Introducing Harm Reduction in Mauritius

Emphasizing on the lack of services for

Young People Who Inject Drugs

Guffran RostomHead of Department

Prevention, Advocacy, Communication & Training

July 23, 2012

Republic of Mauritius

Small Island in the South West of the Indian Ocean

Total Area – around 2,000 Km² (about the size of Melbourne or Moscow!)

Population – 1.3 Million

Multi-ethnic, multi-cultural

and multi-lingual

Young People

15 – 29 years: around

25% of total population

A Little Bit of History..

Long history of Drug Use in Mauritius

As far back as in the late 1800’s - cultural consumption of Cannabis

1960’s – Opium in Chinese Opium Dens

Early 80’s – Heroin introduced, mostly smoked but soon began to be injected.

1980’s – Introduction of Brown Sugar (Impure form of heroin)

1985 – Amsterdam Boys, caught with 20 Kg of Heroin

Today Subutex® (Buprenorphine) - 70-80% of market share as compared to other

opiates

Current Situation of Drug Use

Mauritius – 2nd

largest consumer of opiates in terms of percentage of the population,

after Iran (WDR 2009)

Ranked 1st

within the African region in terms of opiates use rate

In 2011 - Number of PWID estimated to be about 10,000

0.7% of the island’s population (IBBS 2011)

Roughly 950 females who inject drugs on the Island

Integrated Biological and Behavioral Survey (IBBS 2011)

PWID Population Estimate – 10, 000

0.7% of Island’s Population

People Who Inject Drugs (PWID) Biological Results

HIV prevalence - 51.6%

HCV prevalence - 95.8%

Among HIV seropositive PWID, 96.8% also tested positive for HCV infection

HIV prevalence among females who inject drugs - 85.5%

HIV Epidemic in Mauritius

Concentrated Epidemic – 0.97% of active population (8,000 – 12,000)

First case detected in 1987

Total No of Cases detected – 5, 282 (March 2012)

2002 2003 2004 2005 2006 2007 2008 2009 20100

102030405060708090

100

Heterosexuel

Heterosexuel/UDIs

UDIs

Others

Harm Reduction in Mauritius

Vibrant and on-going Advocacy for Harm Reduction Services by Civil Society since 2004

2006 – Pilot Needles & Syringes Programme by Civil Society (CUT)

Rapid buy-in by Minister of Health & Quality of Life, scaling-up the programme

November 2006 - Methadone Substitution Therapy (MST) Programme introduced by Govt.

Harm Reduction in Mauritius

First Country in Africa to implement Harm Reduction Services

Today – more than half of PWID Population are on MST (around 5000 PWID)

Harm Reduction Programme coverage - Increased from 20% in 2008 to 70% in 2010

Young People and Drug Use

21.5% of PWID - Young People aged 15-29 years

Age at first non-injected drug Use – 95.8% started at less than 24 years old (Median Age:

20)

Age at first drug injection use – 76.5% injected at less than 24 years (Median Age:20)

20% of People Living with HIV is aged between 15-24 years!

Young People and Drug Use

HIV Knowledge, Attitudes, Behaviours & Practices Study - 2008

15-24 years old

20% declared using ‘soft’ (Cannabis, Oral Medication) drugs

4% declared using ‘hard’ (Cocaine, heroin, Buprenorphine..) drugs

1.4% declared injecting heroin

1.1% injecting Subutex® (Buprenorphine)

Young People and Drug Use

SAFIRE (NGO) – 2012 National Study on Children in Street Situation

(5-19 years old) - 940 interviewees

Capture/Re-capture method

30.2% uses drugs. Out of these:

95.1 % smokes cigarettes

37.2% uses Cannabis

1.1% injects drugs

74.2% declared drugs were readily available

77.4% found that drugs are too expensive

(No) Harm Reduction for Young People

Dire lack of services for young people who use drugs, let alone ‘youth-friendly services’

tailored for the needs of the youth

NSP and MST not available to people aged less than 18 years old - age/legal barriers and

priority given to older, problematic drug users

Shifting focus of drug dealers/pushers from Adults to Young People, since nearly half of

PWID population of Mauritius is on MST

(No) Harm Reduction for Young People

7 out of 10 people seeking help at certain Rehab Centres are Young People nowadays

NGOs concede that specific needs of the youth has been neglected in advocacy as well as

Harm Reduction Programme development and implementation

(No) Harm Reduction for Young People

UN Economic and Social Council - Committee on Economic, Social and Cultural Rights

(2010) called on Mauritius to:

“Remove age barriers to accessing opioid substitution therapy and develop youth-friendly

Harm Reduction services tailored to the specific needs of young people who use drugs"

What has been done until now?

Timid (but ongoing) advocacy for Harm Reduction Services for Young People

(CUT Conferenceon HR in 2009 & 2011)

YouthR.I.S.E. present at the CUT Conference on Harm Reduction 2011 (Anita Krug)

Training by YouthR.I.S.E., PILS & CUT on HR for YPUD targeted to NGOS and Rehab

Centers in 2011

What remains to be done? The way forward..

Lobbying for inclusion of law review as well as strategies and activities related to HR for

YPUD in forthcoming HIV National Strategic Framework 2013-2018, through participation of

Young People in this process. 

Advocacy for harmonisation of Mauritian laws with the UN Convention on the rights of the

child

What remains to be done? The way forward..

Strong Civil Society, Private and Public Sector Partnership for renewed National Action Plan

on Drug Use

SAFIRE (NGOs working with Children in Street Situation) partnering with YouthR.I.S.E. for

Peer Education Training by end of 2012

Source: ANALYSIS Research International. National Study on Knowledge, Attitudes, Behaviors and Beliefs related to

HIV/AIDS among the Youth (15 to 24 years old) of Mauritius, 2008. UNGASS Country Progress Report – Mauritius, 2010

Cut Conference Report 2009Cut Conference Report 2011

Graph 1: Relative prevalence of modes of transmission of HIV in Mauritius (2002-2010) National Aids Secretariat. UNAIDS HIV Prevalence Estimates exercise, 2010

Lisa Johnson, Integrated Behavioural & Biological Surveillance Study, 2009, MOH&QL. Integrated Behavioural & Biological Survey, 2011, MoH&QL

SAFIRE – National Study on Children in Street Situation, 2012

Thank YouGuffran Rostom – PILS

www.pils.mu