workers and transsexuals with
community empowerment; and

Strategy 8: Improving the quality of life of PLHIV through improving access to treatment,
care and support.

3.4.5 Monitoring and Evaluation of the NSP

The AIDS/STD Section of the Disease Control Division within the Department of Public Health of

33
the MoH will be responsible for the central coordination, monitoring and evaluation system for
assessing the impact of the NSP.

As part of the National Strategic Plan on HIV/AIDS 2006-2010, the country now has a
rudimentary national Monitoring and Evaluation (M&E) plan utilising indicators including those
of the UNGASS process, covering the duration of the NSP. The MoH lacks a dedicated M&E unit
or department based within the HIV and AIDS framework. The MoE is not tracking the HIV
response in its sector.

3.4.6 Other relevant national strategies and interventions

The Adolescent Health Plan of Action, 2006-2020

The MoH has developed a national plan of action for adolescent health for the period 2006-2020
(MoH, 2007). It has the objectives of:

Promoting the development of resilient adolescents through promotion of health and


responsible living;

Preventing the health consequences of risk behaviours through promotion of wellness


and provision of health care services;

Promoting active adolescent participation in health promotion and preventive


activities.

There are seven strategies and five priority areas. The strategies cover the following areas:
health promotion, access to appropriate health services, human resource development,
adolescent health information system, research and development, strategic alliances and
legislation. The priorities are: nutritional health, sexual and reproductive health (SRH), mental
health, high-risk behaviours and physical health. The MoE will contribute Reproductive Health
and Social Education (PEERS) in the Health Education curriculum in school.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Round 10)

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) signed its first grant with
Malaysia to fight the spread of HIV among populations at risk in 2011. The Malaysian AIDS
Council will receive US$ 5.6 million over two-and-a-half years to implement the programme.
While the national HIV prevalence in Malaysia is under 1%, research conducted in the capital,
Kuala Lumpur, and environs last year showed a prevalence of 22.1 per cent among injecting
drug-users, of 10.5 per cent among female sex workers, and of 9.7 per cent among mak nyah
(transgender) sex workers. The grant focuses on a package of services with emphasis on
prevention for these three groups. There is no funding for the education sector.

3.5 The Education Sector Response to HIV in Malaysia

3.5.1 National Policies and Plans

Under the curriculum transformation in education which starts with Year 1 in 2011, the Health
Education subject which comprises 75 per cent of PEERS component will be taught as a subject

34
in primary and lower secondary education. Topics such as HIV or sexuality education are taught
through Health Education. There is a lack of a medium term action plan for school health and
the HIV response. The policy framework that exists for school health comes under the Ministry
of Health. There is also a lack of an education sector specific HIV and AIDS workplace policy.

Relevant policies for HIV mainstreaming which are currently in place include the following:

National Child Protection Policy;

National Policy on Disabled Children; and

National Policy on the Indigenous Child.

3.5.2 HIV and Sexuality Education in schools

In Malaysia, school-based sexual and reproductive health education has been implemented as
Family Health Education (FHE). FHE has been taught to secondary school students since 1989
and to primary school students since 1994. The FHE curriculum has been incorporated into the
subjects of physical and health education, biology, science, ethics and religion as presented in
table 2 below (Huang, 2000):

Table 2. Integration of FHE in the curriculum

Subject Status

Physical and health education Compulsory, not examinable subject

Science/additional sciences Compulsory and examinable

Biology Compulsory and examinable

Morality education (ethics) Compulsory and examinable for all non-Muslim


students

Islamic education Compulsory and examinable for all Muslim


students

Informal NGO activities Single activity conducted and lack of continuity of


the activities conducted

Health Education textbooks are standardized for the whole country and workbooks have been
produced based on the curriculum to be used in the class. The FHE curriculum is carried out
through Health Education and is included lesson plans for teachers to follow. The FHE topics that
incorporated in the subject and taught in school levels are described below.

Primary school

At primary level, FHE is integrated only in the Physical and Health Education subject. Personal
hygiene and family relationships are the first topics to be introduced and emphasized
throughout the primary school level. Genital health is particularly mentioned in grade 5 in order
to be coupled with a menstruation hygiene topic. The differences between sexes are

35
emphasized across all topics taught, while puberty is first mentioned in grade 4, and then
elaborated more to be appropriate for students in grades 5 and 6.

