Four bilateral agreements signed with Pakistan

The Maldives has signed four Memorandums of Understanding with Pakistan today during president Abdulla Yameen’s ongoing two-day state visit.

The MoUs were for mutual cooperation in healthcare, education, sports, and combating drug abuse.

President Yameen was accompanied by first lady Fathmath Ibrahim, speaker of parliament Abdulla Maseeh Mohamed, and cabinet ministers. The delegation is due to return tonight.

President Mamnoon Hussain hosted a banquet in honour of president Yameen last night. The pair held talks on strengthening bilateral ties earlier in the day.

“President Yameen thanked his Pakistani counterpart for the excellent hospitality extended to himself and his delegation,” said the president’s office.

“President Yameen also extended an invitation to President Mamnoon Hussain to visit the Maldives at his earliest convenience. At the meeting, both the leaders deliberated on enhancing trade and cultural exchanges, as well as expanding the scope of investment opportunities. Discussions were also held on supporting each other in the global arena.”

Yameen has also reportedly invited prime minister Mohamed Nawaz Shareef to attend an official function due to be held on July 26 to mark the golden jubilee of the Maldives’ independence.

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Women urge drastic action from president on drugs

A women’s group campaigning against drug abuse has handed the government a petition urging President Abdulla Yameen to prioritise the Maldives’ drug crisis.

The Society for Women Against Drugs collected 359 signatures calling on the president to improve the quality of drug rehabilitation care, and to launch medical care for addicts suffering from withdrawal symptoms in police custody.

“Successive governments have attempted to address the problem of drugs, but they are not doing enough and we don’t see politicians prioritizing the issue,” said the group’s chairperson Fathimath Afiya after handing over the petition last week.

According to a 2012 UN report, there are 7,496 drug addicts in the Maldives. However, critics say the true figure is much higher.

Meanwhile, health advocacy groups have expressed concern over a high risk of HIV spreading among an unmonitored population of injecting drug users.

President Yameen in February acknowledged that changes were needed in the drug rehabilitation system, but the cabinet in March discussed mechanisms to decrease state expenditure on drug care centres.

Home Minister Umar Naseer last year pledged to prioritize drug trafficking and last month brought in a sniffer dog squad.

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Two arrested from Hulhumalé youth show

Police arrested two men aged 19 and 20 at a music show dubbed “Youth for the Nation” held at Hulhumalé last night, reports Sun Online.

While one was arrested on suspicion of drug use, police said the second suspect was arrested for allegedly harassing a girl at the show.

The show was also held in Malé. It was reportedly organised by a group of youth with the aim of airing and addressing concerns and grievances of young people

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Drug Court sending addicts to jail after detox centres reach capacity

With government detox facilities at capacity the Drug Court is sending addicts to jail in the interim, prompting the Maldives’ National Drug Agency to call on private businesses and NGOs to fill the gap.

Twenty-four men have been sent to prison for 90 days, or until space becomes available for treatment, in accordance with the Drug Act which states the court has the authority to do so if “rehabilitation centers are unable to facilitate treatment”, according to local media.

All emergency medical detox centers are full nationwide – the Himmafushi Island, Villingili Island, Fuvamulah and Addu, National Drug Agency (NDA) Chairperson and State Health Minister Lubna Mohamed Zahir Hussain confirmed to Minivan News today (May 1).

“Rehab is not full, however detox is full for the next 14 days. Demand is so high that clients are waiting in prison,” said Zahir.

“The Drug Court is sentencing too many people every day. There are so many – too many – cases. The court doesn’t want to delay sentencing, so people eligible for rehab must wait in prison – for a maximum of three months,” she added.

Zahir stated that 24 men currently in jail – awaiting the first phase of rehab, which is detoxification – will be moved to the drug rehabilitation center on Himmafushi island within two weeks. No women are awaiting detox, claimed Zahir.

“We are calling for help”

Zahir emphasised that current government regulations allow for the privatisation of rehabilitation centers and the NDA has requested bids for private companies in the government gazette, however no applications have been submitted thus far.

“We are looking forward to receiving applications. It’s time the government opened international bidding to do so,” declared Zahir.

