MAURITIUS NATIONAL PEER
EDUCATION STRATEGY
(DRAFT)
PREPARED FOR
National AIDS Secretariat, Mauritius, March, 2012
APMG
108/1 Erskineville Rd
Newtown 2042 Australia
Telephone +61 2 9519 1039
Facsimile +61 2 9517 2039
admin@aidsprojects.com
www.aidsprojects.com
ACN 106 054 326
Abbreviations used
AIDS
ARV
HCT
HIV
KAPs
MST
NAS
NEP
NGOs
PEP
PLWHA
PMTCT
PWID
STIs
SW
Acquired Immune Deficiency Syndrome
Antiretroviral medication
HIV counselling and testing
Human Immunodeficiency Virus
Key Affected Populations
Methadone Substitution Therapy
National AIDS Secretariat
Needle Exchange Program
Non Government Organizations
Post HIV-exposure prophylaxis
People Living with HIV and AIDS
Prevention of Mother to Child Transmission
People Who Inject Drugs
Sexually Transmitted Infections
Sex Workers
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Table of Contents
Abbreviations used ............................................................................................................. 2
Table of Contents ................................................................................................................ 3
Introduction ........................................................................................................................ 4
Goal ..................................................................................................................................... 5
Objectives............................................................................................................................ 5
Guiding Principles ............................................................................................................... 5
Strategies: ........................................................................................................................... 6
Strengthening co-ordination and leadership .................................................................. 6
Reducing HIV Vulnerability Amongst KAPs and their partners....................................... 6
Policy Approaches ........................................................................................................... 7
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Introduction
The HIV/AIDS epidemic in Mauritius is classified as ‘concentrated’ whereby HIV
prevalence is estimated to be below 1% among women tested at antenatal clinics and
above 5% among one or more of the Key Affected Populations (KAPs). In 2000, 2% of
new HIV infections were among People Who Inject Drugs (PWID). By 2005, this had
increased to 92%. Although rates have gradually decreased to 73% in 2008,
an Integrated Biological and Behavioural study in 2011 showed that the prevalence of
HIV was 51.6% among PWID and that 10.8 % of this population reported still sharing
needles and syringes in spite of national coverage of needle-syringe exchange
programmes.
The persistence of risk-taking
behaviours among PWID and the
implications for a potentially rapid
extension of the disease to other
KAPs and the wider population
requires the sustained mobilization and close coordination of all
national stakeholders.
People who
inject drugs
Prison
Detainees
Female Sex
Workers
Peer
Building on the success of the
Education
Needle Exchange Programme
(NEP) and the Methadone
Substitution
Therapy
(MST)
Programme, the National Harm
Men who
Transgender
have sex
Reduction
Strategy
(2011)
with men
provided a national framework to
unify and strengthen these harm
reduction approaches. This in turn
supported the National HIV/AIDS response to prevent further transmission amongst
KAPs and the wider community.
Peer education is a critical component of HIV prevention amongst KAPs. KAPs peer
outreach workers are utilised to identify at-risk individuals within their own community
networks and are well placed to encourage drug use and/or sexual risk behaviour
change. However, particular vulnerabilities of KAPs are frequently complex and
challenging to effectively address, and the oversight capacity of implementing
organisations is often limited. Subsequently, unrealistic expectations are placed upon
the implementing organisations and their personnel. The National Peer Education
Strategy aims to address these issues by building capacity throughout all key
stakeholders in peer education, an approach successfully and widely used to access
KAPS in many countries.
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Goal
The goal of the National Peer Education Strategy is to position peer education as a
critical component of HIV prevention programmes targeting KAPs in preventing the
transmission of HIV/AIDS.
Objectives
1. Build national capacity and leadership in both government and civil society to
provide peer education to all KAPs in Mauritius
2. Build support for peer education by strengthening linkages with existing services
and networks including law enforcement, civil society organisations, health and
welfare workers and other stakeholders.
3. Promote the importance of inclusion of representatives of KAPs in all relevant
decision making bodies at all level of government and civil society.
