Transcript Powerpoint

Harmonizing
public health and public safety
in a politically conservative environment
Joëlle Rabot
Field Coordinator
Collectif Urgence Toxida (CUT)
Mauritius
www.aids2014.org
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
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The current situation
Opportunities for harmonisation
Key Challenges
The way forward for better harmonisation
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Mauritius & its socio-political
environment regarding drug use
• Population : 1,2 M inhabitants
• Surface area about 2000km2
• 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
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HIV epidemic in Mauritius
Mauritius has a concentrated epidemic with a prevalence
of 1.02% in the general population
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First case detected in 1987
5863 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)
HIV Prevalence Rate among KAPS (IBBS, 2011)
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PWID
MSM
52%
20%
FSW
29%
Public Health approach :
Introduction of Harm reduction strategies
A little bit of history
1996 : Civil society starts raising the alarm about HIV among
PWIDs
Early 2000’s : Exponential growth of HIV Infection within the PWID
population
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HIV Incidence in PWIDS in Mauritius
2000-2005
1000
92%
900
921
New HIV Cases
PWIDs
800
700
600
87%
500
525
400
300
66%
200
225
14%
100
2%
7%
98
2000
2001
2002
50
0
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55
2003
2004
2005
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.
2009 : 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
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Public Health approach :
Introduction of Harm reduction strategies
Needle and
Syringe
Programme
• About 40 NSP sites
• 2540 PWIDs registered
• Different model of intervention
used ( Fixed/Mobile/Backpack)
Methadone
Substitution
Therapy
• About 6000 people on MST
• Introduction of MST in prison
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The Current Situation
HIV Incidence Rate in Mauritius (2000-2013) showing PWID
incidence rate
1000
900
800
New HIV Cases
700
PWID Incidence Rate
600
500
400
300
200
100
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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The Current Situation
Decrease in crime rates
for drug related offences
Reported cases
3000
2500
2650
2466
2046
2000
1641
1500
1295
1000
1085
500
0
2007
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2008
2009
2010
2011
2012
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
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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
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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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Thank you for your attention
www.cut.mu
[email protected]
www.facebook.com/Collectif.Urgence.Toxida
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