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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