“[The NDA] is open for discussions about opening a rehabilitation resort. A similar program to cabins in Chiang Mai, Thailand, which is a really good program.

“For example, foreigners can come to the island destination [for drug rehabilitation], the profits of which could be used to subsidise treatment for Maldivians,” Zahir explained.

The private rehabilitation centers would be supplementary to the national treatment center for men and women, which is required by law, according to Zahir.

She also highlighted the need to strengthen aftercare programs in partnership with local communities. This is a particular challenge for NGOs who are working with drug addicts.

“Communities fail to understand the work NGOs are doing with drop-in clients. Awareness and education are needed, because NGOs are running into lots of problems with communities,” said Zahir.

Political polarisation and the focus on the upcoming presidential elections seems to be preventing this work from occurring, claims Zahir.

“It is easy [for NGOs] to apply for and get community [drug] rehab licences to conduct relapse prevention. And we are really calling for help,” she implored.

NDA has also issued requests for qualified people to apply for councillor positions with NDA to support their outpatient community rehabilitation programs.

There are between 200 and 400 clients, but very few councilors, Zahir explained.

Facilities lacking

The limited space within the Himmafushi rehabilitation center becomes available on a revolving basis – as clients complete their treatment – however capacity to conduct the three day emergency medical detoxification is extremely restricted.

The Himmafushi center has space to detox about 20 people at any given time, however it only has the capacity to manage about 10 individuals. The center is able to conduct drug rehabilitation for 150 men and 12 women maximum. Additionally, 12 detox spaces are available on each of the islands of Villingili, Fuvamulah and Addu.

“Two years ago we used a detox dorm for women on Himmafushi, however they were shifted to the female specific unit established on Villingili June 26, 2011,” explained Zahir.

“The NDA and Gender Department – under the Health Ministry – ran the rehabilitation center for women on Villingili. But it was closed in 2012 when the Gender Department became the Gender Ministry and took over the building.

“We requested from [former Gender, Family and Human Rights Minister] Diyana Saeed to keep center. Demand is high, we need a unit always,” she added.

Subsequently, women in need of drug treatment did not have a center for seven months until the original female dorm located on Himmafushi was reopened.

The NDA is planning to add three additional units to the Himmafushi drug treatment center and had requested government funds for the project, according to Zahir.

“NDA lacks implementation capacity”

“Drug abuse is too much money for the government to bear, because the problem is so wide-spread and the cost is so high,” an expert in holistic drug prevention, treatment, and aftercare told Minivan News today.

“The government is doing almost nothing for drug prevention, which then puts a huge burden on the government, including the public health sector. There is also a dire need for early intervention,” claims the source.

“NDA lacks the capacity and staff to do everything. They are not able to handle prevention, inpatient or outpatient treatment. Currently, they do not even have a CEO and are operating outside of the law,” the source continued.

“NDA should act as a governing body and watchdog only. Otherwise they cannot handle the demand,” added the source. “There is only one rehabilitation centre and it’s always full because there are so many people in need.”

The source suggested that the state-run detox and treatment centers should be outsourced to private or civil society institutions, leaving room for the NDA to oversee and regulate. Additionally, building NGO capacity to address drug abuse would “benefit the entire nation”.

“There is no one to monitor and make them responsible if NDA is the implementing body,” said the source.

A “clear cut” country strategy – similar to the recently released 2013-2020 European Union drug strategy – needs to be developed in the Maldives, the source believes. The entire sector in Maldives works at cross-purposes and is not aiming for one particular prevention, treatment, or aftercare goal.

“Addiction is a lifelong chronic, relapsing brain disease. A person will relapse six to eight times or more before they completely stop using and live a sober life,” explained the source.

“Relapse is not failure, rather it’s due to the treatment program or person lacking some kind of support. Addiction is a very complex disease and affects each person differently.

“Often addiction is accompanied by another disease, such as depression or other mental health issue, but treatment in the Maldives does not address this. Thus, people relapse easily, which adds to the stigma surrounding drug users.

“This concept needs to be internalized in the Maldives and a continuum of care must be provided. This includes environment based intervention, evidence based and client focused treatments, as well as continuing guidance, education and support programs,” said the source.

