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Madagascar AIDS: How to avoid the explosion? |
AIDS
Madagascar is one of the few countries where
AIDS is not considered to
be a public health danger.
But maybe the official figures are only the
tip of the iceberg?
Contrary to the situation in many African countries, AIDS is not a major public health problem in Madagascar. Malaria is presently the country’s most fatal disease. Madagascar is one of the few countries in the world with a low HIV-positive rate — less than 1%. The first AIDS case was detected in 1987, and official records for this year, 2000, indicate 40 people as having AIDS and just under 200 as being HIV-positive. But «this is only the tip of the iceberg», notes Doctor Rasamilalao Désiré, in charge of Madagascar’s National Programme for Fighting Against Sexually Transmitted Diseases (STD)s/AIDS. It’s thought that between 8,000-10,000 Malagasy people are unaware they’re HIV-positive; 1,000-4,000 patients have AIDS and between 600-2,000 deaths are the result of being HIV/AIDS infected. (Statistics from a World Bank study on AIDS in Madagascar). However, the current situation (both official figures and estimated figures) is still described as being «containable» according to Madagascar’s health officials, compared to what occurs in the rest of the world and in particular in Africa.
Why? — Until now, nobody has come up with an explanation as to why Madagascar has not yet had a dramatic AIDS outbreak. Especially as there’s certainly not been any radical change in the average persons «sexual behaviour» in spite of the existence of AIDS. Most people, especially those living in rural areas, (85% of the population), don’t even know AIDS exists, or they simply don’t believe in it. Information and communication is state-controlled. There’s a certain amount of awareness information available in the towns and cities, but very little in the rural areas — this concerns everything, not just AIDS. The fact is, if you don’t tell people about this public health danger, then they’re not going to take much care when it comes to «sexual behaviour». So, people are carefree. They say: «That only happens to others. I’m not in any danger». But more and more tourists are arriving in Madagascar for what’s called «sex tourism». A law intended to clamp down on this kind of thing, especially regarding paedophilia has just been passed.
Madagascar’s health authorities have been trying to explain the country’s particular situation regarding AIDS. It has to be remembered that Madagascar is an island, and is thus somewhat protected, but as mentioned above, the number of the tourists has been increasing in recent years and the Malagasy people themselves move about. Another explanation could be that as Christians, most Malagasy people are monogamists (officially); but that doesn’t prevent other sexual practices among both men and women. The fact is, nobody can really explain Madagascar’s present circumstance.
What does the future hold? — The doctors draw special attention to the significant number people contracting STDs: nearly 30% of pregnant women and most, if not all, the prostitutes. People get AIDS via STDs, and most of the present victims have contracted AIDS by having sex.
At all events, it’s absolutely necessary to intervene in order to stop the disease spreading. Madagascar’s National Programme for Fighting AIDS was established in 1988, after the discovery of the first case. The importance of using condoms is now being encouraged. In Antananarivo, the public can get a check-up at a specialised HIV clinic. It costs nothing and absolute discretion is guaranteed. A number of non-governmental organisations (NGO)s are also involved in this kind of work. The National Programme For the Fight Against AIDS provides financial help. But awareness programmes remain too irregular.
The World Bank study indicates that there are as many men (47.8%) as women (47.3%) victims of this epidemic. Men form a majority (73%) when it comes to AIDS first being detected i.e. those first infected are primarily men. The same study also considers the future progress of the disease. If serious measures are not taken, something between 3%-15% of Madagascar’s adult population could be infected with HIV by the year 2015. That’s to say, the number of people HIV-positive would be anything between 450,000-2.1 million. New patients will be between 40,000-193,000. Deaths due to AIDS would range between 260,000 and 1.3 million. As for orphans, (i.e. children below 15 years), by the year 2015, they could number between 107,000-458,000 — one of the most serious social consequences of the epidemic.
AIDS weakens the body structure and provides a ready field for the onslaught of Tuberculosis. This is a major public health problem in many countries, but not yet in Madagascar. No case of tuberculosis coming as a result of having contracted AIDS or of being HIV-positive has so far been detected, say the medical authorities. But new Tuberculosis cases are already between 18,000-20,000 per annum. With the AIDS epidemic ready to explode, one can expect this figure to rise to between 21,000-100,000 by the year 2015.
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