Secondary school

In secondary schools, FHE is taught in Physical and Health Education classes, science, biology
and Islamic education. In Physical and Health Education, the prevention of STIs is introduced in
the final three years of secondary school but is most extensively dealt with in the final two
years. Sexual relations and practices are taught in the context of the family institution.

Science, additional sciences and biology, the biological aspects of human reproduction, disease
and growth are extensively covered in these subjects to be more relevant to the FHE.
Contraception is not introduced until the final year of the secondary school. Condoms are
introduced as one a method of contraception not for having safe sex. FHE is included in Islamic
education, this subject and taught grades 9 and 11. The emphasis is on moral and spiritual
virtue and the prevention of illicit behaviours.

Since its inception from 1989 until 2002, the FHE curriculum had several changes (in 2000, 2003
and 2005). For this second modification the FHE was then referred to as Sexuality Education. In
2006, the name was changed again and now it is called Reproductive Health and Social
Education (or PEERS for a Malay acronym).

PEERS is to be taught in primary levels 1, 2 and 3. It will include the physical difference between
boys and girls, personal hygiene, responding to social situations that would lead to unsafe sexual
contact, the importance of preserving ones self-respect and emotional management. PEERS
taught in primary levels 4, 5 and 6 will include conflict management, puberty and physical
changes, the reproductive system, skills needed to preserve ones self-respect, risks of
premarital sex, the spread of STIs and how to refuse cigarettes, alcohol and narcotics. (See
Annex 2 for PEERS topics covered in core school curriculum).

PEERS taught in secondary levels 7, 8 and 9 will include social psychology, life-skills needed to
handle high-risk situations, stress management, the spread of STIs, sexual growth traits, identity
and sexual orientation, relationships and the adverse effects of alcohol, cigarettes and narcotics.
PEERS taught in secondary levels 10, 11 and 12 will include social psychology, emotional and
mental stability, youth pregnancy, family issues, the spread of STIs and preventative measures
against cigarettes and narcotics.

Topics covered in PEERS were modified to fit the current situation that youth are facing in their
daily lives. The topics are additional/modified topics from those of FHE implemented in the past.
However, the CDD-MOE has made plans to review and revise PEERS in 2011.

In addition to PEERS, the co-curriculum, PROSTAR, was launched in 1996 and initiated by the
Ministry of Health and the UNICEF Malaysia country office. It has taught students about high-
risk activities, AIDS and other related issues to youth at all school levels. About 64,000 PROSTAR
peer-educators have been trained nationwide and over 1,000 PROSTAR Clubs have been
established. More than 3,450 PROSTAR activities has been conducted and involved nearly
667,000 youth. This was developed to promote youth friendly HIV prevention and life-skilled
based activities for vulnerable youth.

36
The Deputy Education Minister held a press conference in December 2010 and explained that
the parliament had lobbied to teach PEERS as a separate school subject for the 2011 curriculum.
PEERS will be taught in four 40-minute sessions each month in secondary schools and in a 30-
minute session each week in primary schools. Only teachers who have undergone training
sessions are eligible to teach this subject in order to ensure the effectiveness of the teaching
and learning process.

An additional module such as I Am in Control has been also used for the past four years in
secondary schools. This activity-based module was developed by the Ministry of Women,
Family and Community Development, the United Nations Population Fund (UNFPA) and other
NGOs.

Currently, Malaysia is facing unwanted teenage pregnancy and there is no existing government
policy on sexual and reproductive health education. The CDD-MOE has developed a
reproductive health (RH) guideline that covers RH issues for all age groups. This guideline is
intended for both NGOs and government organizations to initiate programs and activities
pertaining to the issues. This guideline will be implemented in the near future.

3.5.3 Specific findings on implementation of school-based HIV education

Teaching and learning processes

In the PEERS programme, capacity building to strengthen teacher competence and support of
the senior school management is considered crucial to effectiveness.

However, the subjects in which PEERS content is incorporated are often neglected as they are
not compulsory for academic exams and progress among teachers and students. Thus, it
appears that PEERS has not been actively taught in all schools. Additionally, physical and
health education are non-compulsory subjects and less attention is paid if a teacher for this class
is qualified also to teach all of the topics covered for the PEERS.

