The policy implications of HIV/AIDS as a social problem in Mauritius

Today, 1stDecember 2007, on World AIDS day, I wish to share with you a nice piece of work that my sister has done as an assignment for university.Here it goes:

The Human Immunodeficiency Virus known mostly as the HIV is a retrovirus that infects cells of the human immune system. It destroys or diminishes the efficiency of our antibodies. During the first stage, the person has no really noticeable symptoms. However, as the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to so-called opportunistic infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS. The HIV/AIDS epidemic in Mauritius dates back to 1987 when the first HIV positive case was detected. Since then the number of recorded cases has continued to increase and according to statistics produced by the AIDS Unit of the Ministry of Health, the rate of progression was mild during the early years following detection. Since 2003, the country seems to be heading towards a critical phase with the rate of increase assuming an almost exponential trend. And it is predicted that it would become still sharper in the years to come. So, the causes of this trend and the social impact on the society should b analysed and ways have to be found to b able to counteract this crisis.

The number of HIV positive cases in Mauritius is predicted to rise to 10 000 by the year of 2010 from its current level which is around 2000.However, many HIV positive persons are known to be either unaware of being infected by the virus or deliberately conceal the truth status from the authorities due to the marginalization problem. Thus, in any society the real number of infected persons far exceeds the number officially registered. The estimate generated by one model recognised by UNAIDS and utilized by the AIDS Unit of the Ministry of Health would indicate the real figure for year 2010 to be around 25,000. So, it can be seen that the actual number and the real number has a large difference. Until 2002, the main mode of HIV transmission was heterosexual but nowadays the main route through which it occurs is through the sharing of injecting needles. Up to 95% of the newly current cases of HIV infection is contracted through injecting drug use. It has seen to be prevalent most among youngsters from 20 -25 years.

The modes of transmission of HIV/AIDS are:

• Having unprotected sexual intercourse(anal or vaginal or oral)
• Transfusion of contaminated blood
• Sharing of contaminated needles
• Between a mother and infant during pregnancy(child birth and pregnancy)

Now, let us examine some of the causes which have encouraged the spread of HIV/AIDS in Mauritius. Contrary to many African countries, where the main reason of HIV spread is due to sex, here, in Mauritius, the main reasons responsible for its spread is namely due to the prison inmates, drug users and sex workers and other factors too which have been contributing. According to the AIDS of the ministry of health, most of those who are HIV positive live in Port-Louis and in the region of Plaine wilhems. It accounts for 74% of the total HIV cases for the country. As we are a small country and the mobility of the population, the spread of the disease to the other districts can be much faster.

The spread of HIV among the drug users; the social worker Cadress Rughen states that the increases vulnerability for drug users to HIV/AIDS is due to the fact more emphasis was being put on the spread of aids through sexual behaviour. The other ways through which AIDS could b transmitted was much ignored and one of them was through needle sharing. Thus, meanwhile the HIV virus has spread like wildfire among the members of this marginal group. These people normally meet in places which are not much frequented by the public. Social workers visit place to hand out new syringes and condoms. The used syringes and needles are collected in a plastic box and destroyed. Social workers use this contact to sensitize drug users to HIV/AIDS issues. ‘‘It is not only a programme to exchange syringes. It is not a mechanical exercise. We are doing it to reach out to drug addicts and convince them to go to one of our rehabilitation centres,’’ says Runghen. Drug addicts tend to hide themselves from the public eye for fear of being arrested. The social workers have to win their confidence. ‘‘This is a long process. Drug addicts want to talk to people. They want to feel the warmth of people who listen to them. They do not want to be rejected,’’ Runghen adds. Social workers are trying to get to the root of the problem so as to decrease the number of HIV contaminated. The Mauritian parliament adopted the new HIV and AIDS Act at the end of 2006 which introduced a syringe and needle exchange programme and methadone treatment. Methadone is used to alleviate withdrawal symptoms during the rehabilitation of drug addicts. If the number of cases due to the practice of needle sharing is not decreased as from now, it will be much tougher to do it later on.

Another way through which AIDS is spreading is due to the practice of unprotected sex and it is found to be more common and rampant in school children. They are at a stage of their life where they think that they can do anything and in the mid way they tend to forget the preventive measure which is very much vital. Meanwhile, religious leaders are warning people about their sexual behaviour. Catholic priest Jocelyn Grégoire has appealed to Mauritians, saying: ‘‘The house is on fire and we cannot save it. But we should save the furniture. You are being told to use condoms. If they cannot protect you from pregnancy (at 100%), how can they protect you from HIV? (at 100%)” Thus, there should b a program which is in the school curriculum which makes the students being more aware of the risk of having unprotected sex. Because, here in Mauritius, sex is considered as a taboo subject and it cannot be discussed openly with your parents. So it is better to integrate it in their school time table so as everyone gain access to such information and they will be able to protect themselves in a much better way. Also, the fact of gender equality has contributed to the spread of AIDS, because the female feel inferior to the males and they do not have enough courage to negotiate the use of condoms.

