Mauritius

ANTANANARIVO/GENEVA, 27 March 2024—Despite progress across most of sub-Saharan Africa, UNAIDS warns that gaps in HIV prevention are driving new HIV infections in the Indian Ocean Countries (IOC) and several other countries in Africa. The critical gaps in HIV prevention were the focus of a workshop organized by UNAIDS and UNFPA which was hosted in Madagascar between 18 and 20 March to address some of the barriers to accelerating progress.

Insufficient focus on HIV prevention in a number of African countries including Egypt, Madagascar, Angola, Sudan and South Sudan has resulted in these countries not achieving the proportionate declines in new infections seen in the rest of the region.

For example, the increase in the number of new infections in a country like Madagascar for example, is in stark contrast to the downward trend in Botswana which has seen a 66% decline in new HIV infections since 2010 and 36% decline in AIDS-related deaths during the same period.  As a result, Botswana—along with Eswatini, Rwanda and Zimbabwe— are on the path to end AIDS having achieved the global 95-95-95 targets through strong HIV prevention and treatment interventions.

Madagascar, one of the poorest countries in the region, has been hit by cyclical natural disasters including drought and cyclones, making it difficult for the country to recover and mount an effective response to HIV. Madagascar recorded a 151% increase in the number of new HIV infections since 2010, and a 279% increase in AIDS-related deaths during the same period. In addition, just 18% of the estimated 70 000 people living with HIV in Madagascar had access to treatment in 2022, and 3200 people died of AIDS-related illnesses. Sudan and South Sudan are also falling behind on HIV prevention and treatment efforts. Inequalities are exacerbating people’s vulnerability to HIV.

“Local research indicates increases in new HIV infections among key populations, including people who use drugs, and among young women and girls. This could be attributable to many factors including drug routes, recurring cyclones and deep poverty in some areas that is making people more vulnerable to HIV infections,” said Professor Zely Randriamanantany, Madagascar’s Minister of Public Health. “We need our international partners to invest with us before it's too late. This prevention focus is very welcome indeed."

“It is clear from our visits to communities and from speaking to health specialists in Madagascar, that the HIV epidemic is changing. The persistent rise in new infections in Madagascar since 2010, for example, shows that it could spread rapidly if we do not stop it in its tracks immediately,” said Anne Githuku-Shongwe, UNAIDS Regional Director for Eastern and Southern Africa. “We know the path that ends AIDS. It’s not a miracle. It requires strong political and financial support.”

Gaps identified in some countries include a lack of data that would point to where HIV prevention efforts need to focus. Data gathering interventions are key to implementing evidence-informed and effective programmes. Some countries are also lacking commodities, including HIV testing kits and condoms.

“Inadequate investment in HIV responses is holding back ending AIDS as a public health threat,” said Jude Padayachy, UNAIDS Country Director for Comoros, Madagascar, Mauritius and Seychelles. “We need to accelerate the HIV response in the Indian Ocean Island states by ensuring all the basics—making sure people are informed about HIV and how to prevent it, and making sure people have access to HIV prevention services and commodities, such as condoms. We also need to make sure that people who are HIV-positive know their status and get the treatment they need.”

UNAIDS is committed to support countries to accelerate political leadership, investments and better data for prevention.

The meeting in Madagascar brought together HIV experts and programme leaders from a number of countries across Africa to learn from each other and to review and strengthen their national plans on HIV prevention to support countries in scaling up their HIV responses. The meeting included teams from Comoros, Egypt, Madagascar, Rwanda, Sudan and South Sudan.

Participants explored ways to improve data collection to help develop more of an understanding of the dynamics of their HIV epidemics to ensure an effective, evidence-informed, human rights-based response. They also drafted national assessments which will serve as a guide to facilitate dialogues with communities, governments, and partners. This will aid in refining strategies and setting priorities to implement ambitious HIV prevention plans. UNAIDS will continue to support countries in their internal assessments to strengthen their HIV responses.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

This will speed up progress to end the AIDS pandemic and save lives.

GENEVA, 4 October 2023—The United Nations in Mauritius—which includes UNAIDS, UNFPA, OHCHR, UNDP and WHO—welcome today’s ruling by the Supreme Court of Mauritius that a discriminatory law criminalizing consensual same sex relations is unconstitutional and will be immediately struck from the legal code. Previously, under Section 250 of the Mauritian Criminal Code (which dated back to 1898) anyone convicted could have faced up to five years in prison.

“The Supreme Court today overturned an obsolete colonial law and demonstrated its commitment to non-discrimination and leaving no-one behind,” said Lisa Singh, United Nations Resident Coordinator in Mauritius. “The UN in Mauritius and internationally welcomes the decision of Mauritius to join the growing list of African countries protecting the human rights of everyone, including LGBTQI+ people.”

