HIV has done one interesting thing to Mauritius: it has mobilised diverse groups to discuss the issue. But what is the fight against HIV really about? We live in a welfare state, where our government is responsible for our social and economic welfare. HIV tests and treatments are free and available in all hospitals, with the presence of trained doctors in those hospitals. The service is here, the law to protect people living with HIV has been enacted, a national coordinating body for the response of HIV in Mauritius is present. Then, what is the fight really about?
The global response to AIDS is been highly politicised. In Mauritius, the key factor for the national AIDS response is the prejudice and discomfort around the ways that the virus is transmitted. HIV is transmitted only through bodily fluids, namely semen, blood, vaginal secretions and breast milk. HIV infection is also associated with identities or behaviours such as homosexuality, drug addition, sex work or promiscuity. HIV infection is therefore often thought as a moral fault, a result of personal irresponsibility. In addition, there is a common belief/attitude in Mauritius: “Sida pa mwa sa, li sa”.
Amidst this moral baggage related to HIV, the epidemic is also fuelled by many injustices. The HIV epidemic has revealed many political loopholes in our system to tackle issues like poverty. Mauritius has adopted a consistent stand to the effect that there is no need to include economic, social and cultural rights in our Constitution since the welfare state is guaranteed by other legislations. Even an independent body like the National Human Rights Commission, which has been created to ensure better protection of human rights, does not deal with complaints related to rights to education, health services and rights to social security as it is assumed that such rights are catered for by the local legislation provided in our welfare state system.
However, provision of free essential medicines in public hospitals does not ensure that those medicines are accessible to everyone. Children living with HIV and AIDS cannot travel to the public hospitals to collect medicines and there is no such policy whereby essential medicines should be made available to persons who are in need of them. Also, not all medicines are available (such as treatment for Hepatitis C).
Similarly, up until now, no harm reduction strategies has been proposed to people who inject drugs in Rodrigues (e.g. methadone substitution therapy, clean needles and syringes). Information on health services, including safe injecting drug practices, information on safe sex practices and access to condoms and contraception to young people who require it are still unavailable. Failure to access comprehensive sexual education make the young people more vulnerable to HIV and other sexually transmitted diseases, early pregnancies, school drop-outs and exposed to other hazards such as forced sex work and criminal offences.
We are currently in an electoral campaign, with one of the highlights being the amendment of our Constitution for the Second Republic. However, we know with HIV that blatant human rights are currently denied in our constitution, for instance, rights to Education, rights to Housing, rights to Basic Amenities, rights to a Healthy and sustainable environment (including rights to access healthcare services and reproductive healthcare) and Rights to Freedom of Trade, Occupation and Profession. The fight both exposes and exacerbates multiple fault lines and injustice, revealing our political system’s weak points. HIV is therefore an epidemic which has altered political systems and has defined the approaches in managing its impact in Mauritius.
Addressing HIV in Mauritius also calls to address socio-economic factors related to HIV. So many times we get urgent request for food or other basic amenities. I will always remember the man who asked me: “Mo kapav pran sa bann bwat kartron? Pou mo dormi aswar…”
We treat poverty as a static condition, instead of an outcome of social structures, political decisions and equity. People move in and out of poverty for many reasons and the fight therefore calls for more initiatives that take advantage of the political economy to lessen poverty. Another social factor related to HIV is gender-based violence. Women economic empowerment, their entitlements, their marginal positions in labour markers, including women and transgendered engaged in sex work, teenage pregnancies and feminization of poverty fail to capture the attention of our policy-makers, and sadly enough, to the attention of our female policy-makers.
AIDS activists have been more successful in putting HIV in the international agenda when many other global campaigns, in healthcare or other issues, have either struggled or failed to have such an impact. HIV treatments called antiretrovirals (ARVs) have for long been unavailable to many poor countries because of their excessively high price. AIDS activists then lobbied donor nations to buy the drugs and pressurized pharmaceutical companies to lower their prices while encouraging generic companies to enter the market to create more competitive prices.
The rights to access treatment/ essential medicines can also be coupled with the fight for the presence of a more effective global health in our public health system, which includes more coordination among healthcare providers, more specialists to tackle the various health issues and calls for more budget and political will to strengthen our current health system. Best and most effective treatment should be available in Mauritius.
The fight against HIV calls for discussion on the alternatives to the failed war on drugs. The urgent need to reform our national drug policies has become more important since we know the devastating impact of bad drug policies on HIV and Hepatitis C; the criminalisation of drug use or possession ostracises people from vital health and social services, confers people to prisons where they are exposed to more dangerous injecting practices and drugs and as well as conferring certificate of character which further condemns people for life. We hear many stories of people who resort to sex work to be able to pay for “street drugs”, or other reports of one syringe shared among 30 inmates to inject drugs. Condemning the person who use drugs to prisons means sending the person to be more exposed to HIV and Hepatitis C. The fight against HIV therefore calls for advocating more effective and humane ways to manage drugs in Mauritius.
It is not surprising that there is still more political will needed in this fight. We are still battling to have more than 4 specialised doctors to support and treat people who are HIV positive in Mauritius. On a public health paradigm, all the effective strategies to reach zero new infection, zero AIDS-related deaths and zero stigma are available. Are the policy-makers in Mauritius not aware of those strategies? Or do they find it more rational to put our tax-payers money on grandiose ceremony than on saving and/or improving human lives? What will policy-makers, including our candidates gain or lose by speaking out and supporting HIV issues?
But the fight will go on.