Madagascar makes progress against HIV/AIDS

updated 7:03 p.m. ET Dec. 16, 2007

A yearlong exploration by The Associated Press suggests that despite immense challenges, progress is gaining a foothold in pockets of Africa, in spheres ranging from democracy to education. And after minimal results from five decades of Western advice and aid, the progress is led by Africans themselves.

ANTANANARIVO, Madagascar - On a back street in one of Antananarivo's seedier neighborhoods, Saholy clutches at the hood of her blue jacket, pulling it down against the light rain. She steels herself for more verbal abuse from her fellow street walkers plying their trade on the corners.

Saholy is 39, a single mother of three teenagers, a prostitute ashamed of her life and, for the last couple of years, a weapon in Madagascar's war on AIDS. Several nights a week, she dons a blue uniform and white badge and tries to convince prostitutes to have only protected sex and get regular medical checkups.

"The other sex workers insult us and try to drive us away because we are interfering with their work," said Saholy, who does not want to be identified further for fear her children will learn what she does. "We leave but keep coming back. Eventually they listen to what we have to say."

Madagascar has the lowest HIV rate in sub-Saharan Africa, with less than 1 percent of its people infected. Yet this island is waging one of the most aggressive campaigns against AIDS on the continent — a model for how to prevent HIV and improve basic health care at the same time.

"On HIV and AIDS, Madagascar is the only country in Africa that is getting it right," said Dr. Hugo Templeman, a Dutch AIDS specialist in South Africa who advises Madagascar President Marc Ravalomana on fighting AIDS.

AIDS seen as Africa's biggest problem
Other African countries are making some headway against the disease — the number of new infections in Uganda and Kenya has dropped after widespread public campaigns, for example. But 80 percent of Africans still see the spread of AIDS and other diseases as the continent's single biggest problem, according to a Pew Global Attitudes Project survey based on 57,000 interviews in 10 countries.

Madagascar's all-out attack on AIDS comes from the fear that HIV will arrive along with a more open economy and an influx of foreign workers. Foreigners come every year to work in the vanilla plantations and in new ventures such as a mining project recently launched in once-remote Fort Dauphin.

The island has been protected so far largely by its isolation, but it has only to look across the water to southern Africa to see the killer wave headed its way. Nine of the world's ten most HIV-ridden countries are in southern Africa, with infection rates of more than 37 percent in Botswana and Swaziland.

If AIDS takes hold in Madagascar, it could explode. Madagascar is one of the poorest countries in the world, and some of its people take the risk of sex work to live. It also has a high rate of sexually transmitted diseases, a sign of vulnerability to AIDS.

The response to AIDS starts at the top. President Ravalomanana makes it a point to take AIDS tests in public, in contrast to his South African counterpart, Thabo Mbeki, who has publicly questioned whether HIV causes AIDS. Health care is such a priority in Madagascar that the national AIDS office is in the presidential palace, where the top adviser can report to the president at a moment's notice.

"The AIDS campaign is a personal initiative from the president," said Dr. Fanjaniaina Rajoelisolo, who runs the AIDS office. "He himself negotiates with the donors. The president tells me to go and see out in the country — he wants to see the impact of his policies."

Prevention seen as key
The crusade against AIDS ripples from the palace through this country of about 19 million people. Prevention messages scream from billboards and posters, and condoms are readily available. More than 100 screening centers have been set up, and mobile testing units are sent to remote areas. The government hopes to distribute 400,000 HIV test kits by the end of 2007.

In villages, hundreds of local AIDS councils take action in their own ways. The village of Maroambihy, for example, held a carnival, showed films and organized home visits reaching more than 8,000 people. Young players in the football club were taught to carry condoms, and women demonstrate their use at regular health service sessions to weigh children.

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Groups considered at risk get special attention, including young people aged 19 and under who make up half the population of Madagascar. Thousands of teachers are trained in how to convey the AIDS prevention message to their students. Young people can get check-ups at a discount, and training kits are passed out to scout troops so they can talk about AIDS.

At a small private clinic in one of Antananarivo's poorer neighborhoods, Dr. Voahirana Lalao Raniriharisoa ushers her last patient, a young woman, to the door. The office is spartan, with a cluttered desk and dingy white equipment cramped into about eight square feet.

The doctor said the AIDS prevention campaign is helping, and more young people are going for treatment.

"There is a lot of sensitivity now to health issues," she said. "Health care is improving, and now more people are aware of their own health."

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