AIDS IN MADAGASCAR - II - POLICY INTERVEN TION TO PRESERVE LOW HIV PREVALENCE IN MADAGASCAR

The HIV seroprevalence per 100,000 adults Malagasy rose from 20 in 198 9, to 30 in 1992, and to 70 in 1995. In that year the total number of HIV infected people in the Big Island was estimated at 5,000, the numb er of people sick with AIDS at 130, and the people at risk at more tha n 1,000,000. The latter are the persons infected with other STDs and i ndividuals (or their partners) with risky sexual behaviour (e.g. numer ous sexual partners, occasional sexual partners, and/or sexual contact s with commercial sex workers). The HIV prevalence rate is low as comp ared with those of other countries. Nevertheless, the spread of the HI V infection is alarming in some parts of the country and the risk fact ors are also present, namely the high prevalence of STDs, numerous sex ual partners, the low use of condoms in all groups, the development of tourism, the development of prostitution associated with social and e conomical problems, and internal and international migrations (with ri sky sexual contacts). Therefore, the still low but rising HIV prevalen ce in 1995 does not warrant complacency To estimate the trend of HIV p revalence within the population, it is useful to know two different as sumptions as follows : firstly a controlled evolution of the epidemic (low epidemic) and secondly a very fast spread of the epidemic (high e pidemic). If we consider the 5.000 individuals seropositive in July 19 95, the Aids Impact Model (AIM) projection model shows that HIV seropr evalence rates among adults in 2015 might be between 3% (when the prog ression course of HIV epidemic is low) and 15% (when the progression c ourse of HIV epidemic is high). By 2015 AIDS could have severe demogra phic social, and economic impacts. Then, it is necessary to take measu res to prevent contamination. Five major interventions are required: p ublic information about AIDS, HIV transmission mechanism, and its prev ention communities education via the respected people and the notabili ties to promote moral values, reduce the number of sexual partners, de lay visit of sexual activity, and advice for infected couples; screeni ng of blood donors and the supposed high risk group; control of STDs; reduction of the number of sexual partners; promotion of condom use, a bstinence, and fidelity. To sum up, the fight against AIDS is not only the health professional workers' problem. It concerns all Malagasy pe ople. Therefore successfulness in prevention efforts to slow the epide mic needs concerted, collective, and long lasting actions from ail sec tors of the society for the nation's future and the well-being of the rising generations.