The ruling noted that “Section 250 was not introduced in Mauritius to reflect any indigenous Mauritian values but was inherited as part of our colonial history from Britain. Its enactment was not the expression of domestic democratic will, but was a course imposed on Mauritius and other colonies by British rule.” It also noted that a growing number of countries have decriminalized consensual same sex sexual relations, including the United Kingdom which overturned its law in 1967. 

“Mauritius' decision to decriminalize homosexuality is an important step forward for public health and a step towards equal rights, respect and dignity for the LGBTQI community,” said Anne Githuku-Shongwe, Director of UNAIDS’ Regional Support Team for Eastern and Southern Africa. “UNAIDS applauds Mauritius for today’s decision which will mean that men who have sex with men will have much easier access to the health and social services they need without fear of arrest or criminalization. Work will need to continue to break down the barriers of stigma and discrimination towards the LGBTQI community, but today’s ruling is a positive step in the right direction. It will save lives.”

Mauritius becomes the latest in a growing list of countries to declare that laws which have criminalized LGBTQI people are unconstitutional. However, UNAIDS estimates that 66 countries still have laws which criminalize consensual same sex relations. In addition to contravening the human rights of LGBTQI people, these laws impede access to health and social services, including HIV services. Such laws fuel stigma and discrimination against LGBTQI people and put them under constant fear of being punished or detained.

The case was brought forward by Abdool Ridwan Firaas Ah Seek, President of Arc-en-Ciel, the largest and longest-standing organisation in Mauritius championing the human rights of LGBTQI people, and was supported by partners including the Human Dignity Trust.

Civil society organizations, especially community-led organizations, are at the forefront of a global wave of progress that advances access to health for all. UNAIDS urges all countries to decriminalise same sex sexual relations. Decriminalization saves and changes lives.

Maneesh Gobin, Attorney General and Minister of Foreign Affairs and Regional Integration in Mauritius said, “In keeping with its internationally acclaimed respect for the rule of law, Mauritius will indeed report to United Nations Member States at the next cycle of the Universal Periodic Review.” The Universal Periodic Review is a unique mechanism of the Human Rights Council that calls for each UN Member State to undergo a peer review of its human rights records every 4.5 years.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The challenges for the AIDS response in small island developing states are unique. Increasingly, they face natural disasters, community displacement and migration. On these small islands, HIV is most prevalent among key populations—sex workers, gay men and other men who have sex with men and people who inject drugs—and most HIV infections are among young people.

In a recent visit to Seychelles, Michel Sidibé, the UNAIDS Executive Director, addressed a meeting on laws, policies and strategies to meet the 90–90–90 targets—whereby, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—in small island developing states.

Mr Sidibé highlighted the need for small island developing states to protect the human rights of key populations and to invest in HIV prevention and treatment services for adolescents and young people. He also stressed the importance of improving economic opportunities for communities.

During his visit, Mr Sidibé also addressed the Seychelles National Assembly to stress the importance of ensuring that Seychelles is on the Fast-Track towards ending AIDS. Despite Seychelles’ efforts towards meeting the 90–90–90 targets, new HIV infections among key populations are continuing to grow, highlighting the need to reach populations at higher risk of HIV with effective HIV services.

Mr Sidibé commended the President of Seychelles, Danny Faure, for his bold leadership of the national AIDS response and his commitment to build a generation without AIDS. 

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

Two of the major networks of people living with HIV in the Indian Ocean region have merged. The decision, which is aimed at strengthening civil society participation in the AIDS response in the Indian Ocean islands, was announced during the 13th Indian Ocean Colloquium on HIV and Hepatitis, which concluded on 10 October in Saint-Gilles-les-Bains, Réunion.

Ravane+, which means uniting people living with HIV, and Femmes Positives Océan Indien will work together under a single network—Ravane Océan Indien—in advocating for the rights of people living with HIV and those most vulnerable to HIV infection. The network will focus on advocating for equitable health care and public services for people living with HIV and creating an enabling policy and legal environment for populations at higher risk of HIV infection, including men who have sex with men, sex workers and people who inject drugs.

The newly appointed President of Ravane Océan Indien, Ronny Arnephy, stressed that although each island has specific challenges in the HIV epidemic, having a common goal will bring greater opportunities for stronger advocacy and representation from civil society.

For the past 12 months, the two networks—with technical and financial support from UNAIDS and other partners—have been working together in refining the details of the merger, including defining the vision, operational modalities and workplan for 2015. 

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

In 2006, the Government of Mauritius started harm reduction programmes—needle exchange programmes and opioid substitution therapy (methadone)—to reduce the transmission of blood-borne infections among people who inject drugs both inside and outside prison. Government figures from 2012 show that more than 5 400 people were enrolled on opioid substitution therapy, and the Global AIDS response progress report for Mauritius for 2012 shows that HIV transmission through injecting drug use in Mauritius declined from 73% in 2010 to 68% in 2011.