To compensate for this, some schools have invited NGOs to conduct such activities that aimed
to reduce high-risk behaviour, but usually the activities are implemented as a single activity
during the school year instead of continuous or serial activities which are important for
effective learning. Based on the information obtained through FGDs, the topics are not covered
fully in the classrooms and are, instead, presented in bits and pieces. This teaching method will
clearly weaken the programmes aim of preventing high-risk behaviours. In order to build skills
and knowledge for student to handle with or prevent their risk taking, serial and sequenced skill
building activities are required, rather than a single, one-off activity.

During interviews and discussions, deputy principals and teachers referred to sex and sex
education as sexuality. When asked to clarify the meaning of sexuality, no clear answers
emerged. Understanding of sexuality is very important to conduct PEERS activities and give
the right message to the students. It is suggested that this issue be resolved by MoE clarifying
the terminology during future capacity building sessions.

In examining of the PROSTAR activities, some areas for improvement were identified. It was
reported that a single peer-educator training session was conducted and the number of peer-
educators was disproportionate compared to the student body. Moreover, peer-educators

37
were not spread out equally across grade levels which would not allow students to convey
information effectively if peer-educators were not the same grade as their peers.

The issues taught through PROSTAR tend to focus on lifestyle choices rather than HIV risk
behaviours. Some schools had partnered with the state health department to held training
sessions and camps for their peer-educators. The total number of hours taught on HIV and
AIDS is about three hours per year which is not sufficient. The teaching methods used to teach
the HIV and AIDS-related issues have been didactic, rather than participatory.

With regard to the adequacy of HIV and AIDS information students received at school, it was
found that some students were still not clear if HIV/AIDS/STIs were related to one another and
were sexually transmitted. Some students felt that the information was enough to help them
protect themselves from infection while other students (about half of those interviewed)
mentioned that the amount of information on these topics did not prepare them to deal with
challenges of post-school life when they would not have parental monitoring and guidance. The
perception of students of the HIV issue is that it is far from their concerns. During the group
discussion, female students listed abandoned infants and pregnant teens dropping out of school
while their male counterparts listed gangs and vandalism as major problems faced by todays
Malaysian youth.

Skills-building components and the curriculum

Based on the review of available data and classroom observation, the FHE curriculum focuses on
provision of information rather than skills-building. In lesson objectives, it was clearly stated that
teachers should conduct a discussion with students but they rather prefer a didactic approach.
The curriculum contents have a tendency to mould students attitudes and values to expected
social norms instead of encouraging critical thinking, decision-making and problem solving
regarding to particular risk behaviours. Thus, the curriculum has insufficient activities in
building skills of students to deal with risky situations and to avoid high-risk behaviours. Only a
few lessons identified skill-building objectives such as decision-making and problem-solving skills
in the curriculum.

Related Factors contributing to the effectiveness of the implementation of HIV and AIDS
Education

Factor 1: Role of the central HIV and AIDS and sexuality PEERS education policy

The government has provided a clear message of support for the implementation of the PEERS
curriculum in the schools during the press conference by the Deputy Education Minister in early
December 2010. He stated that PEERS would be part of the new curriculum transformation that
will be introduced to the 2011 school year. This is important as Malaysia operates through a
centralized education management system and PEERS will be implemented through Health
Education in all primary and secondary public schools.

CDD-MOE staff have a pivotal role to play in training and supporting classroom teachers to
provide effective education that includes skills-building activities in relation to HIV prevention
and sexuality education.

Factor 2: Roles of the school principal and the deputy principal

38
School principals are important as they will monitor and support the actual teaching and
learning of PEERS. It was found during interviews that a deputy principal should also play a
similar role, since the principal can be very busy with school management and back up is
required. There is a need to train education management staff to better understand the PEERS
content and sufficient classroom hours are needed to carry out all activities.

Factor 3: Curriculum development and program implementation

During the process of PEERS curriculum development and implementation, the content was
designed based on the review and comments made by NGOs and other stakeholders, such as
parents, to be more culturally and socially acceptable. According to the National Union of
Teaching Profession (NUTP), teachers are more willing to accept the PEERS curriculum because
it is a government policy HIV and AIDS educational program and integrated into existing core
subjects curriculums rather than creating a separate school subject.

The CDD-MOE has produced guidance on appropriate terms to be used by the teachers when
talking about sexual health with the students. The terms are deemed culturally appropriate and
should minimise controversy among the communities and families. It is well recognized that
skill-based education can help youth from risk taking behaviours better than information-based
education.

