1. Presented by Nathalie Rose Social Worker PILS (Prevention Information Lutte contre le Sida) 5 August, 2008 IAC

2. MAURITIUS: A PROFILE Population 1.3 million, more than 10% living in the capital, Port Louis average annual income of 200 USD 40 years ago, to 6,300 USD per capita today. [1] However, the distribution of income is still quite uneven. [1]average annual income of 200 USD 40 years ago, to 6,300 USD per capita today. [1] However, the distribution of income is still quite uneven. [1] Mauritius is located in the Southwest Indian Ocean, off the eastern coast of Africa. Though average annual income is USD 6,300 per capita, the distribution of income is quite uneven.

3. HIV SITUATION IN MAURITIUS  1987: First registered HIV case  UNAIDS estimates prevalence rate of 1.8% (15,000 to 20,000 cases). Very high rate of IDUs infected with HIV, reaching its peak in 2005  Today, 3,524 official cases (92% OF NEW CASES).

4. INJECTING DRUG USE IN MAURITIUS Highest prevalence of opiate use in African region Second highest prevalence of opiate use worldwide Figures : World Drug Report 2008, UNODC MAIN SUBSTANCES INJECTED: BROWN SUGAR & BUPRENORPHINE

5. ARV IN MAURITIUS  Available since 2002, after strong lobby from civil society, namely PILS  About 398 people on ARV, of which 60% are IDUs. Nearly all IDUs who are PLWHA are also co-infected with Hepatitis C. No medical treatment for HCV offered by public hospitals.  ARV is available for free to every PLWHA with a CD4 count below 250 cells

6. ARV FOR IDUs  However, many IDUs do not seek medical follow-up and medication  No empowerment of IDUs: Many do not know how to read, and are difficult to reach  Some IDUs go on ARV only when they get proper follow-up (harm reduction, counseling)  No reported case of IDUs being refused ARVs

7. Role of civil society in ARV provision and harm reduction 1996 2002 Free ARV available after strong lobby from PILS 2005 PILS forms coalition of NGOs (named CUT) to advocate for harm reduction strategies in Mauritius 2006 CUT launches first needle exchange program in the region as pilot project PILS CREATED

8. WORK PROCESS OF PILS Regular follow-up If they do not show up, we proactively look for them Contact with PILS through outreach work (NEP, field visit) Referred to PILS premises (counseling, referred to health services) If they do not show up, we proactively look for them NDCCI : PILS psychologist ensures pre/post test counseling & other psych follow up

9. HARM REDUCTION IN MAURITIUS  Harm reduction available since 2006 after strong lobby from civil society. Needle exchange program launched by NGOs Methadone substitution therapy launched by Ministry of Health Harm reduction : Bridge between hidden populations and health and social services Has encouraged IDUs to go for medical follow-up and ARV.

10. Case Study 1:Paul,47 Early 2006 IDU since 20 yrs old CD4 145 Co-infected with HCV Not on ARV Several detox programs but always relapsed No regular medical follow-up Mid 2006 Doctor advises ARVTakes irregular doses, CD4 unchanged Mid 2007 Starts methadone Has now found stable job as security officer Opened bank account Learns to read and write Regular medical follow-up, good adherence CD4 339 First visit at our organization Early 2008 Stable social situation

11. Case Study 2:Brenda,27 2004 First visit at our organization Co-infected with HCV CD4 405 All family members IDUs No regular medical follow-up 2004-07Regular visits Asks for clean syringes Talks about her addiction problems CSW & IDU Has gone on methadone April 2008 Asks questions about methadone Daily visits to NEP Concerns about her health situation Early 2008 No real compliance Doctor advises ARVCD4 falls to 210 Mid 2007 Not using illicit substances now Start taking ARV more seriously Regular medical follow-up Still CSW CD4 345 Not on ARV

12. RECOMMENDATIONS Empowerment of IDUs/MST users Better advocates for health & social services Better advocates for policies Better leaders for IDU community Adequate Harm Reduction Strategies Get in touch with hidden populations and encourage them to go for medical follow-up Home-based care Appropriate means to work with IDUs in collaboration with the Government Empowerment of civil society dealing with substance abuse issues Social support for those in need Proper psychosocial follow-up of patients

13. THANK YOU FOR YOUR ATTENTION!