HIV Resurgence among People Who Inject Drugs in Mauritius
Mauritius is seeing a rise in HIV among people who inject drugs (PWID), partly as a result of the government's scale back of harm reduction services.
In 2006, the government of Mauritius introduced opioid substitution therapy (OST) and needle and syringe programmes (NSP) for PWID in an effort to combat endemic rates of HIV among this population. According to a United Nations report, PWID accounted for 92 per cent of new HIV cases in Mauritius in 2005.
The results of introducing OST and NSP - both well-evidenced interventions that prevent the transmission of HIV - were dramatic; by 2014, PWID accounted for 31 per cent of new HIV cases.
Despite the services’ success, harm reduction programmes were scaled back in the country after a new government was elected in 2014.
In July 2015, OST was discontinued for any new patients wanting to access the service, and its distribution was moved to outside of police stations, adding to the stigma felt by existing service users. Collectif Urgence Toxida (CUT), a Mauritian network of harm reduction NGOs, claims that “a lot of methadone users [are complaining] that this is very inconvenient as they are being perceived as criminals while seeking a medical treatment”.
The phasing out of OST will furthermore affect PWID in Mauritian prisons, where such services have operated since 2011. Siddick Lallmohamed, the president of the Prison Officers Association, told Le Mauricien that once-sceptical prison staff now believe methadone services have had a positive effect on PWID in prisons: “initially, some of us were reluctant because it was something new. [But now, the] strength is clear”. CUT reports that illicit methadone trafficking is now on the rise in Mauritian prisons.
Unlike OST, NSP will continue to operate in Mauritius; however, changes to its implementation are reducing its efficiency. The quantity of needles that the Ministry of Health provides for distribution has become insufficient; between 2014 and 2015, the number of people using NSP increased by 69 per cent, yet, in the same time period, authorities only increased the number of needles to distribute by 30 per cent.
Complicating the process further, the Ministry of Health has requested PWID to provide identification in order to acquire clean needles. However, CUT, the main organisation working at the NSP sites, reports that its refusal to check PWID's identification is currently being “accepted by the authorities”.
On World Aids Day 2015, the Minister of Health, Anil Gayan, declared that he was "determined to help end the AIDS epidemic" in Mauritius. Indeed, the absolute numbers of people being infected with HIV in the country is continuing to reduce. However, for the first time in 10 years, HIV among PWID is increasing again; after accounting for 31 per cent of new HIV cases in 2014, PWID constituted 35 per cent of HIV cases registered in 2015.
To counter this, CUT recommends that the Ministry of Health immediately relaunch the opioid substitution therapy programme for new participants, and increase the number of needles provided to match demand. Without doing so, the HIV rate among PWID is bound to increase, and the great accomplishments made over the past decade may be undone.