The source further recommended referring to the US National Institute on Drug Abuse to structure these programs.

“The government spends so much money and this is such a small place, they should be able to do something,” concluded the source.

Nationwide drug abuse controversy

The United Nations Office on Drugs and Crime (UNODC) and NDA published a survey in February, claiming there are 7496 drug users in the Maldives.

Informed sources who participated in the survey process previously expressed serious concerns about the “flawed methodology” of the data collection process, which they claimed had produced a final report that inaccurately and grossly underestimates drug use in the Maldives. Key populations such as those in jail, women, and users of ‘party drugs’ were left out of the survey.

The NDA subsequently refuted criticisms over the drug report’s methodology in a letter sent to Minivan News.

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Experts lambast results of US$170,000 million National Drug Use Survey

A survey published by the United Nations Office on Drugs and Crime (UNODC) and Maldivian National Drug Agency (NDA) has claimed there are 7496 drug users in the Maldives.

According to the findings of the nationwide survey, 6.64 percent of people aged 15-64 in Malé and 2.02 percent in the atolls are currently using drugs, with the highest proportion of drug users aged between 15 and 19 years old.

The study also sought to determine drug use patterns, assess behavioral characteristics, and identify “community knowledge, attitudes and perceptions towards the drug problem”.

According to the study, being unmarried is considered a “risky behavior among drug users”.

Non-governmental organisations (NGOs), community based organisations (CBOs), and other stakeholders were also found to “heavily emphasise law enforcement and faith-based value systems,” as opposed to treatment and rehabilitation.

“A strong endorsement of Sharia’h law was apparent. In words of a key stakeholder, ‘Treatment alone will not yield results. It must be in conjunction with proper punishment’,” the report stated.

The survey findings also “confirmed that drug use in Maldives is predominantly a male phenomenon” and claimed the most common drugs are hash oil and brown-sugar (a heroin derivative) – known locally as theyo and hakaru, respectively.

However, key populations such as those in jail, women, and users of ‘party drugs’ were left out of the survey.

Controversial findings

Informed sources who participated in the survey process have expressed serious concerns about the “flawed methodology” of the data collection process, which they claimed had produced a final report that inaccurately and grossly underestimates drug use in the Maldives.

The number of drug users reported by the survey was extremely low compared to the number of actual users, the sources said, which previous studies had found ranged between 20,000 and 30,000 people.

“The methodologies used are flawed and do not work in the Maldivian context because of social stigmas surrounding drug use. There was no effort to develop a methodology that would be appropriate for this country context,” said a source.

The enumerators used to conduct interviews for the survey were “very young, inexperienced kids” while those with “extensive experience” in drug abuse prevention and with surveying were marginalised, sources claimed.

“No one in the Maldives will openly admit ‘I’m a drug user’ – it’s seen as a moral issue because of religious beliefs,” the sources stated.

“The survey team was getting zero numbers from some atolls. But they insisted they were using a scientific methodology and this would be corrected at a later date,” the sources explained.

“All these young people who just finished school who were used as supervisors, they were useless,” the sources alleged.

“Teenage interviewers would go to houses and ask elders if there were any drug users in the household, and of course they said no. Additionally, drug users are also very manipulative,” the sources said.

Production of the report involved 50 enumerators surveying 3500 households, 762 people, and 72 focus group discussions.

“The incentives used – 20 MVR for completing a questionnaire – targeted heroin users only. Additionally, 80 percent of incarcerated population uses drugs and they were not included in this survey,” informed sources stated.

“Furthermore, the differentiation between male and female addicts, and the exclusion of women from the survey, is not something normally done,” the sources added.

The sources claimed the National Drug Agency (NDA) was informed about the methodological flaws, however no action was taken to correct the problem.  Moreover the NDA did not set policy standards or engage in oversight and instead conduct implementation without any monitoring, they claimed.

“When this survey started two years ago, the government was informed about all these problems, but they did not give a damn about this. The purpose of all this manipulation is for political reasons. They want to show the public that the [drug abuse] problem is improving,” the sources alleged.

“The government should know what they are doing in this sector. They should know better than to use drug addiction as a political tool,” the sources stated.

