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A Sickening Society

A Sickening Society
While waste and energy grab the headlines, there is another threat to our way of life whose
consequences are at least as severe. Our society is sick and without the proper treatment it will
only get worse.

Symptom:
increasing
spread of HIV

Highest
prevalence:
intravenous
drug users
(IDUs), sex
workers

At risk groups:
wider
population,
tourists

Vectors: shared syringes, unsafe sex

The role intravenous drug users (IDUs) play in spreading HIV to the wider population through
unsafe sex has been recognised for a long time. This is principally because IDUs have little
inclination to utilise condoms. In Mauritius, nearly all IDUs inject opiates and while we have
consistently had the highest prevalence of opiate use in Africa, the incidence of HIV has been
relatively low. However, the rate of notified HIV infections has increased rapidly in recent years.
In 2007, WHO estimated that the number of people living with HIV was 13,000 (7,000
28,000), equivalent to 1.7% (1% 3.6%) of the adult population (15-49 years).
The latest UNAIDS report on Mauritius makes grim reading. While in 2000, only 2% of new
cases of HIV were among intravenous drug users, this has exploded to the point that 85% of
those registered as infected are IDUs, with between 30% and 60% of all IDUs being infected.
The report quotes studies claiming that half of IDUs have sex with non-regular partners and one
fifth with commercial sex workers; very few use condoms. Around three quarters of commercial
sex workers are also IDUs and most of them have unprotected sex with their clients or partners.
There is now every indication that HIV is bridging into the wider population.

SADC has recognised the risk HIV/AIDS poses to regional tourism. Mauritius has traditionally
been known as a safe holiday destination. However, as the prevalence of HIV increases, its
reputation as a high class resort is bound to suffer and its desirability decline. This is
compounded by the inreasing rate of acquisitive crime, about which potential tourists are now
being warned by their governments. The link between crime and drug use is well established and,
with a typical habit costing Rs.15,000 Rs.30,000 per month, opiate users are undoubtedly
responsible for a significant proportion of attacks on tourists visiting Mauritius. Opiates not only
generate the need to find additional income to feed the addiction, their very use confers the
audacity to commit crimes.
It is not just the tourist industry that is under threat. Just the prescription of anti-retroviral drugs
on a large scale would put great strain on our health care budget. However, these medications
only slow the onset of AIDS, they do not prevent it. With an increasing proportion of the
working population suffering from AIDS related health complications, the effect on every sector
of the national economy, not just health care, would be significant.
Mauritians have a tendency to believe that if problems are ignored then they will probably
disappear. While this may well be true for many things, from complaints made against a
government department to high profile criminal proceedings, it will not be the case for
HIV/AIDS. If we still have time to act, the window of opportunity is shrinking rapidly.
Sexual transmission of HIV must be reduced by redoubling our efforts to educate the population
on the need to only engage in safe sex. Nowhere is this more important than the commercial sex
industry. However, as already noted, IDUs are not inclined to use condoms. Therefore, it is
absolutely vital to detoxify every sex worker who injects opiates.
This can be ensured by regulating sex workers: frequently screening them for every sexually
transmissible disease and giving them absolute priority for treatment for opiate addiction. While
our conservative society may baulk at the idea of legitimising prostitution, the very fabric of our
society is threatened because sex workers are the largest conduit for HIV to pass from IDUs to
the wider population. Once free from their expensive addiction, many will have no further need
to engage in prostitution.
As a society, it is high time to drastically intensify our collective efforts to eliminate intravenous
drug use in Mauritius. The example of America's extremely expensive, but ultimately ineffective,
war on drugs proves that it is impossible to eliminate an established drug supply, even if there
is a genuine will to do so, as long as there is demand. This should be self-evident to anyone with
the most basic understanding of economics. So what is the source of demand?
While some people experiment with drugs because of coercion or peer pressure, most turn to
drugs through choice, often to relieve some underlying physical or psychological condition. In
Mauritius, this started amongst slaves, who used to illegally brew alcohol to momentarily escape
their sense of repression. It was later augmented when immigrants from India and China
introduced cannabis and opium respectively. However, drug use was contained within certain
socio-cultural contexts and did not present a significant problem.

