AIDS IN MADAGASCAR - I - EPIDEMIOLOGY PRO JECTIONS, IMPACT, INTERVENTIONS

Madagascar is still among the rare states of low prevalence of HIV. Th e seroprevalence rate is nevertheless rising. The aim of this study is to show the current view of the epidemic, its future tendency its eco nomical and social impact on people and what measures to be taken at t he national scale. In Madagascar, we can state by 1995 20 cases of not ified AIDS and probably 130 cases of non-notified AIDS. Seroprevalence data are collected every year by the National Reference Laboratory ST D/AIDS. But, they are insufficient to estimate the number of infected people. So, they had been completed by a serosurveillance study of AID S and syphilis in middle of 1995 and at the beginning of 1996. Pregnan t women, persons with STDs and prostitutes are been screened in the si x biggest cities of the island. Results show, not only a high prevalen ce of syphilis, but also indicate that now we have about 5.000 seropos itive people in the country. Besides, by the number of people with STD s, it is estimated that one million Malgasy adults risk to be infected . Based on estimates of the epidemic, be it the cases of a high scenar io, (Kenya) or of a low one (Thailand) by the year 2015, the seropreva lence rate could represent 3 % or 15 % of adults. Demographic conseque nces of the epidemic will be serious, particularly if HIV spreads quic kly. Nevertheless, it does not stop the increase of population. Theref ore, there will be more infected people with the disease, especially y oung people between 15 and 49 years old. The increase of dead people w ill be serious. Social consequences of the epidemic (case of high scen ario) will be gravely felt, in particular by the rise of the number of AIDS orphans. Tuberculosis outbreak can be observed too. This disease is already a serious problem in Madagascar At last, the epidemic will bring with it a high increase of money spent on health and will have grave consequences on agriculture, industry and commerce. Nevertheless , Madagascar still benefit a big luck which is the prevention of the e pidemic not to be exploded in a near future. For this, struggle agains t it is particularly effective on its start. In addition to counsellin g given to infected people and care-given to patients, means of preven tion of AIDS contamination in all target groups must be set up quickly . it is about broadcasting information on AIDS, community education, c ontrolling other STDs e.g (importance of medicaments' program), promot ing the use of condoms and screening HIV new cases. Only an urgent coo rdination of everyone's efforts can control the epidemic of AIDS.