During an official visit to Mauritius, UNAIDS Executive Director Michel Sidibé visited the Central Prison in Beau-Bassin, Mauritius’s largest prison, to learn about its opioid substitution programme, which allows inmates to continue receiving a daily dose of methadone while imprisoned.

During the visit, Mr Sidibé commended the Government of Mauritius and nongovernment organizations for putting in place a programme that ensures the well-being of inmates. “The quality of the treatment of prisoners reflects the level of humanity in Mauritius,” said Mr Sidibé. “The Central Prison in Beau-Bassin is restoring human dignity in all its dimensions.”

Government figures show that in March 2014 an estimated 2 289 convicted and remand detainees were held in nine prisons in Mauritius. Almost 40% of male inmates in the country are imprisoned due to drug-related crimes, and 30% of inmates are living with HIV. Sharing of smuggled injecting equipment is common in jail, which increases the risk of HIV infection while in custody.

Mauritius is proud to be among the few countries to implement a methadone programme in prison, which covers more than 200 inmates,” said Jean Bruneau, Commissioner of Prisons in Mauritius. “Because of this programme, Mauritius has been able to reduce HIV transmission among prisoners who use drugs.”

“I am grateful to the government for supporting the methadone programme and other important services at the prison care centre,” one prison inmate told Mr Sidibé. “This is preparing me to get back to a normal life and be a valued member of my community.”

During his visit to Mauritius, Mr Sidibé also met with representatives of civil society organizations and networks of people living with HIV to discuss opportunities and challenges in the national AIDS response.

“My discussion with civil society was a moment of truth, an exchange that brought a face to the epidemic,” said Mr Sidibé. “As we look to our post-2015 goals, we must make sure that no one is left behind.”

Stigma and discrimination towards people living with HIV remain critical to the national AIDS response. The People Living with HIV Stigma Index shows that in Mauritius 30% of respondents—people living with or affected by HIV—had fears about being insulted or verbally threatened or harassed, while 23% feared physical assault. Additionally, 28% of respondents reported being denied access to health services due to HIV, while 40.5% reported discriminatory or very discriminatory responses to disclosures of their HIV status to health-care workers.

“People are stigmatized and discriminated because of their HIV status—they are continuously denied services, excluded from their communities and face the threat of deportation. These are the realities of people living with HIV in Mauritius,” said Nicolas Ritter, Executive Director of Prévention Information et Lutte contre le SIDA.

The government of Mauritius commits to removing the current stay and residence restrictions for people living with HIV. During a meeting with UNAIDS Executive Director Michel Sidibé in Port Louis on 18 April, Prime Minister of Mauritius Navin Ramgoolam pledged to setting up a special committee to review and make recommendations towards lifting the remaining travel restrictions in the country.

Mauritius is one of the 44 countries in the world that enforce HIV-related restrictions to entry, stay and residence for people living with HIV. Welcoming the government’s decision, Mr Sidibé stressed on the need to making sure that people have equal access to freedom of movement – regardless of their HIV status. He added HIV treatment has revolutionized the life of people living with HIV and allowed them to be productive, equal and global citizens.

Earlier in the day, Mr Sidibé met with President of Mauritius Kailash Purryag at State House in Le Réduit to discuss progress and challenges in the national AIDS response. President Purryag outlined his vision to eliminating extreme poverty which is critical to overcoming the AIDS epidemic.

In the last few years, Mauritius has made good progress in its AIDS response. In 2012, only 2 babies were born with HIV in the country and more than 95% of pregnant women living with HIV were accessing treatment. An estimated 11 000 people were living with HIV in Mauritius in 2012 – an increase from 7 300 in 2001. The HIV epidemic in Mauritius is concentrated among people who inject drugs. In 2011, it was estimated that 10 000 people were injecting drugs in Mauritius – 51.6% of people who inject drugs were living with HIV in 2012.

Mr Sidibé commended the government of Mauritius for its leadership and efforts in making an AIDS-free generation a reality. Mr Sidibé also applauded Mauritius for successfully implementing harm reduction programmes in prison settings for people who inject drugs.

According to government figures, HIV infection among people who inject drugs has started to decline from 73% in 2010 to 68% in 2011 due to innovative programmes which provide free syringes and needles as well as opioid substitution therapy.

During his visit, Mr Sidibé also met with the Minister of Foreign Affairs, the Minister of Health, and representatives from the Indian Ocean Commission and civil society to take stock of the AIDS response in Mauritius. The discussions focused particularly on provision of HIV prevention and treatment services to key population at risk of HIV, stigma reduction and equity in the AIDS response, as well as applying regional approach to the AIDS response in the Indian Ocean islands.