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In Antananarivo, the capital of Madagascar, my taxi driver
told me: “I have never heard of anyone with AIDS…
I haven’t seen this disease, AIDS.” I have heard this many times while traveling with my colleagues,
Dr. Maryinez Lyons from the USAID regional office, and Wendy
Benazerga, chief of the Health Office at USAID/Madagascar.
Madagascar has a reported HIV prevalence rate of 1.1 percent.
But that could change without appropriate and consistent intervention. USAID/REDSO and USAID/Madagascar are poised to assist the
Malagasy to reduce—or at least maintain—the very
low prevalence of HIV/AIDS, especially given the high number
of mining laborers coming in from mainland southern Africa
and the potential impact on sexual health. It will not be an easy task, as public health history has
shown the difficulty of sustaining health and prevention messages.
The long latency of HIV before the onset of AIDS means that
many people simply do not perceive themselves to be in danger
of infection. Elsewhere in Africa, countries with much higher rates of
HIV infection have launched effective campaigns to prevent
its spread only when a significant proportion of the population
has begun to experience personally the impact of the epidemic.
It was only when family or neighbors began to fall ill and
die that many individuals could personalize the risk of HIV
sufficiently to take real steps to avoid contracting the virus.
Public health messages that attempt to shock people into behavior
change usually do not work. Behavior change, while an individual
action, takes place within a context of social, economic and
political factors often over a very long period. Sustaining
it is a major challenge. It would be disastrous for the Malagasy to delay changing
behavior until individuals witness personally the impact of
HIV/AIDS. Fortunately, the Malagasy government has taken energetic
steps to quell the epidemic and the president has made the
fight against HIV/AIDS a major priority. USAID supports various initiatives in Madagascar. Organizations
such as Catholic Relief Services support voluntary counseling
and testing; the Futures Group International provides condoms;
and Population Services International works with sex workers
to combat sexually transmitted diseases. USAID led a two-day workshop in June that brought together
groups to work on developing a “statement of collaboration.”
While there are impressive programs presently operating in
the country, greater collaboration will ensure better delivery
of services and information and help Madagascar to avoid the
ravages of a full-blown epidemic. Equipping the Malagasy people with appropriate knowledge and access to effective, high-quality prevention and care services is an important and fundamental task for the Agency’s HIV/AIDS program in this beautiful country.
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