Factor 4: Teacher training sessions

The MoE is responsible for organizing training sessions to equip teachers with the skills needed
to properly implement the PEERS teaching manuals. However, according to information
obtained from the teachers, there were several occasions where not all of the teachers involved
in PEERS were invited to attend the training sessions. The sharing of the training sessions
between trained and untrained teachers is not compulsory so many teachers who are
responsible for implementing the PEERS curriculum have inadequate knowledge and skills to
implement sessions/activities to meet the needs of students. In order for teachers to gain the
skills required to teach their students and for PEERS to be implemented successfully, it is
important for all relevant teachers to attend regular training sessions.

There are some differences about approaches or methods to be used for teaching HIV
education. The teacher training sessions conducted by the CDD-MOE, through an NGO named
Focus on the Family uses its own manual called No Apologies: The Truth About Life, Love and
Sex. This is based on the abstinence-only approach to sex while UNICEF Malaysia also held
workshops and introduced Life Skill-Based Education for HIV/AIDS Prevention which is focused
on skills building to handle everyday life situations and giving choices for problem-solving.

During FGDs, teachers mentioned that the time allocated to teach PEERS was not sufficient to
deliver all activities through a skill-based approach. They reported that life skills-based HIV and
AIDS education needed more time and continuing training sessions to enable them to use all the
manuals with the students. Teachers are uncertain with different guidance on using HIV and
AIDS education materials that have been received from different sources. Finally, the NUTP
Secretary General and several teachers raised their concerns about the lack of professional
training sessions or standardized teaching regarding to this subject.

Factor 5: Teachers coaching support and the role of the State Education Department

39
During interviews, teachers noted that for the most part, State Education Department
representatives were not involved in the training sessions. These would help them coach or
mentor the teachers who are implementing the PEERS activities in the classroom. Officers from
the CDD-MoE have tried to encourage the health education teachers to pay attention to the
quality of teaching and time allocations for this issue, but with a lack of clarity in policy towards
HIV & AIDS and sexuality education, they tended to give priority to compulsory, core subjects
instead.

The CDD-MOE not only acts as the key agency in putting the HIV and AIDS and sexuality
education policy into practice, but also has the key role in developing the curriculum, subject
standardization and conduct of training for teachers throughout the country. However, they
were not able to monitor and coach involved teachers. Teachers are key in delivering sexuality
education to the students. Their understanding and proficiency in facilitating the skill-based
activities are crucial.

Another division under the MoE that can influence the implementation of the HIV and AIDS
education programme, especially if the skill-building part is strengthened and integrated into
the PEERS curriculum, is the Text Book Division. This division has a key responsibility for
developing the standardized textbooks of all subjects for the entire country. If skill-building
components are integrated into the curriculum, it is vital for the Text Book Division to
understand these components and for these components to be reflected in the textbooks
related to the PEERS curriculum.

Factor 6: Monitoring and evaluation

There is currently no systematic monitoring and evaluation on the impact of the HIV prevention
programmes on reduction of risk taking behaviours among youth in the education system. Most
of the studies found during the data review process tended to narrate only upon the youths
knowledge level and the level of youth engagement in high-risk sexual behaviour. None of the
studies reviewed mentioned the effectiveness of the HIV education programme/curriculum
implemented on reduction of high-risk sexual behaviours or delay of the average age of first
sexual intercourse.

Factor 7: Financial Resources

No data were available on budget allocations for the implementation of PEERS in schools.
However, no constraints on budget support were mentioned during the FGDs. Lack of
appropriate trained teachers and mentors on HIV and AIDS and sexuality education were often
mentioned.

3.5.4 Drug prevention education in schools

The National Anti-Drug Agency (NADA) has been a key organization dealing with drug abuse
prevention in Malaysia since 1996 (National Anti Drugs Agency, 2010). The National Anti-Drugs
Agency Act of 2004 formally established NADAs functions and powers in addressing this issue.
The objective of NADA is to ensure the implementation of national policies on narcotics and
coordinate, monitor and evaluate all activities relating to the control and prevention of drug
abuse in order to create a drug-free nation by 2015.

