Postcards from a sick island

It is hard not to resort to clichés when writing about Mauritius: 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,” said Imran Dhannoo, director of the Dr Idrice Goomany Centre, an addiction treatment facility.

The UN office on drugs and crime (UNODC) said syndicates have expanded their network of transit areas through Ethiopia, Mauritius, Tanzania and Uganda to try to disguise trafficking routes. The 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 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.

Sitting on a volcano

Dr Fayzal Sulliman, head of the only centre offering methadone treatment, a substitute substance used to wean heroin users from their addiction, conducted an 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.

“I was 20 when I became addicted,” said Marie-Ange Frivert. “It was after my son was born. He was three years old. My husband and I 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 when she sought help at the Chrysalde drug treatment centre, which caters for women. After “graduating” from the rehabilitation programme she become a volunteer at the centre.Three years later she does outreach work in the sex industry. “I go to all the places where they sell drugs. I offer them counselling and refer them to the centre. I also offer them condoms.”

Most female drug users 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,” said Frivert.

The calculations are simple: if you charge 100 rupees ($3) a 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 said. In his assessment Sulliman found that 50% of drug users reported sharing needles, 80% never used a condom and, of the 4 800 commercial sex workers who were IDUs, 25% reported sharing needles.

The findings indicate an ideal setting for HIV transmission. Apart from risky sexual behaviour, sharing contaminated needles is an efficient way to exchange blood and, therefore, to transmit 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,” said Sulliman.

The numbers are changing too. In 2005 HIV prevalence in Mauritius was a low 0,1% to 0,5%, but new government statistics show that HIV prevalence in Mauritius is an estimated 1,8%.

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

The number of IDUs has increased 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. Needle and syringe exchange programmes provide users with clean equipment.

Government resistance to these programmes is strong, because 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 at times 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 prominent 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. The methadone pilot programme has been running for a year. About 350 drug users have been treated.

The government also works with 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.

Oodally said condom distribution has increased and condoms are more easily accessible in pharmacies and at health facilities.

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

Rose, who is a social worker at Pils (Prevention, Intervention et Lutte contre le Sida), an Aids support organisation, is frustrated at the pace. “It’s still slow; there are too many delays,” she said, adding that it has taken a long time to convince the government to kick-start needle exchange campaigns.

Sulliman agreed: “Mauritius is a bit late in implementing harm-reduction measures, but it’s understandable; it’s a difficult decision for a government to make.”

But Dhannoo said “drugs and Aids don’t go according to the whims of a government. This is an alarming situation—1,8% HIV prevalence is most alarming. We have good documents and frameworks. We no longer need a plan, we need action—political leadership with vision and action—the work is not being done in a coordinated way.”

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