HIV- and AIDS-Related Knowledge, Awareness, and Practices in Madagascar

The prevalence of HIV in Madagascar has been slowly rising in the past decade but in 1999 was still less than 0.5 percent. Although this rate is low compared with the rates in many other countries, including the United States and especially sub-Saharan African nations such as Zimbabwe and South Africa, the risk factors for an epidemic are present. High rates of syphilis, hepatitis B virus, and other STDs, as well as extreme poverty, suggest that many of Madagascar's 14 million people are at risk for acquiring HIV. The AIDS Impact Model projected that HIV seroprevalence could reach 15 percent by 2015 if Madagascar follows the epidemic trend of countries like Kenya.

In the current study, the authors sought to determine directly whether high-risk behaviors that might lead to rising infection rates were present in this population. The aims of the study were to determine a baseline level of public awareness and knowledge about HIV/AIDS and ascertain the HIV/AIDS risk-related behaviors of a segment of the general population in the capital city, Antananarivo.

Of the 134 participants, 71 (53 percent) were women. The participants' median age was 33.5 years; 90 (67 percent) had completed high school. Ninety (67 percent) were married, and 32 (24 percent) lived in rural areas.

The data from the HIV knowledge assessment suggest that HIV/AIDS awareness is high in Antananarivo, but knowledge of how HIV/AIDS cannot be transmitted and the use of condoms in prevention are limited. Understanding how HIV is not transmitted is important for preventing stigma against individuals with HIV/AIDS. Fear of stigma is known to deter citizens from being tested for HIV, an important opportunity for HIV/AIDS prevention counseling. The two potential protective factors found in this study were minimal travel to mainland Africa and the lower reported number of sexual partners for persons with multiple partners. High rates of multiple partnering and low condom use rates among people with multiple partners suggest that Madagascar is at risk for an epidemic.

A larger study that pairs HIV- and AIDS-related knowledge and behavior surveying with HIV testing and includes participants from other parts of the country is needed to confirm these findings and to develop specific and effective surveillance and prevention programs.

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