4. Reduce stigma and discrimination associated with HIV/AIDS and harm reduction
services to build sustainable services and enhance the quality of life of KAPs,
their families and the wider community.
Guiding Principles
Mauritius’s response to peer education will be guided by the following principles:
 All KAPs will be provided with access to the information and support they need
to protect themselves against HIV infection.
 Gender norms and relations are a key factor in determining who acquires HIV in
Mauritius, and in determining treatment, care and support outcomes. All peer
education programs will devise and implement strategies that address gender
norms and relations. Addressing the prevention and care needs of women and
girls will be a particular focus, combined with attention to male behaviour and
cultural norms that increase the likelihood of women contracting HIV.
 Leadership across all sectors will be fostered and valued, and the capacity of
each sector to contribute to the overall peer education response will be
strengthened. This includes community leadership, which will be encouraged
and supported through the mobilization and support of communities to respond
to HIV.
 All levels of government, including law enforcement will be encouraged and
supported to play a role in increasing the effectiveness of peer education in
reducing the impact of HIV and AIDS on individuals, families and communities.
 Sustainability will be promoted by incorporating peer education into existing
programmes servicing KAPs communities.
 The response will be backed up by sustained political commitment and by the
mobilization of resources to sustain the required effort.
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Strategies:
Strengthening co-ordination and leadership
The national peer education response will be guided and co-ordinated by a single, multisectoral coordinating body. In May 2007, the National AIDS Secretariat (NAS) was
officially established, and is well positioned as lead coordinator of the peer education
strategy. The National AIDS Secretariat is located inside the Prime Minister’s Office.
1. Political commitment
A consistent and effective long-term response to peer education as an effective strategy
in reducing HIV and AIDS will depend on political commitment from all parties and all
levels of government. Encouraging the participation of KAPS in all levels of program
management, design and implementation is essential for effective peer education.
It is essential that peer education and the importance of KAPS inclusion in all policy
decisions is agreed upon by all parties and by governments at all levels, and that political
leaders provide leadership by understanding the issues relating to peer education in
their jurisdiction.
2. Religious and civil society leadership
Creating an environment in which peer education can be effectively implemented will
require the support and leadership of religious and civil society leaders. These leaders
help to shape opinion within communities and can help communities to find ways to
reduce the stigma and discrimination experienced by KAPs. Religious and civil society
leaders can also play a vital role in establishing an environment that supports the overall
objective of peer education of preventing HIV transmission amongst KAPs and the wider
community.
The active participation of groups established by and for people with HIV and AIDS will
be particularly encouraged.
Reducing HIV Vulnerability Amongst KAPs and their partners
Mauritius has a concentrated HIV and AIDS epidemic that will be most efficiently
controlled by peer education amongst the KAPS most likely to be exposed to HIV. These
are:






Injecting drug users
Men who have sex with men and transgender
Prisoners
Sex workers
Mobile populations
Sexual partners, spouses and children of the people in these populations.
The primary focus of peer education will be on reducing HIV infection amongst these
populations. The National Peer Education Strategy will adopt a public health approach
that seeks to work in partnership with these populations, and that takes care not to
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further stigmatize them. The strategy will encourage and promote the training of peer
educators from KAPS. Reaching these populations will involve peer educators working
with health services, NGOs and community groups to determine approaches, strategies
and messages that are accessible, appropriate and acceptable to these populations.
There will be a particular focus on bringing services as close as possible to the
communities most affected, to ensure a long-term connection between services and
these communities.
The Peer Education Strategy will reduce vulnerability to HIV infection among KAPs and
their partners by expanding access to a comprehensive package of harm reduction
services. The package of services will include:










Needle and syringe programmes (NEPs)
Opioid substitution therapy (OST) and other drug dependence treatment
HIV testing and counselling
Antiretroviral therapy (ART)
Prevention and treatment of sexually transmitted infections (STIs)
Condom programmes for KAPs and their sexual partners
Targeted information, education and communication for KAPS and their sexual
partners
Vaccination for, and diagnosis and treatment of, viral hepatitis
Prevention, diagnosis and treatment of Tuberculosis (TB)
Strategies to enhance peer education activities
Policy Approaches
Effective peer education requires a consistent approach across all sectors and at all
levels of government and community. This is assisted by providing a set of consistent
laws and policies that support peer education strategies. The key aim of the legal and
policy framework is to provide and maintain an enabling environment for peer
education to provide prevention, treatment, care and support programs and services to
all KAPs.