40
The four core strategies of NADA in eradicating the supply of and demand for narcotics in the
country are: 1) Prevention, 2) Treatment and rehabilitation, 3) Law enforcement and 4)
International cooperation. Primary prevention programmes involve prevention education in
schools and dissemination of information to the public. The activities carried out in 2009 fall
into five broad categories:

Advocacy and Information programmes;


School-based programmes;
Community mobilization programmes;
Drug prevention programmes for parents; and
Drug prevention programmes in the workplace.

The key school or learning institution-based drug prevention programmes include the following
(National Anti-Drugs Agency, 2009):

1. Tunas (or Buds): This programme is specially developed for pre-school-aged children (5-
6 years old) and is based on the philosophy that healthy lifestyles and activities have to
be inculcated while the children are young. In 2009, 248 kindergarten schools
participated in this program.
2. Kem INTIM (Kem Kecemerlangan Intelek Murid) (or INTIM Camp): The objective of this
program which is catered to students in grade 5 (10 11 years old) is to enhance their
knowledge and life-skills to resist the negative peer pressure to take drugs and other
narcotic substances. In 2009, 5,326 students attended a total of 50 camps.
3. PIP (Program Intervensi Pelajar) (or Student Intervention Program): The NADA
conducts surprise or random urine screenings for high-risk students so that early
intervention actions can be taken. Students identified positive for drug use would be
counselled by the school guidance counsellor and requested to attend motivational
camps/courses to enhance their self-esteem and interpersonal skills. Parents of these
students are also invited to participate and share experiences with others on parenting
skills. In 2009, a total of 2,610 students from a total of 264 schools were screened and
49 motivational camps were held for the affected students.
4. SEGAK (Sekolah Gemilang Antidadah) (or Excellent Anti-Drug Schools): Programs are
implemented in schools which are located in hot spotted areas and students are
exposed to drug-related activities. Students resilience in saying No to drugs is
developed through interpersonal skills so that they are able to resist pressure to abuse
drugs. 13,527 students from a total of 76 schools took part in this program in 2009.
5. Institutions of Higher Learning: Programmes are conducted for undergraduates in
institutions of higher learning (universities, colleges and other training or technical
institutions) throughout the country to enhance their awareness and knowledge on
drugs. In 2009, 42 programs were conducted in universities/colleges for a total of
16,048 undergraduates while 7,258 students from a total of 62 training or technical
institutes participated in preventive education activities.

Drugs education in Malaysia has been implemented through curricular, co-curricular activities,
teacher trainings, early intervention programs and community-oriented and school-based
programmes. Elements of drug use prevention education was also included in core school

41
subjects such as physical education, health, ethics, history, languages, home economics, math,
science and art.

According to available data, the drug prevention education programme has never been fully
integrated into the core curriculum. Instead, the most pragmatic approach for reaching all
students in the schools was to have teachers give a series of 5-minute anti-drug talks at the start
of each lesson over a period of five school days. It was believed that by doing it this way, all
teachers and students nationwide got involved in drug prevention education immediately. The
talks covered a wide spectrum of topics including:

The definition of a narcotic drug;


Types of drugs and their effects;
Drug addiction;
The profile of drug users to learn about effects of drug on peoples lives;
Drug laws;
National anti-drug policies and strategies;
Religious perspective on drugs; and
How to avoid drug use.

Health Education teachers have taught the drug use prevention in school in coordinating with
the guidance counsellors and NADA staff. NADA would approach schools to conduct its
activities and the guidance counsellors were to facilitate those activities. A 5-minute talk given
by the teachers is still being carried out as an extra activity to reach all students. It was found
that most of the drug prevention programmes conducted at public schools are additional
activities conducted/assisted by outsiders (e.g. NADA). It has become customary that NADA
would organize an event each year at schools. All classes adjusted their lesson plans in order to
participate in the NADA event which included talks on drugs that discussed various types of
drugs, how drugs affect the body, families and society and law enforcement.

3.6 Summary of Response Issues

The National Strategic Plan on HIV/AIDS (2006-2010) included as an objective reducing the
number of young people aged 1524 who are HIV-infected. It has 6 strategies, one of which was
to reduce vulnerability among women, young people and children. The main educational thrust
for children would be increasing access by young people to life skills-based education. In
addition, access to youth friendly services and the creation of a supportive environment for HIV
prevention among youth was to be developed.

The education sector response has been rather weak. The 2010 UNGASS on HIV report for
Malaysia provides a coverage figure among schools that have implemented life-skills based
education of 0.2%, one of the lowest rates reported in the world, with only 22 schools
participating in a pilot project. There remains a need to improve the policy environment for
improved health of young people through the education sector contributions to health
promotion.

