Harmonizing public health and public safety in a politically conservative environment Joëlle Rabot Field Coordinator Collectif Urgence Toxida (CUT) Mauritius

Setting the scene Mauritius & its socio-political environment regarding drug use HIV epidemic in Mauritius Public health approach : The introduction of Harm Reduction(HR) strategies The current situation Opportunities for harmonisation Key Challenges The way forward for better harmonisation

Mauritius & its socio-political environment regarding drug use Population : 1,2 M inhabitants Surface area about 2000km 2 Generally speaking, drug use is tackled with a repressive approach General population still conservative about drug use Politicians usually use populist ‘ tough on drugs’ approach

HIV epidemic in Mauritius Mauritius has a concentrated epidemic with a prevalence of 1.02% in the general population First case detected in detected cases (up to end of March 2014) 70.5% of new transmission is related to injecting drug use. There is an estimation of 10,000 People Who Inject Drugs(PWIDs)population in Mauritius Integrated Biological & Behavioural Surveillance(IBBS) survey, 2011)

: Civil society starts raising the alarm about HIV among PWIDs Early 2000’s : Exponential growth of HIV Infection within the PWID population Public Health approach : Introduction of Harm reduction strategies A little bit of history

New HIV Cases PWIDs HIV Incidence in PWIDS in Mauritius

Public Health approach : Introduction of Harm reduction strategies A little bit of history (Contd) 2004: Platform created by Civil society to advocate for Harm Reduction Strategies in Mauritius. This platform will later be CUT (Collectif Urgence Toxida) 2006: Launching of illegal Needle and Syringe Program(NSP) by CUT & Methadone Substitution Therapy(MST) by the Ministry of Health & Quality of Life (MOHQL) 2007: Legal Framework for NSP through the HIV/Aids Act Creation of National NSP Committee by the govt where CUT is invited to sit : CUT opens its premises and follows-up on NSP and advocacy on Harm Reduction 2010: Global fund allows upscaling of Harm Reduction Services 2011: MST in Prisons

Public Health approach : Introduction of Harm reduction strategies About 40 NSP sites 2540 PWIDs registered Different model of intervention used ( Fixed/Mobile/Backpack) Needle and Syringe Programme About 6000 people on MST Introduction of MST in prison Methadone Substitution Therapy

The Current Situation HIV Incidence Rate in Mauritius ( ) showing PWID incidence rate

Decrease in crime rates for drug related offences The Current Situation

Opportunities for harmonisation Legal Framework available for NSP Harm reduction present in national strategies and supported by the Global Fund HIV/Aids National coordinating body has created an enabling environment for Harm Reduction Private sector implication Policy Dialogue between Govt and NGOs Availability of data through recent research Training of Police force & Legislators

Key Challenges No National Drug Control Master Plan since 2009 Clash between the repressive approach of the system and public health approach Repressive approach – Behaviour of KAPs are criminalised High level of stigmatisation towards KAPs – Police Harassment at service delivery

The Way towards better harmonisation STRENGTHEN ADVOCACY – with media, partners, users, Community, Govt, police, CSRs, etc – For a National Drug Control Master Plan based on the 4 pillars approach that should also include : Legal reviews Drug policy reform Recognition of HR approaches in strategic plans of law enforcement – For the ongoing training of police, media, partners, users, CSRs on HR and the inclusion of an HR module in the police force curricular RESEARCH FOR ADVOCACY –Need of data to strenghen arguments based on evidences POLICY DIALOGUE – Promote representation of KAPs on platforms that can enable more harmonisation – Better implication and representation of civil society in commitees such as the CCM, HR Committee, etc

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