Flawed findings

Expert sources involved in the survey process had strong negative reactions to many of the report’s findings.

“Being unmarried is not a risky behavior related to drug use. How did they come to this conclusion? It’s crazy!” said one informed source.

“NGOs, CBOs, and stakeholders are not in favor of punishment over treatment. NGOs changed the law to have drug abuse recognised as a disease,” they said.

New trends in drug use were excluded from the report’s focus as well.

“There are drugs that are not even mentioned in this survey coming in now, like meth, and most of the party drugs are available in the Maldives now, such as speed, ecstasy, and LSD.

“Older users are going for the heroin, while youth that are to use hashish oil are now also going for party drugs,” the sources explained.

More harm than good

The survey’s findings were “commendable”, said National Drug Agency Chairperson and State Minister for Health, Uza Lubna Mohammed Zahir Hussain, in the report’s foreword.

“The information provided by this survey without a doubt contributes to a better understanding of the nature and extent of the impact of drug abuse and this understanding will help decision makers to identify appropriate strategies to combat the problem of drug abuse in the Maldives,” Lubna stated.

However, the informed sources were distraught by the possible ramifications of the report’s “flawed” findings.

“Future plans, policies, and interventions will be designed based on this survey, which is not accurate. We know very clearly the results are wrong,” they said.

“Now for another 10 years there will not be enough funds for drug prevention and treatment. Donors will refer to the survey and think the Maldives doesn’t need any prevention or treatment programs, because the reported prevalence rate is so low,” said sources.

For example, expert sources explained there was only one rehabilitation center in the Maldives and that it is “inappropriate” for the Maldivian context, as well as understaffed. No experts in drug abuse treatment staffed the rehabilitation centre, the NDA or Health Ministry, they added.

“The NDA is running the rehab center, which employs a behavior-based program for heroin users. It doesn’t work for other types of addicts and there is no oversight. There are no beds and all the toilets are broken.

“There was a marijuana user sent for treatment. Every other day he tried to swim away from the rehab island and nearly drowned because he has  mental problems. The program didn’t match his needs,” sources stated.

Sources explained there were numerous such problems which will now be greatly exaggerated by the survey’s “false” findings.

“Already there are next to no prevention efforts, supply reduction policies, or harm reduction programs; nothing comprehensive.

“Customs and the Maldives Port Authority have no container scanning machines and no drug-sniffing dogs. Anyone can bring drugs into the country,” they said.

“Meanwhile, government policies are changing almost every day. Whenever the government involves themselves in this sector they do harm, not good,” the sources lamented.

Sources claim that government policies under the last three administrations have been “ad hoc” and worsened drug abuse within the Maldives. Multiple international consultants have conducted drug use assessments and their recommendations are nearly identical, yet these recommendations are never enacted as policies, the sources stated.

Minister of Health Dr Ahmed Jamsheed Mohamed also voiced concern regarding drug abuse policies. During his speech at the survey’s launch, he stated that drug abuse was the “worst enemy of development” and based on the survey’s findings, it is necessary to “take a break, take stock, and strategise”.

The National Drug Use survey was conducted between 2011 and 2012, by the UNODC, NDA, INOVA Pvt Ltd, All India Institute of Medical Sciences (AIIMS), in partnership with five civil society organisations. The European Union and Swedish government provided US$2,180,200 in funding.

Download the National Drug Use Survey

Clarification: The National Drug Agency (NDA) has responded to this article in a letter, published on Minivan News. According the NDA, the US$170,000 budget for the survey was “a small amount of the overall budget of expenditure pertaining to the NDUS research”, and therefore the reference in this article’s prvious headline to the total funding of US$2 million was misleading. Minivan News has clarified the headline to avoid confusion.

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Maldives identifies “first” child HIV infection

Senior health figures have called on the government, NGOs and members of the private sector to help step up attempts to promote AIDS prevention in the country after authorities discovered that a two year-old child had tested HIV positive earlier this year.

While accepting that HIV infection rates remained relatively low in the Maldives, Minister of State for Health Lubna Zahir Hussain said that efforts needed to be increased across all sectors of society to tackle attitudes towards high-risk behaviours that allow the virus to be transmitted.

