Country situational analysis

Compared to most countries in the eastern and southern African region, HIV prevalence in Madagascar is still low at 0.2%. Although recent data shows that prevalence among sex workers is slightly higher at 0.5% there is little data available about key populations at risk namely men who have sex with men and injecting drug users.

There 214 people on antiretroviral treatment at the end of 2009, which corresponds to 2% coverage of all people in need.

Some of the factors that could explain Madagascar’s low HIV prevalence are the country’s relatively isolated geographic position, its low exposure to HIV and high levels of male circumcision. However low literacy, widespread poverty, limited access to health and social services, early sexual debut, multiple and concurrent partnershops, high rates of sexually transmitted infections and an increasingly transient population make Malagasy vulnerable to HIV.

Key elements of the national response

Madagascar’s response to HIV has been characterised strong political commitment at the highest levels. The country’s President chairs the National Council against AIDS (CNLS).

The AIDS response is integrated within the planning of development of each 22 regions that has a technical coordinator. AIDS is included in the Madagascar Action Plan 2007-2012. A new National Strategic Plan (NSP) 2007-2012 including a national monitoring and evaluation plan are fully operational. A partnership forum and the Global Fun Country Coordination Mechanisms were also established to improve stakeholder coordination.

The country’s overall strategy focuses on behavior change and prevention, treatment of HIV and STIs, and AIDS education. THE CNLS has re-oriented its focus toward key populations at higher risk (in particular men who have sex with men and injecting drug users).

Key achievements

• Inclusion of HIV in the Madagascar Action Plan 2007-2012
• Acceleration of HIV prevention in key populations at higher risk (sex worker, men who have sex with me, injecting drug users): development of a five-year action plan, strengthening capacity and availability of strategic document for populations at higher risk
• Decentralization of the HIV response
• Launch of the national network of people living with HIV in 2007
• Launch of a communication strategy aimed at populations at higher risk
• Recognition of associations of men who have sex with men in 2006
• Creation of a national platmfor of religious leaders in 2006
• Distribution of more than 20 million condoms in 2007

Key challenges

• 2009 was characterized by a substantial reduction of foreign investment and the national AIDS programme due to the protracted political crisis in the country.
• Low capacity to manage and implement efficient HIV interventions
• Services such as counselling and testing and provision of antiretroviral therapy only reach of small proportion of those in need
• Need to create a 'culture of information' that would improve the quality of data analysed
• Limit competence in epidemiological analysis

Useful links

• National Strategic Plan
  
• PMTCT and Paediatric Care and Treatment Fact Sheet
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
Bâtiment Ariane V
BP 1348
Antananarivo
Tel: +261 20 23 366 32
Fax: +261 20 23 641 84