Harm Reduction as a Complex Adaptive System: Results from a Qualitative Structural Analysis of Services Accessed by Young Heroin Users in Mauritius

Abstract

Harm Reduction (HR) was introduced in Mauritius in 2006 to mitigate the local Human Immunodeficiency Virus (HIV) epidemic mainly driven by injecting drug use. With an estimated population of 55,000 drug users and an estimated population of 6600 injecting drug users with an average of 21 years at first injection, the impact of drug use on the epidemic remains high. Those aged 15–24 years account for 20% of all new HIV cases detected annually since 2010, with known causes of incidence including both injecting drug use and unprotected sexual intercourse. Beginning with an exploration of access and barriers to needles and syringes, our study evolved to consider the dynamics between concurrent services and the effectiveness of the resulting system. Utilising snowball and purposive sampling, we conducted in-depth interviews with 27 participants, including service providers, identified by peer fieldworkers from various NGOs. Our analysis showed that HR services were connected via informal networks and displayed the same characteristics as Complex Adaptive Systems (CAS). We propose using qualitative structural analysis as a viable method to explore the complexity of HR. CAS and proper acknowledgement of peer support could guide current and future HR policy reforms.