There are no specific Ministry of Education (MoE) policies or plans in place to develop a
comprehensive approach to HIV, drugs, sexuality or sexual health issues. The Ministry of Health
(MoH) has prepared a plan for adolescent health and essentially drives the HIV response. There

42
is ample scope for more concerted multi-sectoral action, with a much stronger contribution
from MoE. The approach to school health and nutrition appears to be fragmented and in need
of greater policy and institutional coherence, more in line with international best practice.

MoE has integrated HIV and reproductive health education across the curriculum in secondary
education and in Physical Education (PE) at primary level. The approach to integration is content
based and has lack inclusion of life skills education. It has relied strongly on the reinforcement of
moral values. This may be necessary, but not sufficient in the context of a rapidly changing
Malaysia. The original Family Health Education has been recently revamped as PEERS. It includes
enhanced drugs and sexuality education content at primary and secondary levels, with life skills
education introduced. Co-curricular activities through the MoH developed PROSTAR
programme, which includes peer education, is ongoing in schools, though coverage data are
lacking.

The quality of PEERS and PROSTAR delivery are constrained by shortcomings in teacher/peer
educator training and support, school leadership and commitment, the lack of assessed learning
outcomes, and weak community involvement. Greater policy clarity is required on the
contribution of NGOs to HIV, drugs and sexuality education.

It is hard to discern a clear response to the impact of HIV on the education sector in relation to
the rights of children living with and affected by HIV. There is no specific HIV workplace policy in
place in the sector. There is no clear position on anti-discrimination education concerning
people living with HIV or any visible programming.

The response to date falls short of being comprehensive. Table 1 below summarises key
elements of the response. Key issues to be addressed by MoE are:

Policy development (School health/workplace);

Teacher education and support (Pre-service education and school based support);

Strengthening co-curricular activities; and

Strengthening coordination and M&E.

Table 1. Elements of a comprehensive response in HIV, drugs and sexuality education

Key Elements of a comprehensive response Malaysian Response

An education sector policy on HIV and AIDS that Not in place


addresses both HIV prevention and issues that arise
from their impact on the school such as stigma and
discrimination and teachers and students living
with HIV;

HIV/drugs training for MoE staff at all levels; No training plan.

Training appears to be ad hoc.

HIV/drugs prevention education curriculum Taught specifically in primary and secondary


development (sexuality education) and age specific education through PEERS components in Health
teaching and learning materials; Education subject under the new curriculum

43
transformation

Pre and in-service teacher training to implement Reliance on in-service teacher training
the sexuality education curriculum;
Co-curricular activities such as peer education In place, but there are issues of quality and
coverage

Monitoring arrangements to ensure programme Not in place


effectiveness.

4. Recommendations

On the basis of this SRA, it is recommended that the MoE take steps to strengthen HIV, drugs
and sexuality education, building on what is already in place. The following specific
recommendations are made to MoE:

1. Convene a Task Force on HIV, drugs, health and sexuality education;

2. Develop a medium term action plan to strengthen programming across the


education sector through a participatory process involving key stakeholders;

3. Review current policies on school health, HIV and drugs education;

4. Put in place an appropriate M&E arrangements for PEERS/PROSTAR;

5. Consider developing parental education programming;

6. Strengthen the inclusion of gender issues in the curriculum and co-curricular


activities;

7. Develop appropriate content for the pre-service training curriculum and associated
materials and train trainers; and

8. Train school leaders/managers in HIV, drugs and sexuality education;

9. Consider developing innovative methods to reach youth both in and out of school,
including the use of social media.

44
Annex 1: Persons Interviewed

1. Ms. Maya Faisal, Social Policy Specialist, United Nations Childrens Fund Malaysia
country office.
2. Mr. Nur Anuar Abdul Muthalib, Project Officer Monitoring and Evaluation, United
Nations Childrens Fund Malaysia country office.
3. Ms. Yeoh Yeok Kim, Executive Director, Federation of Reproductive Health Associations,
Malaysia.
4. An officer of the Curriculum Development Division Health Education, Malaysia
Ministry of Education.
5. Twenty students (Grade 11 or Form 5) of a government secondary school comprised 10
males and 10 females who ten of them are Malay and other 10 are Chinese and Hindu.
6. Two Physical and Health education teachers of a government secondary school.
7. Two counselors of two government secondary schools.
8. One senior school assistant (deputy principal) of a government primary school.
9. Two senior school assistant (Academic) (deputy principal) of two government secondary
schools.
10. One principal of a government primary school.
11. One senior school assistant (co-curricular) (deputy principal) of a government primary
school.
12. Two school teachers who are engaging in the PROSTAR project of a government primary
school.
13. A college graduated student who is currently involving in HIV/AIDS prevention and
related activities.

