NDA talks national drug studies, prevention policies and budget difficulties

The National Drug Agency (NDA) has defended the accuracy of a recent national survey into the scale of narcotics abuse and addiction in the Maldives, claiming the prevalence model used by researchers was the most efficient method presently available.

Some sources who participated in the survey process have expressed serious concerns about the “flawed methodology” of the data collection process, which they claim produced a final report that was inaccurate and had grossly underestimated the extent of drug use in the Maldives. The NDA has previously refuted criticisms over the drug report’s methodology in a letter sent to Minivan News.

NDA Chairperson and State Health Minister Lubna Mohamed Zahir Hussain has since claimed that on the back of a reduced state budget for its prevention and treatment programs in 2013, the findings would play a key role in helping authorities devise its future strategic action plan.

Lubna’s comments followed the publication by the NDA and the United Nations Office on Drugs and Crime (UNODC) last month of a prevalence survey based partly on primary data obtained from atolls capitals and almost two dozen randomly selected islands across the country. The survey concluded there were a total of 7,496 drug users in the Maldives, with the highest proportion among those aged between 15 and 19 years old.

To gather the findings, the team behind the study said they had used a scientific methodology combining secondary data from the state, such as police and prison services, with survey information gathered from 35 of the country’s inhabited islands.

Representatives from the team involved in compiling the study added that the data provided risked being “skewed” if its researchers had focused specifically on islands with known drug problems, rather than random parts of the country.

The NDA was among one of three key agencies working on the report that also included the (UNODC) and Inova Pvt Ltd – a national research organisation.

Sources who had worked on the report have alleged that the number of drug users identified in the survey was extremely low compared to the number of actual users, claiming that previous studies had estimated that the number of local users ranged between 20,000 and 30,000 people.

The report’s authors contend that there had been little scientific study to confirm such figures beyond anecdotal evidence in the past, with the latest figures better reflecting the scale of the problem in the country.

“Significant drug problem”

Criticisms were also raised by sources involved in the survey process over the scope of testing, which was alleged to have excluded women and the country’s prison population.

The charges were denied by the state organisations and civil society groups behind the report, who added that the latest figures indicated a significant drug problem in the country, with the study providing the first such data of its kind on drug use in the Maldives at a national level.

As part of the methodology used for the report, the survey team told Minivan News that respondents aged between 15 to 64 years of age were questioned across 35 of the country’s inhabited islands.

According to the report’s producers, two islands per atoll were focused on in the study. These included the capital of every atoll and another randomly selected island.

Asked whether such a system could provide an accurate reflection of the number of drug users around the country, the survey team claimed that prevalence studies were favoured by some experts as they allowed for greater control of perceived error limits that might affect the outcome of findings.

A similar methodology used to in the report’s calculations had also used to compile national data for the World Drug Report, according to the research team.

“The methodology [used in the national drug report] is in line with information gathered in the World Drug report. The is the first such information of its kind [for the Maldives],” a member of the team who compiled the report claimed.

“Skewed” figures

A source who has worked in the Maldives NGO sector for the last two years also accused the NDA, UNODC and other stakeholders behind the report of using a methodology that was not relevant to assessing the true scale of drug addiction across the country’s often isolated island communities.

However, a civil society representative involved with the study told Minivan News that the formula used in the report would have been “skewed” if researchers had singled out islands suspected of having more severe levels of drug use and addiction.

Under the same rationing, the survey team claimed that directly including the country’s prison population, 80 percent of whom are claimed to have been imprisoned on suspected drug offences, would again have adversely impacted the formula used to compile its most recent findings.

Rather than omit prison populations entirely, the report’s authors said they had turned to secondary information such as prison data and arrest figures from the police to help “indirectly estimate” the number of drug users using a specially devised methodology.

Researchers behind the survey added that the only other alternative to this model would have been to conduct a census-style test. They claimed such a model would have been too costly for the nation considering the economic challenges facing the country in recent years amidst heightened calls for reduced state spending.

The NDA also added that the study had been independently monitored by the EU and UNODC during the survey period that was conducted across various atolls for a period of two to three months, starting in October 2011. The study period was said to have run for slightly longer in the capital of Male’, according to the research team.


With the findings now released, Afiya Ali, a clinical psychologist working on the study said that the findings had shed new light on the reasons why people were turning to drugs in the country, with young people between 15 to 19 years of age being particularly susceptible.

Afiya said that the findings had indicated that a large number of people turning to drugs in the country found to come from regular backgrounds as opposed to common perceptions of drug takers coming from criminal or troubled backgrounds.

Experimentation was highlighted as a major driver to encouraging young people experiment with alcohol and drugs.

“It is only recently that life skills have been introduced to schools as their has been reluctance from parents and senior figures in the schools to accept these topics,” Afiya explained.

However, she added that that work was being undertaken within the national curriculum, even with young children to indirectly teach them about peer pressure that could lead to such experimentation.


The team behind the report told Minivan News that a high level of social stigma among Maldivian females of being associated with drugs had limited the overall effectiveness of understanding narcotics use among women and girls – despite maintaining that users in the country remained predominantly male.

Further study specifically around the amount of females using or addicted to drugs in the Maldives was highlighted by Lubna and the survey team as an area potentially requiring a greater focus in the next few years.

“There will always be limitations to such studies, this include the difficulties in capturing data on females using drugs,” the report authors claimed, adding that similar challenges faced researchers around the world, with drugs widely accepted to be a male-orientated problem.

“There is a social perception that for a guy to be labelled a drug user is less taboo than for a woman. We need to conduct targeted research on women only [concerning drug use].”

Also highlighted among limitations that would impact the final report by the team was the prevalence of drug use among teenagers and children below 15 years of age. However, the NDA claimed that it would be possible to replicate such a study using a similar methodology used in its most recent report.

In terms of the report methodology researchers were sent to 35 of the country’s inhabited islands, where it used four separate questionnaires to try and screen interviewees to ascertain if they may have had experience using drugs

According to researchers these included an initial questionnaire with lighter questions such as whether a respondent knew anyone who had been a drug user. For subjects anticipated of having used drugs, picture cards depicting various drugs available in the country, along with both their English and Dhivehi names, were distributed in order to try to gage familiarity among respondents with the drug scene.

“We had a 90 percent response rate, people wanted to give us information,” said the researchers.

Respondents were also asked to sign a confidentiality agreement and consent form expressing that findings would not be shared with law enforcement authorities, with no individual records said to have been kept.

Future focus

With the report now complete, NDA Chair Lubna Mohamed Zahir Hussain stressed that a heightened focus on corporate social responsibility (CSR) programmes and greater coordination between state and civil society bodies had been highlighted as key aims for its efforts during 2013.

Lubna highlighted “budget difficulties” as a key challenge going forward, particularly in terms of providing placements and work opportunities as part of rehabilitation programmes.

“The budget will be difficult for 2013, so we are looking for possible CSR partners. This is something that we started back in June 2012 with groups like John Keels by providing opportunities in the hospitality sector,” she said.

According to the NDA, thirteen individuals last year undertook the programme, which was based around the food and beverage sector.

Lubna added that authorities were increasingly seeking corporate partners to assist with the programme, not just in terms of providing work experience for recovering addicts, but to also provide potential financial assistance to sponsor placements assisting with the rehabilitation of others.

Providing support to users undergoing Methadone Maintenance Therapy (MMT) was among the key areas where support was being sought, however the state budget was deemed insufficient to do so, according to Lubna.


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.