MAURITIUS: Dangerous paradise - sex, drugs and HIV

It is hard not to resort to clichés when writing about Mauritius: the white, sandy beaches, sunny blue skies and swaying palm trees. This Indian Ocean island paradise is the stuff travel brochures are made of. Stepping off a plane filled with eager tourists and a group of honeymooners proudly flashing "just married" t-shirts, it is easy to see how tourism has become the main source of income.

Tourists are not the only ones pouring into the country: extensive air and sea connections to south and southeast Asia, Australia, Africa and Europe, combined with free ports and an offshore banking industry, have made Mauritius a drug trafficker's paradise.

"There are families who've been in drug trafficking for four generations ... it's a big business in Mauritius. This is one way of making money - a lot of money," commented Imran Dhannoo, director of the Dr Idrice Goomany Centre, an addiction treatment facility.

The UN Office on Drugs and Crime (UNODC) said syndicates have been expanding their network of transit areas through Ethiopia, Mauritius and Tanzania and Uganda in an ongoing attempt to disguise trafficking routes. These countries are used as arrival points for illicit drugs from Asia, which are then taken to Kenya, South and West Africa, the main regions for onward drug distribution to Europe and North America.

Some of the narcotics also end up on the busy streets of the Mauritian capital, Port Louis, to satisfy growing domestic demand. Heroin is by far the drug of choice, with half the local drug users preferring to inject.

Dr Fayzal Sulliman, head of the only centre offering methadone treatment, a substitute substance used to wean heroin users from their addiction, conducted a rapid assessment three years ago, and now estimates that 20,000 Mauritians are injecting drug users (IDUs) - the highest prevalence of this type of abuse in Africa.

Sitting on a volcano

"I was 20 when I became addicted," said Marie-Ange Frivert. "It was after my son was born. He was 3 years old. Me and my husband had separated ... I just couldn't cope on my own. I started with opium; I was smoking it, but I wasn't addicted. Then, when opium disappeared, I used heroin."

She was 41 years old when she sought help at the Chrysalde drug treatment centre catering for women. After "graduating" from the rehabilitation programme she become a volunteer at the centre; three years later she has become an outreach worker in the sex industry. "I go to all the places where they sell drugs, I offer them counselling and refer them to centre; I also offer them condoms."

Most female IDUs sell sex to support their habit. "They need the drug and it costs a lot ... so this is a quick and easy way to make money," Frivert told IRIN/PlusNews.

The calculations are simple: if you charge 100 Rupees (US$3) per client, two clients will give you one "dose" of heroin. "An addict needs about three or four doses a day, so that means at least six or eight clients a day," she added.

In his rapid assessment Sulliman found that 50 percent of drug users reported sharing needles; 80 percent never used a condom, and of the 4,800 commercial sex workers who were injecting drug users, 25 percent reported needle sharing.

These findings indicate an ideal setting for HIV transmission: apart from risky sexual behaviour, sharing contaminated needles is a particularly efficient way of exchanging blood and, therefore, of transmitting the HI virus from infected to uninfected users.

"The picture has changed in Mauritius. There's been a shift, and now injecting drug use is the primary mode of transmitting HIV," Sulliman told IRIN/PlusNews.

The numbers are changing too. In 2005, HIV prevalence in Mauritius was a low 0.1 to 0.5 percent, but new government statistics reveal that HIV prevalence in Mauritius has climbed to an estimated 1.8 percent.

"Mauritius is sitting on a volcano that is going to explode very loudly ... and the Indian Ocean region is in for big trouble," warned Dr Farida Oodally, the UNAIDS Focal Point in Mauritius. She said movement between the islands was common, and governments had to start waking up to this new threat.

Injecting drug use numbers have been climbing in the Seychelles, which also has a large population of men who have sex with men; IDUs have been reported on the coast of Madagascar, which has seen alarmingly high levels of sexually transmitted infections (STIs).

Response

Treating drug users for addiction as well as HIV is highly controversial, both in developed and less developed regions of the world. Where treatment is available, a programme might treat a specific drug dependency, including drug substitution treatments like methadone, and needle and syringe exchange programmes to provide users with clean equipment.

Government resistance to these programmes is strong, as they are sometimes believed to encourage non-injectors to use drugs, even though there is no evidence for this. Public objection to such initiatives, especially in more conservative countries, has sometimes also been heated.

There are mixed views about how well and how quickly the government in Mauritius has responded. In a 2006 report on drugs and HIV in Mauritius, Sulliman, Imran Dhannoo and UNODC's Reychad Abdool acknowledged that "the changing pattern of HIV infection, with injecting drug use emerging as the most important mode of transmission, has stimulated the government to take a number of drastic measures."

Legislation was passed early in 2006 to make the therapeutic use of methadone for detoxification or maintenance possible, and the methadone pilot programme has now been running for a year, having treated about 350 drug users to date.

The government is also working with non-governmental organisations (NGOs) to prevent HIV infection among drug users, while the health ministry's HIV/AIDS unit and NGOs have initiated a number of programmes to reach untreated IDUs, encourage them to be tested for HIV and enter drug rehabilitation.

According to Oodally, condom distribution has increased, and condoms are now more easily accessible in pharmacies and at health facilities.

The government has also legalised needle exchanges. On 12 November 2007 the government officially launched its needle exchange programme in collaboration with CUT (Collectif Urgence Toxida in French), a coalition of NGOs working to tackle drug abuse and HIV, said Nathalie Rose of CUT.

Rose, who is also a social worker at PILS (Prevention, Intervention et Lutte contre le SIDA in French), an AIDS support organisation, has been frustrated by the pace: "It's still slow; there are too many delays," she commented on how long it has taken to convince the government to kick-start a needle exchange campaigns.

Sulliman agreed: "Mauritius is a bit late in implementing harm-reduction measures but it's understandable; it's a very difficult decision for a government to make."

But Dhannoo warned that "Drugs and AIDS don't go according to the whims of a government. This is an alarming situation - 1.8 percent HIV prevalence is most alarming. We have good documents, frameworks; we no longer need any plan, we need action - political leadership with vision and action - the work is not being done in a coordinated way."