Policy interventions to preserve low HIV prevalence in Madagascar

Policy interventions to preserve low HIV prevalence in Madagascar.

Int Conf AIDS. 1996 Jul 7-12;11(2):44 (abstract no. We.D.233). Unique Identifier : AIDSLINE MED/96923307
Ravaorarimalala C; Behets F; Rabeson D; May J; Andriamahefazafy B; Rasamindrakotroka A; Institut d'Hygiene Sociale, Anatananarivo, Madagascar.


Issue: Madagascar has been relatively spared of the HIV epidemic. However factors favoring the spread of HIV are present such as: high prevalence of curable STDs increasing poverty prostitution and tourism. Project: To avoid complacency and inertia a project was initiated to inform and mobilize leaders nationwide. HIV and syphilis seroprevalence studies were conducted mid 1995 among pregnant women prostitutes and patients seeking STD care. Results were used to evaluate the current HIV problem to develop prediction models estimate the socioeconomic impact and articulate prevention interventions. A user-friendly interactive computer program posters a brochure and a video movie were developed as communication and dissemination tools. Qualitative research was conducted to evaluate the obstacles to condom use by prostitutes and their clients and STD patients. High and medium level decision makers and opinion leaders across diverse political and economic sectors were targeted for information dissemination and consensus building regarding prevention interventions. A training seminar was organized for journalists. Results: Among 4,131 individuals evaluated 8 (.2%) were HIV seropositive and 732 (17.7%) syphilis seroreactive. The total number of seropositives in Madagascar was estimated at 5,000; the persons at risk at 1,000,000 for a total population of 13,100,000. Syphilis seroreactivitiy was significantly associated with lack of schooling and prostitution. Projection models predicted HIV seroprevalence rates among adults between 3% Thailand scenario) and 15% (Kenya scenario) in 2015. The impact of specific interventions was modeled. December 1 1995 the dissemination of the results was launched during an official ceremony with 6 ministers. Lessons Learned: Madagascar opted for a rare approach: despite numerous grave problems inherent to a poor developing country deliberate efforts were made to prevent the spread of HIV while the prevalence is still low. The observed high syphilis seroprevalence rates require urgent actions. Other common curable STDs should be controlled. However because of inadequate public and private resources nationwide STD control will require external funding.

Keywords: *Health Policy *HIV Infections/PREVENTION & CONTROL *HIV SeroprevalenceKWDhealthpolicyKWDhivinfections/prevention&controlKWDhivseroprevalence

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