Lubna heads the National Drug Agency (NDA). Her comments followed the hosting of a special NDA workshop on HIV prevention held on December 1 to commemorate World AIDS Day. The workshop was focused particularly on the HIV infection through drug abuse.

Though statistics indicate HIV infection rates have been limited in the Maldives over the space of the last two decades, health officials in the Maldives have begun to raise concerns about the risk of cases spreading across the country.

In October Minister of Health Dr Ahmed Jamsheed Mohamed claimed it was only through “incredible luck” that HIV had not spread across the Maldives, considering the prolific levels of unprotected sex and intravenous drug use.

Addressing concerns raised by Health Minister Jamsheed about the potential scope for HIV to spread beyond high-risk communities such as drug users, Lubna said greater effort was needed to address attitudes of the general public to the spread of the virus.

“I think what the health minister was saying is that it is not only people living bad lifestyles that are at risk [of HIV infection],” she said, reiterating concerns about the number of young people engaged in intravenous drug use and potentially dangerous sexual practices.

She spoke about a child who was suspected of having been infected from her mother at birth.

“We were first made aware of the case in April 2012 and as far as I know, this is the first case [of a child in the Maldives being born HIV positive],” she said. “However, I think it is important for the public to know the reality of the situation right now, whilst respecting [the child’s] privacy and well being.”

Lubna said she was ultimately encouraged by the work of the country’s health authorities in trying to address the HIV risk from national attitudes towards sex and drug use in the country, yet warned against complacency.

“This doesn’t mean that we continue to work at this pace to try and address attitudes towards AIDS and its spread,” she said.

Lubna called on civil society, the business community and government to speed up efforts to hold awareness and education events about the dangers posed through unprotected sex and intravenous drug use, and to promote preventative measures to reduce the national HIV risk.

Attempts have been made to work with local drug NGOs such as Male’-based Journey on running special outreach programs and blood tests to try and monitor and manage infection rates.

However Lubna said that drug use was not the only area of concern in trying to curb HIV infection.

“Prostitution is another area that needs to be looked into. Awareness work in this area needs to be seen immediately,” she said.

She said greater awareness was needed not just among the general public, but by government authorities and law enforcement agencies.

First Lady’s concerns

During the NDA workshop, First Lady Ilham Hussain stressed that growing numbers of the country’s youth were subjected to dangerous habits that could potentially lead to HIV infection.  She highlighted recreational drug use in particular as the leading cause of the virus spreading nationally.

“Incredible luck”

Speaking earlier this year on the issue of HIV infection rates, Health Minister Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

“What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire,” he said at the time.

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.

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EU’s anti-drug money will go towards rehabilitation

The Maldives has signed a memorandum of understanding between the European Union (EU) and United Nations Office on Drugs and Crime (UNODC).

The deal includes an aid package worth €1.5 million over two and a half years to strengthen the country’s response to drug abuse.

Foreign minister Dr Ahmed Shaheed said the money, which comes from the EU and would be in the hands of UNODC, will mostly be used to help with the rehabilitation of drug addicts, make people aware of the relationship between HIV and drug use.

Dr Shaheed signed the agreement at a ceremony yesterday with EU Ambassador Varnerd Savage and representative of the UNODC Regional Office South Asia, Cristina Albertin.

Speaking at the ceremony, Varnard said the program would strengthen the national response to combating drug abuse in the Maldives, and would target the major problem areas of drugs and crime.

Albertin said 10 per cent of the Maldivian population is affected by drug abuse, and that UNODC hoped the program would assist  in the country’s enforcement of drug laws.

Reaction

Chairperson of the Society for Women Against Drugs (SWAD) Fathmath Aafiya said she hoped the project would not end up like the government’s previous ‘WAKE-UP’ program.

”The government does not do sufficient work to reduce the number of drug importers,” she said, criticising the government’s lenient treatment of dealers by placing some under house arrest and letting others go free.

Aafiya said the government had “a lot of work to do” to reduce the importation of drugs into the country.

SWAD was expecting the new program to be beneficial, she added, as it would increase the aftercare and rehabilitation of drug users.

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