Introducing Harm Reduction in Mauritius Emphasizing on the lack of services for Young People Who Inject Drugs Guffran Rostom Head 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) % of market share as compared to other opiates

Current Situation of Drug Use Mauritius – 2 nd largest consumer of opiates in terms of percentage of the population, after Iran (WDR 2009) Ranked 1 st within the African region in terms of opiates use rate In Number of PWID estimated to be about 10, % 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, % of Island’s Population People Who Inject Drugs (PWID) Biological Results HIV prevalence % HCV prevalence % Among HIV seropositive PWID, 96.8% also tested positive for HCV infection HIV prevalence among females who inject drugs %

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)

Harm Reduction in Mauritius Vibrant and on-going Advocacy for Harm Reduction Services by Civil Society since – Pilot Needles & Syringes Programme by Civil Society (CUT) Rapid buy-in by Minister of Health & Quality of Life, scaling-up the programme November 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 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 years!

Young People and Drug Use HIV Knowledge, Attitudes, Behaviours & Practices Study 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) 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 , 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, UNGASS Country Progress Report – Mauritius, 2010 Cut Conference Report 2009 Cut Conference Report 2011 Graph 1: Relative prevalence of modes of transmission of HIV in Mauritius ( ) 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 You Guffran Rostom – PILS