45
Annex 2: PEERS topics covered in the core school curriculum

Grade Level Physical education and health Science and Biology Islamic Education

Primary school (Grade 1-6, ages 6-11)

Grade 1 Personal hygiene

Grade 2 1. Physical and emotional differences between


boys and girls (activity-based)

2. To express pride and joy in ones sex

3.Birthing process; Love for ones parents

Grade 3 1. Family members and their geographical


locations

2. Family concepts including love, close ties,


cooperation, loyalty to parents, etc.

Grade 4 1. Puberty as growth stage

2. Physical changes

3. Differences between boys and girls

Grade 5 1.Female menstruation and nocturnal


emissions

2.Female menstruation hygiene practices

3. Sexually transmitted infections (STIs) and


how they are transmitted and prevented

Grade 6 1.Common physical problems faced by


teenagers and how they can be overcome

Secondary schools (grades 7-11, ages 12-16)

In secondary schools, FHE is taught in Physical education classes, science, biology and Islamic education.

Grade 7 1.Physical, emotional and social changes during 1.Reproduction including Sexual
the teenage years and asexual reproduction; Male
and female sex organs; Sperm and
2. How to deal with strangers ovum; The menstrual cycle and its
effects; Fertilization and
3. Discuss, explain and exemplify a range of implantation; Stages from
health-related issues: neglect, responsibility, pregnancy to birth; Prenatal
consequences of neglect and decision making nutrition and the fetus; Meiosis cell
division; Fetal development; Birth;
Twins; Problems relating to
fertilization; The placenta and its

46
functions; Reproductive
technologies: artificial
insemination, in vitro fertilization
(IVF) and contraceptive methods;

2. Diseases: A range of viruses that


cause diseases, including HIV (AIDS
is referred to as being caused by a
virus. Also, it is noted that viruses
in general are incurable and that
practicing a healthy lifestyle is the
best form of prevention.), Disease
spread by sexual activity such as
HIV and venereal diseases, Human
growth and development, The
development of secondary sexual
characteristics, The menstrual cycle
and hormonal control

Grade 8 1. Personal, family and community health

2. Positive and negative moral values that


affect personal health

3. Relationships between physical, mental,


emotional, social and spiritual health

4. Effects of conflicts on health and overcoming


those conflicts

5. Practice decision-making regarding


emotional and social changes and pressures
experienced during adolescence

6. The responsibility of guarding ones own


health during teenage years

7. Physical changes that affect emotions and


behavior

8. Genital health

Grade 9 1. Discuss classroom friendship patterns; 1. The illicit deeds committed


Investigate good behavior and interaction by man before the Prophet
Muhammad
2. Needs of and responsibilities given to
friends, family and the community 2. The consequences visited
upon those who commit
3. Code of ethics for responsible social illicit deeds
interaction outside of school
3. Teachings that are
4. Personality development; the influence of exemplary (e.g. the story of

47
others and acting responsibly Lot, his people and wife)

5. Social etiquette and behavior regarding


physical development

6. Roles and responsibilities of family members


and parenthood

7. Lifestyle problems; STIs, AIDS, drug use,


cardiovascular disease, cancer, emotional
stress, high blood pressure and diabetes

Grades 10 1.The concept and characteristics of a happy


family

2. Family member roles and responsibilities


from a range of different perspectives:

Before marriage, the institution of


marriage, preparedness for marriage,
financial matters, finding the right
match, marriage customs, religious and
civil laws, governance of marriage, rights
and responsibilities between husband and
wife
Adjusting to married life, before and after
children, conception and birth,
misconceptions regarding fertility and
pregnancy
3.Marriage, family planning, domestic
management, polygamy, different
expectations, family interference, sexual
problems (infertility and impotence)