Also, in prison, currently, there is a high percentage of prison inmates who are IDUs ( Injecting Drug User ) with a past history of high risk sexual practices and other forms of risky behaviour. The authorities have created a temporary “new wing” to house specifically those carrying the AIDS virus. Also, the prison department has plans to upgrade infrastructural facilities to cater for treatment and rehabilitation of those who are admitted to it. The Prison department is pursuing a policy to conduct HIV test on a voluntary basis on all new entrants. Out of 9404 there have been 808 positive cases. It proves that there is high percentage of HIV infected individuals. Their separate placement in the “new wing” has able to assure the security of those who are HIV negative and at the same time providing support to those who are negative. But after the release from the prison, they have more difficulty in integrating the society. There must be program which allows to treat the HIV patients but at the same time not isolating them from the other prison inmates. Their anonymity and self respect should be preserved.

After considering the most affected areas in Mauritius, we will see how these affect the society. Despite the increase in the number of HIV cases, the technology and mode of curing HIV patients has not evolved much, there has been no major change in our current AIDS prevention programmes and our existing policies for reaching out to and curing AIDS patients has remained as they are. In today’s world, the labour force is much important for the smooth running of enterprises. AIDS presents itself as being a potential threat to our work force which can lead to economic loss. With the increase of the AIDS epidemic in Mauritius, there will be a severe stress on the limited resources allocated to the health sector. The financial burden to the state may become astronomical by the year 2010. The Government will face lots of difficulties to find resources for this economic loss. Preventing AIDS perpetuation only can help to face this incoming crisis.

In Mauritius, there is much problem such as social stigma and over-discrimination which are faced by the HIV/AIDS patients and their families. Our existing bodies of legislations confer necessary civil and other rights to all individuals suffering from any ailment including HIV/AIDS. Introducing specific legislations to protect HIV positive patients is implementable but at the same time it may also end up in arousing more public attention towards those suffering from the disease. Relying on enhancing rights might not be one of the best ways out to help them from social discrimination. One study by Lime and Leung Loo (2000) on the employment of HIV positive individuals in Singapore led to the conclusion that protective policy had a negative impact on the morale of the work force. The researchers quote a number of cases of overt discrimination against those known to be HIV positive including the refusal of fellow colleagues to share the same desk with them. Many studies exist on protective measures which have failed to get rid of the discrimination which HIV positive persons suffer from in their workplace or social environments.

All forms of discriminations against persons known to be HIV positive whether manifested openly or covertly, have resulted in making these individuals go underground and conceal their health status. This situation according to Prévention Information et Lutte contre le SIDA (PILS) is more dangerous to society than if their identities were known. The best strategy according to PILS, would be to create a strong institutional structure to reach out, treat, and advise those potentially at high risk, especially IDUs and sex workers. If the treatment services are properly organised and rigorous, PILS considers that a congenial atmosphere can be created for AIDS patients. For that to occur, I think it is very much important to change the attitudes of people and starting with the youngsters. If they understand the tough time these people go through, they can perpetuate these ideas, and when they will become the new working generation they will be able to understand their conditions and help them instead of making their lives tougher.

To be able to counteract the increasing population of HIV patients, some preventive measures can be taken. Sensitization is one of the most popular ways used to reduce its spread. This help to make people more aware of its way of transmission and how they can protect themselves and to promote safer sex. There should also be opportunities for educators such as counsellors to work on HIV and sex education in general. As said before, institutionalising HIV/AIDS education in all centres of learning can be a good method. Creating an environment in the education arena where social stereotypes, myths and taboos that promote the spread of AIDS can be challenged. The youngsters will be able to choose the route they want to follow. Another way is to create awareness among employers in vulnerable economic sectors. Another aspect to consider is the written media, often the manner in which their material are disposed to the public lacks confidentiality and discretion. The aids patients become publicly known due to reporting by the press and result in sufferings. The media should not go against the fundamental principle such as the dissemination of news should not over rule the basic human rights

The use of media channels, mostly television can be an effective means of delivering messages. Programmes can be dedicated to the good health of people. It can be a presentation by medical specialist on various facets of public health including HIV/AIDS. But it should be maintained on a long term basis instead of a short one. It has been noticed that there are programmes but only when there is a special event like AIDS international day. During these periods there will be continuous programmes. What the population needs more is a long term one to keep them aware of all the risk and evolution of the virus.

To conclude, HIV/AIDS is an upcoming epidemic here in Mauritius and one of the main causes was found to be the use of sharing needles among drug addicts. Methods and measures have to be taken to stop this trend. Atleast to mitigate the risk of a sharp rise of HIV cases in the coming year. One of the main ways is to have well organized structures to deliver services in a professional way and reliable manner. At the same time the anonymity of the HIV patient must be preserved so as to maintain his self respect in the society and thus reducing risk of social stigmatization. If the society accepts HIV patients as being normal citizens, their life will be less tough and also it will help to bring out hidden cases to help them medically. If not stopped at the right time, the situation can become catastrophic and the economy of our country will be negatively affected.

Author: SBNJ

 

REFERENCES:

Net reference:

1. http://www.lesotho.gov.ls/articles/2002/Paper%20-%20Min%20Edu%20-HIV-AIDS%20and%20Education.html

2. http://www.nesc-mauritius.org/

3.file:///I:/MAURITIUS%20Syringes%20and%20Needles%20Now%20Part%20of%20Anti-AIDS%20Arsenal.htm

4. http://www.unaids.org/en/Cosponsors/who/default.asp

5. http://gateway.nlm.nih.gov/MeetingAbstracts/102183674.html

Book reference:

Dawning Answers, how the HIV/AIDS epidemic has helped to strengthen public health, by Ronaldo. Valdisem, Oxford university press 2003