In the 1980's, as the opium supply dried up, heroin appeared on the market in the form of brown
sugar. Within a short time, abuse of this drug became epidemic. The government responded by
adopting the advice of the UN and WHO aimed at making Mauritius a drug free nation. The
success of this approach has clearly been limited as both organisations have since encouraged
our government to implement needle exchange programmes to reduce the spread of HIV
amongst IDUs. Given this admission of failure and the risk of the spread of HIV from IDUs to
the wider population, it is high time the zero tolerance approach was revisited.
What is utterly hypocritical about our current policy, apart from failing to distinguish between
various criminalised drugs, is that it totally ignores the dangers of the two most prevalent drugs:
alcohol and nicotine. In addition, it fails to address the underlying causes that drive people to
self-medicate with drugs in the first place. However, the concept of self-medication is implicitly
recognised in society, where it is perfectly acceptable to take an alcoholic drink or to smoke to
relieve stress, for example, after a tough day at work.
The table below indicates the effects and dangers associated with some drugs used in Mauritius.
They are ordered according to the degree of risk they pose to society (greatest first) following a
report published in the respected UK medical journal, the Lancet, (as summarised on msnbc).

Drug

Immediate effect

Human equivalent

Addictivenes
s

Chemical
toxicity

Heroin

Intense pleasure, sense


of well being

Several e.g. endorphins released during strenuous


activity

High

Fatal in
overdose and
withdrawal

Cocaine

Stimulation, euphoria

None. Inhibits re-uptake of


neuro-transmitters

High

Fatal in
overdose

Alcohol

Sedation, reduces stress Produced by intestinal


and inhibition
bacteria

Moderate

Fatal in
overdose and
withdrawal

High

Nicotine is
fatal in
overdose

Low

Non-fatal in
overdose

Low

Fatal in
overdose

Tobacco Varies with


(Nicotine) concentration
stimulation to sedation
Cannabis

None. Activates multiple


neurological pathways

Contentment, antiNaturally produced in the


depressant, anti-anxiety body, also found in human
maternal milk

Ecstasy
Euphoria, intimacy
(MDMA)

None. Complex neurochemical interactions,


releases hormones e.g.
oxytocin

Obviously the more dangerous drugs, even if taken initially to solve a different problem, become
a source of disease due to their addictive qualities and negative side effects. Heroin heads the
table in terms of societal risk. However, since heroin and, more recently, Subutex (a synthetic
opiate used to relieve heroin withdrawal) are the drugs used by nearly all IDUs, they are
uniquely dangerous due to their involvement in the spread of HIV.
To eliminate the use of injected opiates, it is necessary to massively increase the availability of
detoxification treatment. As well as being provided psychological help to deal with the problems
that have resulted from drug use, ideally, ex-addicts should be given the appropriate therapy for
the problems that drove most of them to use drugs in the first place. However, since many of
these issues are systemic ones within society itself, the only way eliminate demand for
intravenous drugs in the short term is to permit people to self-medicate with more benign drugs.
One over-looked suggestion is to temporarily decriminalise the cultivation and possession of
cannabis for personal use. This would make it an accessible alternative to injectable opiates for
both ex-addicts and potential new users looking for symptomatic relief from physical and
psychological problems. Of course, it would be necessary to control it along the same lines as
alcohol and tobacco, including prohibiting its use by minors, consumption in unlicensed public
spaces and driving under the influence. It would also be important to use traditional species of
plant to avoid the problems encountered in European countries with extremely potent, selectively
bred variants.
There are compelling reasons to support this proposal:
1. Cannabis is more benign and significantly less addictive than legal alternatives namely
alcohol and tobacco.
2. Cannabis has well attested therapeutic properties that will provide better results than
other drugs for those seeking to self-medicate.
3. The active ingredients of cannabis can be inhaled using modern vaporisers, which
eliminate the production of tars and the need to burn it with tobacco.
4. Cannabis can be readily cultivated by anyone, obviating the need for drug dealing and the
crime often associated with having to pay a supplier.
5. Cannabis use has roots in the socio-culture of Mauritius.
6. Significant police resources would be freed up from enforcing cannabis prohibition to
help eliminate heroin/Subutex supply.
The last point is important because it is vital to disrupt the supply of injected opiates. If the drugs
are much more difficult to procure, it will encourage IDUs to seek treatment and ex-addicts will
find it significantly easier to sustain their abstinence . This may well require a major purge of the
law enforcement agencies to remove any elements within them that are currently involved in
opiate distribution. One would expect them and their patrons to vehemently oppose this proposal

as it would have significant impact on their income from illicit activities involving both opiates
and cannabis.
In the longer term, it will only be possible to eliminate drug abuse, including alcohol and
tobacco, by improving the mental and emotional health of each member of society. This will
become easier as society itself changes to eliminate the structural problems that are often the
context and catalysts for psychological problems in the individual.
For Maurice Ile Durable to become a reality we need to expand our vision beyond waste and
energy. To
achieve a truly sustainable society we have to address everything that threatens our future. As
well as pollution and climate change, this must include disease, drugs and the underlying causes
that drive people to use them. One of the greatest threats is an HIV epidemic among the
population at large. Can we afford to restrain ourselves from taking every step necessary to
eliminate this risk?
Article theme
Social Just