1. Reducing HIV and AIDS stigma and discrimination
Health services will pay particular attention to reducing the barriers that prevent KAPS
from accessing counselling and treatment. Health workers will be provided with training
and support to ensure that they can provide non-judgemental care and support to KAPS.
Employers will be assisted to modify their policies to ensure that people from KAPS
communities have continued access to employment. Anti-discrimination laws will be
amended to make it illegal to discriminate against people from KAPs. The Media will be
encouraged to play a constructive role through reporting that increases access to
accurate information and decreases KAPs related stigma and discrimination.
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2. Establishing a supportive legislative and policy framework
Existing laws and policies will be reviewed to ensure that they do not increase KAPS
vulnerability and risk, or work against the vision and objectives of the National Harm
reduction Strategy. All agencies involved in the response will be encouraged to examine
their policies to determine whether they are inadvertently contributing to KAPs related
stigma and discrimination. The need for specific Public Health Legislation will be
examined within this process.
3. Policy and programmes based on accurate data, evidence and knowledge
The peer education response will be driven by accurate information about the particular
nature of HIV risk and vulnerability and about the changing needs of KAPs. Surveillance,
operational research, social research, monitoring and evaluation systems will be
strengthened to ensure that they provide the information required to ensure that the
peer education response remains flexible, relevant and effective.
4. Integration of HIV and AIDS initiatives and awareness into existing
programs
Wherever possible, peer education initiatives will be integrated into existing programs
and services targeting KAPS. In health, this will mean integration into sexual and
reproductive health services, maternal and child health, services for sexually
transmitted infections, family health and other mainstream services. In other sectors
this will mean the development of strategies to ensure access for KAPs to welfare,
housing and socio-economic support programs, drug treatment programs, workforce
development programs and other appropriate programs and services. The focus will be
on breaking down access barriers and on avoiding the need for a range of unnecessary
and unsustainable HIV-specific services and programs. Where policies already exist, such
as for workplaces, these policies will ensure that they cover the private informal sector
which is often less organized.
5. Encouraging a whole of government approach - across all government
departments and at all levels of government
All government ministries and departments will identify strategies to contribute to the
implementation of peer education strategies. They will also examine their policies and
programs to ensure that they are not contributing to the further marginalisation or
stigmatisation of KAPs. All government departments will be required to examine their
policies and practices in order to determine ways to contribute to the response to both
HIV and AIDS and accessing KAPs through peer led outreach.
6. Ensuring a multi-sectoral approach that includes the full participation of
civil society and community groups, religious leaders and the private sector
Reaching all KAPs through peer education will require the cooperation, particular
expertise and knowledge of civil society and community groups. In particular, networks
of people living with HIV and AIDS will be supported and strengthened as key providers
of peer education, information, support and care. NGOs and community groups that
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work with KAPs will also be supported and encouraged to establish peer education
programs and to participate fully in the response. These organizations are more likely to
be able to reach and maintain contact with marginalized individuals and communities.
Initiatives that that will implement or establish peer education within these civil society
and community groups into the HIV and AIDS response will be encouraged at national,
provincial and district levels.
Religious leaders and religious communities will also be encouraged to demonstrate
leadership in the reduction of KAPs related stigma and discrimination, by providing
programs and services to reduce the impact of HIV and by assisting in the
implementation of peer education activities to promote behaviours that reduce HIV
transmission.
The participation of the private sector will be encouraged. Employers and employer
groups will be encouraged to develop and implement workplace policies that assist in
accessing KAPS and supporting workers and families affected by HIV and AIDS. Privatesector development projects will be encouraged to assess access by KAPS to their
projects and put in place strategies to minimize KAPs stigma and marginalisation.
