Nicholas Rainer
16 May 2008
interview
Port Louis — The UNAids regional director for Southern and Eastern Africa is back after two years on an official mission to assess the local situation. He will also see how he can give more support to improve the health situation.
What is the purpose of your visit here?
The purpose is two-fold. Firstly, I'm here to take stock of where Mauritius is with regarding its responses to HIV-Aids. I was here two years ago and we had a number of agreements and meetings. I've come back with some colleagues to check where we are with the fulfilment of the steps that the government has taken to respond to AIDS. Secondly, we've been looking at the next steps of how the United Nations system can strengthen its support for Mauritius. Those are the two objectives: take stock of where we are and what can we do to be more helpful.
What have you noticed since your last visit?
There are three overall factors. Firstly, HIV infections are still increasing and they're increasing pretty rapidly. Last year, there were 580 new infections and this year we're anticipating 600 new ones. The trajectory is still upwards and it's at a very high and rapid rate. What that says is that, no matter what's being done, it's not impacting new infections as they should be.
Secondly, there is a positive feature in that the epidemic, which Mauritius has, is largely among injecting drug users and sex workers and addressing those challenges in any society is very difficult. Infection rates are going up and the bottom line is that, to get ahead of the epidemic you have to stop new infections.
Mauritius has addressed, through its policies and some of the key government roles, some of the more sensitive issues. It has set in place a good legal framework, it's recently finalized a good strategic framework and a clear definition of the targets and the actions and the budgets required. The cabinet has been sensitized so that there will be good support of the ministries of Health, Finance, Social security and other key ministries involved, correctional services and prisons.
There's been some good enabling work, such as the demonstration that work around needle exchange and methadone can be done. The authorities have found ways of providing services in the local context, which, compared to two years ago, is a major step forward. The reality, however, is that the coverage of those programs is probably around 10% and if there is to be the beginning of a significant impact, the coverage will have to quadruple within the next year to 18 months. There needs to be a shift from establishing an enabling environment to making that plan operational and extending services to injecting drug users inside and outside prisons and to sex workers.
Given the high prevalence of HIV/AIDS within the drug-injecting community, isn't it necessary to address the issue of drug addiction?
Clearly. Mauritius has a strategy to deal with drugs and, of course, the overall strategy is to reduce drug use, which reduces vulnerability to HIV infections. We are focusing on ensuring that HIV-related implications of that are also being put in place. The needle exchange program is going to be one of the most important interventions and it needs to be scaled up from covering less than 10% of drug users to our target of 15% by the end of 2008 and 17% by 2010. This will require the upscaling of the capacities of NGOs as they will be the key providers of these services at the community level. They will need to have strong relationships with local government officials, the police, health services and good logistical support. All this needs to be thought through.
"These diseases change rapidly. It's important to have good surveillance to see who's being infected, why and whether interventions are effective."
We do have some very active NGOs, such as PILS, and one of their biggest struggles is to help overcome the stigmas associated with the epidemic. What can be done to achieve this?
There needs to be continuous campaigns. You mentioned PILS, which has played a pioneering role and is a wonderful example of leadership. The work within the NGO community is crucial. Faith communities should play a much stronger role because it's them we listen to when we talk about values. Government leadership also has a role to play.
It would be wonderful to see the Prime minister participate in the candlelight vigil this weekend and use those opportunities to express his empathy. The work of schools and youth organizations is also important. It's not going to happen quickly. It'll require a long hard slog but value leaderships need to be consistent in their messages. The stigma, the sense of discrimination, the fear and the shame associated with the epidemic will probably never die.
You're also here to help set up a Regional observatory on infectious diseases. What other diseases pose a health risk to Mauritius?
The main ones affecting children in this region are respiratory infections and diarrheal diseases. As we get older, there are problems of high blood pressure, diabetes and those chronic illnesses. In terms of the observatory, there's a need for stronger surveillance of all these diseases but especially of HIV because the velocity of increase in a number of islands, and particularly Seychelles and Mauritius, is so rapid.
And the risks of it branching from drug users into the general population, through sex, is very high. It's not to say that it will happen but the risk is great. These diseases change very rapidly so it's important to have good surveillance to see who's being infected and why and whether interventions are effective.
In the central prison in Beau-Bassin, seropositive prisoners are separated from the general population. Isn't that grossly discriminatory?
It's unnecessary and we will need to have some further discussions with the authorities about it. There should be no discrimination. We are aware of it and we need to follow up on it with the government.
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