Transcript ARV FOR IDUS IN MAURITIUS

ARV FOR IDUS IN
MAURITIUS
Presented by Nathalie Rose
Social Worker
PILS
(Prevention Information Lutte contre le Sida)
5 August, 2008
IAC
MAURITIUS: A PROFILE
Mauritius is located in the Southwest Indian Ocean,
off the eastern coast of Africa .
Population 1.3
million, more
than 10% living
in the capital,
Port Louis
Though average
annual income is
USD 6,300 per
capita, the
distribution of
income is quite
uneven.
HIV SITUATION IN MAURITIUS

1987: First
registered
HIV case

Today, 3,524
official cases

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
(92% OF NEW CASES).
INJECTING DRUG USE IN MAURITIUS
Highest
prevalence of
opiate use in
African region
MAIN SUBSTANCES
INJECTED:
BROWN SUGAR &
BUPRENORPHINE
Figures : World Drug Report 2008, UNODC
Second highest
prevalence of
opiate use
worldwide
ARV IN MAURITIUS
 ARV is available for free to every PLWHA
with a CD4 count below 250 cells


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 FOR IDUs



No reported case of IDUs being refused ARVs
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)
Role of civil society in ARV
provision and harm reduction
1996
PILS CREATED
2002
Free ARV available after strong lobby
from PILS
2005
2006
PILS forms coalition of NGOs (named
CUT) to advocate for harm reduction
strategies in Mauritius
CUT launches first needle exchange
program in the region as pilot project
WORK PROCESS OF PILS
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
Regular
follow-up
NDCCI : PILS
psychologist ensures
pre/post test counseling
& other psych follow up
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.
Case Study 1:Paul,47
Not on ARV
CD4
Early 2006
First visit at our
organization
145
IDU since 20 yrs old
Co-infected with HCV
Mid 2006
Doctor advises ARV
Mid 2007
Starts
methadone
Early 2008
Stable social
situation
Several detox programs
but always relapsed
No regular
medical follow-up
Takes irregular doses, CD4 unchanged
Has now found stable job as security officer
Opened bank account
Learns to read and write
Regular medical follow-up, good adherence
CD4
339
Case Study 2:Brenda,27
CSW & IDU
2004
2004-07
First visit at our
organization
Regular visits
CD4 405
Co-infected
with HCV
All family
members IDUs
Not on ARV
No regular medical
follow-up
Asks for clean syringes
Talks about her addiction problems
Mid 2007
CD4 falls to 210
Doctor advises ARV
No real
compliance
Daily visits to NEP
Early 2008
Concerns about her
health situation
Start taking ARV more seriously
Asks questions about methadone
April 2008
Has gone on
methadone
Not using illicit substances now
Regular medical follow-up
Still CSW
CD4
345
RECOMMENDATIONS
Empowerment of
IDUs/MST users
Home-based care
Adequate Harm
Reduction
Strategies
Empowerment of civil
society dealing with
substance abuse issues
Better advocates for policies
Better advocates for health & social services
Better leaders for IDU community
Get in touch with hidden populations and
encourage them to go for medical follow-up
Proper psychosocial follow-up of patients
Social support for those in need
Appropriate means to work with
IDUs in collaboration with the
Government
THANK YOU
FOR YOUR ATTENTION!
