1. Nudhar Bundhoo Advocacy officer n.bundhoo@pils.mu 16 April 2015 n.bundhoo@pils.mu Harm reduction for people who use drugs

2. What is Harm Reduction? Harm reduction refers to the range of services and policies to reduce the adverse effects of drug use Instead of insisting that people should stop using drugs, harm reduction acknowledge that many are not able or unwilling to abstain from illicit drugs Harm reduction strategies recognise that many people will continue to use drugs, despite the strongest efforts to prevent initiation and continued use

3. What is wrong with punitive laws? Laws which puts people who use illicit drugs in prison have failed to produce positive outcomes Laws have been unable to reduce supply/demand Laws have not improved public health, including overdose, HIV and HCV prevalence Laws have not been able to reduce criminality, human rights abuses Laws have been unable to reduce environmental degradation

4. Harm reduction for people who use drugs The approach extends to the use of proper language when working with people who use drugs No ‘junkies’, ‘addicts’, ‘social evils’.. Compassionate approach which extends to families of people who used drugs Respect human rights of people who use drugs- rights to the highest attainable standard of health, to social services, to work, to benefit from scientific progress, to freedom from arbitrary detention and freedom from cruel inhuman and degrading treatment

5. Harm reduction and HIV prevalence

6. Injecting drug use in Sub-Saharan Africa Reliable information on injecting drug use in Sub- Saharan Africa is limited Estimates suggest 1,020,000 people who inject drugs Kampala: 16.7% HIV prevalence among people who inject drugs In 2014, Ghana is set to undertake a study to ascertain an accurate picture of trends of injecting drug use Tanzania: 42% reported HIV prevalence among people who inject drugs Tanzania Network of People who use drugs (TANPUD). 2014 ReAct peer-led network of people who use drugs

7. Injecting drug use in Sub-Saharan Africa Research also scheduled in Somalia and Senegal South Africa: CDC contracted CSOs to work on increasing services, awareness and education on harm reduction in Cape Town, Durban and Pretoria Kenya Network of People who use drugs (KeNPUD) Eastern African Harm Reduction Uganda: countrywide harm reduction network Zambia: no verified data on injecting drug use and HIV. No research planned Rwanda: claim no injecting drug use, do not target people who used drugs in their HIV strategy Nigeria: 9% new HIV infection due to unsafe injecting drug use

8. Harm reduction in Sub-Saharan Africa

9. Needle exchange programs: Mauritius first country started NSP 2012 Kenya initiated NSP-10 sites, in Nairobi, Kilifi, Mombassa and Kwale Tanzania: 2014 seven sites, one mobile NSP South Africa: one NSP focused on men who have sex with men who inject drugs Senegal: small scale NSP provision Seychelles: high percentage of people who inject drugs report practising unsafe injecting-no NSP

10. Harm reduction in Sub-Saharan Africa Opioid substitution therapy: Mauritius reaches over 6000 people on methadone substitution therapy Tanzania: newly initiated programmes (three sites in Dar es Salaam, 1,200 receiving methadone) Kenya: Methadone program in development (funded by US government and UNODC) Senegal: OST site built in Dakar South Africa: restricted to one government-funded site, private OST available in clinics Nigeria: no OST Uganda: no OST

11. Policy development for Harm Reduction Since 2012, seven sub-Saharan countries adopted reference to harm reduction in their national HIV policy documents Tanzanian National Strategy for Non-communicable Diseases 2009-2015, Tanzania Third National Multi-sectoral Strategic Framework for HIV and AIDS HIV policy framework in Mauritius, Seychelles and Kenya Senegal 2011-2015 National AIDS Programme Nigeria: harm reduction included in National Policy on HIV/AIDS in 2009 UNDP invited Uganda Harm Reduction Network to develop a model for a regional framework among key pops Department of Health in South Africa drafting operational guidelines advocate for strategies for opiate dependence

12. Funding for Harm Reduction programmes Tanzania: MdM received grant from Elton John AIDS Foundation and French Development Agency to scale up HR programmes in Dar es Salaam. OSF supported capacity building and advocacy, CDC supported OST Kenya: Dutch funded CAHR implemented by International HIV/AIDS Alliance. Global Fund, UNODC and USAID Mauritius: Global Fund Uganda: ITPC South Africa: UNODC, UNAIDS, WHO, PEPFAR

13. Population : 1,2 M inhabitants Surface area about 2000km HIV Prevalence 1.02% 2

14. 1996 : Civil society starts raising the alarm about HIV among PWIDs Early 2000’s: Exponential growth of HIV Infection within PWID 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 Exchange Program by CUT 2006 : Launching of Methadone Substitution Therapy by the Ministry of Health & Quality of Life (MOHQL) 2007 : Legal Framework for NEP through the HIV/Aids Act 2007 : Creation of National NEP Committee by MOHQL where CUT is invited to sit. 2009 : CUT launches premises and follow-up on NEP and advocacy on Harm Reduction 2010 : GFTAM allows upscaling of Harm Reduction Services 2011 : Methadone in Prisons A bit of history on Harm Reduction in Mauritius

15. Existing Harm Reduction services in Mauritius Needle Exchange Program Mobile Caravan for MARPS HR Community services Methadone Substitution Therapy

16. Impact of Harm reduction in Mauritius

17. Reduction in crime rates for drug-related offences

18. Comprehensive Harm Reduction package

19. Laws, policies and practices should be reviewed and revised where necessary, and countries should work towards decriminalization of behaviours such as drug use/injecting, (…) and toward elimination of the unjust application of civil law and regulations against people who use/ inject drugs (WHO, 2014)

20. References and important publications 2009: After the War on Drugs: Blueprint for RegulationAfter the War on Drugs: Blueprint for Regulation 2011: A Quiet Revolution: Drug Decriminalisation Policies in Practice Across the GlobeA Quiet Revolution: Drug Decriminalisation Policies in Practice Across the Globe 2011: A Quiet Revolution: Drug Decriminalisation Policies in Practice Accross the GlobeA Quiet Revolution: Drug Decriminalisation Policies in Practice Accross the Globe 2012: The Alternative World Drug Report : Counting the Costs of the War on DrugsThe Alternative World Drug Report : Counting the Costs of the War on Drugs 2014: HIV and young people who inject drugsHIV and young people who inject drugs IDPC Global Commission on Drug Policy Drug Policy Alliance INPUD Harm Reduction International: Global state of Harm Reduction Transform drug policy foundation Release TNI (Transnational Institute)- Drugs and Democracy Programme TNIDrugs and Democracy Programme

21. Crisis in Mauritius! Law Reform Commission: voluntary HIV transmission to be criminalised Reduction of syringes/needles distributed, despite increasing needs from people who inject drugs Decentralisation of methadone distributing sites to police stations No HCV treatment for people who inject drugs Immigration Act discriminates against HIV positive foreigners coming to Mauritius Mass and arbitrary arrests of sex workers: condoms possession used to arrest