In-depth: Deadly cocktail: HIV and drug use

MAURITIUS: Clean needles out of reach for injecting drug users

Clean needles and syringes are much sought after by the 20,000 injecting drug users in Mauritius
Port Louis, 28 November 2007 (IRIN) - Every weekday afternoon, two outreach workers go to a derelict apartment block that used to house men working on the docks at nearby Tombeau Bay, on the outskirts of Mauritian capital, Port Louis.

Officially no-one has lived here for about 40 years and Tombeau Bay locals say the buildings, stripped down to bare skeletons, will soon be demolished.

But people are still living there, although these are not people the rest of the community are very fond of. Police constantly monitor what is happening at the "ex-docker's" flats; after all, this is where injecting drug users live, having lost their homes and families. This is also where illegal drugs are sold.

When CUT (Collectif Urgence Toxida in French), a coalition of non-governmental organisations (NGOs) working to tackle drug abuse and HIV, decided to implement a needle exchange programme at two sites in Mauritius, this spot seemed one of the logical choices, Nathalie Rose, secretary for CUT, told IRIN/PlusNews. New legislation has legalised exchanging needles, making the initiative possible.

Clean needles and syringes are much sought after by the 20,000 injecting drug users on the Indian Ocean island of Mauritius, which has the highest rate of injection drug use in Africa.

But they are not easy to come by for injecting drug users, and 50 percent have reported sharing needles, while 80 percent said they never used condoms, according to a 2004 rapid assessment by CUT.

The risks of HIV transmission are all too real to Joseph (not his real name), 58, a recovering drug addict who spoke to IRIN/PlusNews at the country's first methadone treatment facility in the small town of Beau Bassin. Methadone is used as a substitute drug to wean addicts off heroin.

After 28 years of injecting heroin, commonly known as "brown sugar", he was diagnosed as HIV-positive and believed he had contracted the virus by sharing needles with his friends.

"The pharmacy won't sell [needles and syringes] to us and chase us away [because of] scaring away their clients ... some of them sell but they put up the price," he explained. A syringe and needle usually costs about 2 rupees (US$0.06), but a drug user can expect to pay from 10 to 15 rupees ($0.33-$0.55).

Joseph is about to complete his two-week in-patient rehabilitation stint at the methadone treatment centre and is quick to add, "Of course, I won't be needing syringes now."

It has been half an hour since social workers Rozy Khedoo and Berty Gevane arrived, and the apparently deserted buildings have come alive as the injecting drug users (IDUs) slowly emerge.

In Tombeau Bay there is still a huge demand for clean syringes. The procedure is simple: an IDU drops any used syringes into an old plastic container and receives the same number of clean needles and syringes from the outreach workers; the container is slowly filling up with used syringes.

Condoms are usually also distributed, but they had run out of stock on the day IRIN/PlusNews visited. Any packaging is discarded in a small heap, which the outreach workers burn before they leave.

Ellen (last name withheld) is the first woman to arrive, and quietly mumbles to the social workers that she also has to get clean needles and syringes for her husband, who is still at work. She leaves and returns to her "flat", but comes back for more clean needles just before the outreach workers leave.

Genave said it was common for IDUs to retreat into the buildings and have a fix before coming back for more clean needles. Ever mindful of the police, who can arrest suspected IDUs in possession of syringes containing a trace of illegal narcotics, many prefer to wrap their drug paraphernalia in plastic and bury it on the grounds of the apartment block.

Ellen is followed by more IDUs in quick succession - an assorted group that Khedoo describes as coming from all walks of life, "not only poor people".
Some stop to exchange pleasantries with Khedoo and Gevane, while others are more abrupt, bristling at the unwelcome "visitors". "We come from this area, so they know us, they are comfortable with us. It's important that they trust us," Khedoo said.

Marie (not her real name) greets Khedoo with a kiss before settling down for a chat. Her husband died of an AIDS-related illness three months ago and she tells the social worker about how she is coping without him.

According to Khedoo, since the needle exchange programme began a year ago, she has known of 10 people who have died from AIDS-related illnesses. "Sometimes, when people are sick they want to go on ARVs, and we try our best to encourage them to get clean and get treatment. But after a few months of taking ARVs they are back here."

CUT's Nathalie Rose pointed out that to HIV-positive injecting users "ARVs are not a priority, drugs are their priority."

By the time Khedoo and Gevane start packing up, the black canvas bag that was filled with clean syringes and needles is empty, and the plastic bottle cannot hold any more used syringes. Over 30 people have come to exchange their needles, and Khedoo anticipates that there will be even more on Friday, ahead of the weekend.

Nathalie Rose admitted that the two sites run by the NGOs could not meet the country's demand for clean syringes. "There are 20,000 [IDUs] and only six or seven treatment centres. Altogether they treat 1,000 drug users a year; even if you want to treat all of them, some people are still going to want to use drugs, whatever you do."

Last month the government officially launched its needle exchange programme, but it has yet to be implemented. In the meantime, needle exchange projects like the one in Tombeau Bay are slowly trying to meet the needs of a population at risk.

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