4.Laws that govern the family and protect


children

5.Common family problems, teenage marriage,


elopements, pregnancies outside of marriage,
broken families, runaway children, child abuse,
spousal abuse

6.Discuss the classification, sign and symptoms


of disease

Diseases that can be spread though a


multiple of means (i.e. AIDS and
hepatitis B are spread through sexual
intercourse, blood transfusions,
injections and the transference of
bodily fluids)
STIs, AIDS, gonorrhea, syphilis,
hepatitis B and herpes
7.Discuss disease prevention and control

48
(condoms are not specifically mentioned as a
method of preventing HIV and STIs)

Health education
Healthy habits
Avoidance of casual sex and
promiscuity
Reporting cases of diseases to
relevant authorities
Early detection and treatment
Cooperating with relevant authorities
Grade 11 Same as Grade 10 1.The blessings of marriage
as ordained by God: To have
lawfully-gotten children; To
produce a clean, new
generation; To nurture love;
To prevent illicit deeds; To
promote spiritual ties

2. How to produce a clean,


new generation and how to
overcome the problems of
contemporary Islamic youth

49
Annex 3. References

Durex. (2005) Give and Receive. 2005 Global Sex Survey Results.
http://www.durex.com/en-jp/sexualwellbeingsurvey/documents/gss2005result.pdf

Huang, M, (2000) Country Profile: Malaysia, Department of Nutrition and Community Health
Sciences, Universiti Putra Malaysia, Serdang, Malaysia.

Malaysian AIDS Council. (2008). Strategic Plan 2008-2010. Kuala Lumpur.


http://hivaidsclearinghouse.unesco.org/search/resources/4772_StrategicPlan20082010Malaysi
a.pdf

Ministry of Health. (2010). Malaysia. 2010 UNGASS Country Progress report. Reporting period:
January 2008-December 2009. Kuala Lumpur.
http://www.moh.gov.my/images/gallery/Report/Cancer/UNGASS_MALAYSIA_final.2_2010-
1.pdf

Ministry of Health (2007). National Adolescent Health. Plan of Action. 2006-2020. Kuala Lumpur.

Ministry of Health (2006). Malaysia. National Strategic Plan on HIV/AIDS. 2006-2010. Kuala
Lumpur.
http://hivaidsclearinghouse.unesco.org/search/resources/1329_malaysia20062010.pdf

National Anti Drugs Agency, (2010). Malaysia Country Report 2009, National Anti Drugs
Agency, Ministry of Home Affairs. Kuala Lumpur.
http://www.aipasecretariat.org/wp-content/uploads/2010/07/Malaysia-Country-Report.pdf

Talib, R (2006). Malaysia - Fighting a Rising Tide: The Response to AIDS in East Asia (eds.
Tadashi Yamamoto and Satoko Itoh). Japan Center for International Exchange. pp. 195-206.
http://www.jcie.org/researchpdfs/RisingTide/malaysia.pdf

UNAIDS. (2004). Three Ones key principles. Coordination of National Responses to


HIV/AIDS Guiding principles for national authorities and their partners. Geneva.
http://www.unaids.org/en/media/unaids/contentassets/dataimport/una-docs/three-
ones_keyprinciples_en.pdf

UNESCAP. (2002) Youth in Malaysia. A Review of the Youth Situation and National
Policies and Programmes. Bangkok.

UNESCAP (2006). Country report: Malaysia. East Asia and Pacific Regional Consultation
on Children and HIV/AIDS Hanoi, Viet Nam 22 24 March 2006.

UNESCO. (2008). HIV preventive education. Information kit for school teachers, Bangkok.
http://www.unescobkk.org/fileadmin/user_upload/hiv_aids/Documents/Information_Kit/HIV_a
dvocacy_toolkit_final_low_res.pdf

UNESCO. (2009). International Technical Guidance on Sexuality Education. Volume 1. An

50
evidence-informed approach for schools, teachers and health educators. Paris
http://unesdoc.unesco.org/images/0018/001832/183281e.pdf

UNODC. (2011). World Drug Report 2011. Vienna.


http://www.unodc.org/documents/data-and
analysis/WDR2011/World_Drug_Report_2011_ebook.pdf

WHO. (2007). Preventing HIV/AIDS in young people. Evidence from developing countries on
what works. A summary of WHO technical report series No 938. Geneva.
http://whqlibdoc.who.int/trs/WHO_TRS_938_eng.pdf

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