Opportunities for public/private partnerships that enhance the national and provincial
HIV and AIDS response will also be identified and supported.
7. Recognising the particular role of individuals from KAPS
People from KAPs will be encouraged and supported to play a key role in peer
education, HIV prevention and care at all levels. This will be achieved through the
support of KAPs networks and the implementation of strategies to foster the greater
involvement of people from KAPs in the design, implementation and evaluation of
programs and services.
KAPs will be supported to implement, monitor and manage peer education
programmes. This encourages ownership of the interventions and empowers KAPs to
become leaders within the outreach programme and their own communities. This
approach involves the incremental building of outreach capabilities along with KAPs
peer training, performance evaluation and opportunities for career progression.
KAPS peer leaders will work with health and community services to develop and
implement strategies that reduce barriers to service use and that promote health and
wellbeing for people living with HIV and AIDS and for individuals and communities
affected by HIV and AIDS. The particular role of people from KAPs in raising awareness
about HIV, promoting tolerance and assisting other KAPs to access prevention,
treatment, care and support services will be encouraged and supported.
8. Health system strengthening
The health workforce will be provided with the knowledge, skills and resources it needs
to work with peer educators to provide effective prevention, treatment and care
services to people from KAPs. This will include training and workforce development,
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access to universal infection control guidelines and to the equipment necessary to avoid
HIV transmission in healthcare settings and access to PEP programs for people
potentially exposed to HIV.
9. HIV Prevention
Prevention efforts will be concentrated on the populations most at risk and will involve
working with government and private health services, civil society and community
groups to put in place a range of targeted interventions aimed at reducing risk
behaviour. Peer education will further strengthen strategies including targeted condom
promotion, outreach to particular populations at sexual risk, integration of HIV into
sexual and reproductive health services, needle exchange outreach to injecting drug
users and referral to drug treatment services, and harm reduction in prisons.
Efforts will be made to ensure that accurate and relevant information about HIV and
AIDS and the behaviours that put people at risk will be made available to people in a
language and format that they understand and from sources that they respect. Peer
education will place a particular focus on reaching people with little formal education,
people who cannot read and people from marginalized groups and communities.
Identifying, training and employing peer educators able to reach particular communities
will be sought to ensure that HIV and AIDS information reaches deep into these
communities.
In line with the focus on populations most at risk, peer education programs should be
established that can access out-of-school youth, migrant workers, mobile populations
and prisoners will be addressed through targeted government and NGO/community
programs.
10. HIV testing and counselling
KAPs will be encouraged to access HIV testing and counselling which is voluntary and
confidential, and which will always be accompanied by access to information and
counselling. People who test HIV positive will be assisted in accessing on-going
counselling, treatment, care and support. Test results will be confidential and systems
put in place to ensure the privacy of people who undergo HIV testing. In cases of
provider initiated testing because of perceived risk or as a diagnostic measure in the
presence of illness, the specific consent of the person will be obtained before testing.
Particular attention will be paid to reducing barriers to access to voluntary testing and
counselling, particularly for women.
11. Prevention of mother-to-child transmission of HIV
Peer education will also focus on ante-natal care services, on assisting pregnant women
to access voluntary, confidential HIV counselling and testing, to access antiretroviral
treatments for themselves, and to access Prevention of Mother-To-Child-Transmission
(PMTCT) programs, if HIV-positive.
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12. Co-ordination between the national HIV and AIDS response, harm
reduction, peer education and the national response to reduce illicit drug
use
A co-ordinating mechanism will be established to maximize co-ordination and cooperation between the national peer education strategy, the national effort to reduce
the use of illicit drugs and the national HIV and AIDS response. This will provide a forum
for ensuring that these important national responses work together effectively.
13. Communication and information sharing between all government and civil
society agencies providing peer education or harm education services to
KAPs communities.
A mechanism will be established to ensure regular meetings and information sharing
occurs between all civil society and government agencies which provide peer education
and harm reduction services to KAPS. This ensures that resources are maximally
utilised, duplication of services does occur and that all services work together
effectively.
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