No prescriptions, but plenty of users

Port Louis, MAURITIUS — Port Louis, MAURITIUS -- The sun set hours ago. Most everyone who sang and prayed in this concrete room with curtains that's still stuffy from body heat have gone home.

Christabelle Piangnee, a 29-year-old whose life has become an incongruous mix of opiates, prostitution and thoughts of quitting both, stays behind and makes a confession of sorts.


"I have it," she says.

She means HIV. She doesn't say more. She simply sits in her black leather jacket, her open sandals revealing painted toenails, her pretty face a picture of fatigue and hopelessness.


Piangnee has injected drugs since the age of 17. Three times today, she says, she has pumped heroin into her veins, though she prefers a drug called Subutex that is widely sold in the streets of this African nation of 1.25 million people. She has heard it's used elsewhere as a medical treatment for opiate addiction, left under the tongue to dissolve, but no one she knows in Mauritius uses it that way. They crush it, mix it with water and inject it, as she does, sometimes sharing needles when the urgency of the hit is the only thing that matters.

Buprenorphine has snared people here in the addiction trap that the drug is designed to eliminate, in a place it is not even prescribed. There should be no buprenorphine in Mauritius, as health officials have not approved its medical use. But authorities say large quantities have been smuggled to this island in the Indian Ocean, a former French and British colony, where it has become a widely used opiate, even more popular than heroin among many addicts.

"When you talk to them, they all say they prefer Subutex," said Gerard Lesage, chairman of the National Agency for the Treatment and Rehabilitation of Substance Abusers. (A different buprenorphine pill, Suboxone, is commonly sold in the United States.)

Subutex costs less than "brown sugar," or unrefined heroin, and a quarter of a pill staves off craving for another high for 24 hours. Unlike heroin, Subutex doesn't make Piangnee see two faces, two TV screens, where there is only one.

"When I take Subutex," she says, "I'm normal."

But normal, she knows, is a relative term for someone who finances her addiction by selling her body and stealing, sometimes from her mother, with whom she lives. Piangnee doesn't want to inject drugs anymore, she says. Her daughter, who is wiser than a 12-year-old should have to be, has implored her to stop.

"I want to get out of this life," she says. "I don't want to die, because I love my daughter."

Mauritius is no longer just an island of sugar plantations; street vendors selling cheap shoes and socks in the capital of Port Louis do so in the shadow of modern buildings near a well-landscaped harborfront. By African standards, life is good here.


The island's relative prosperity -- coupled with good air links to India, Asia and mainland Africa, and off-shore banking operations -- has made drugs a growth business.

Buprenorphine rapidly became an abused drug, in a country ill-equipped to deal with the public health consequences. Addiction is not the only scourge: Public health officials say increased availability of buprenorphine and the sharing by injectors of contaminated needles are helping fuel an HIV epidemic that, while comparatively small, is escalating. Between a quarter and a half of the country's 17,000 to 18,000 injectors share their needles, a government study found last year.

The official cumulative number of HIV and AIDS cases in Mauritius has climbed from a few hundred in 2002 to 3,100 this year. But the nongovernmental organization Prevention Information and Fight against AIDS, which works with HIV patients, suggests that a truer estimate, based on the group's experience in the field, is 12,000 or more.

The epidemic is not being fueled by Subutex alone; heroin is still widely injected, along with a drug mix called La Dame Blanche, or White Lady, in the French spoken here. Another cause is the unprotected sex that is common among intravenous drug users and prostitutes. But the increase of HIV among injectors has coincided with greater availability of Subutex, smuggled in mainly from France.

It's a lucrative business. In short supply in September, it spiked to $130 a pill, 10 times the normal price.

Mauritius' prime minister has proposed amending its drug laws to provide stiffer penalties for possession and trafficking of Subutex. The American firm that sells buprenorphine in France and many other countries, Schering-Plough Corp., said it is taking steps to prevent "illegal commerce" and cooperating with the government here. Though the drug was not introduced as a treatment, "we have a responsibility to the public health and the public good," said Dr. Robert J. Spiegel, chief medical officer and senior vice president of the Schering-Plough Research Institute.


With so much drug use, the demand for addiction treatment exceeds the capacity to provide it. And officials expect HIV cases will continue to climb.

Christabelle Piangnee isn't sure when, or how, she became infected with HIV; her whole adult life has been one risk after another. She doesn't even remember how long ago she found out; it was during one of her two stints in prison for dealing heroin.

On a Friday night in September, she attended her first meeting of the Association for People In Tears, which works with addicts. They met in Roche-Bois, one of the more impoverished neighborhoods on the capital's outskirts. Near the end of the meeting, before the chicken tikka subs were handed out, one of the association's volunteer board members, Jose Cangy, gathered the addicts around him for an eyes-closed prayer.

He laid his hands on Piangnee's bowed head and spoke in sharp bursts. She crumpled to the floor, purged, for a few minutes, of her addictions.

There is a long way to go to recovery. But that night, she committed to a small step. She wouldn't shoot up, she said, before going to bed.