Although it has the lowest HIV rate in sub-Saharan Africa, less than one percent, Madagascar is waging one of the continent's most aggressive campaigns against the virus. The island nation has been protected thus far largely by its isolation, but the government fears that a more open economy and an influx of foreign workers could spread HIV. Madagascar is one of the poorest countries in the world and it has a high rate of STDs, a sign of vulnerability to HIV/AIDS.

Under the leadership of President Marc Ravalomana, who takes HIV tests in public, the national AIDS office has been placed in the presidential palace, where its head, Dr. Fanjaniaina Rajoelisolo, can report to the president at a moment's notice. Billboards and posters spread prevention messages to this nation of some 19 million people, and condoms are readily available. More than 100 testing centers have been established, with mobile testing units sent to remote areas. By the end of this year, the government hopes to have distributed 400,000 HIV test kits.

At-risk groups, including youth under age 19 who make up half of Madagascar's population, receive special attention. Teachers are trained in conveying HIV/AIDS prevention messages; young people are offered check-ups at a discount; and training kits are passed out to scout troops.

In addition to prevention, the government is helping HIV/AIDS patients. In August, the island passed the first law in Africa that fines those who discriminate against patients or disclose their status.

The country has made antiretroviral treatment readily available and hopes to have 90 percent of HIV patients on ARVs within five years. The HIV/AIDS campaign is augmented by a general effort to expand clinics, hire more doctors, and upgrade health care.

"On HIV and AIDS, Madagascar is the only country in Africa that is getting it right," said Dr. Hugo Templeman, a South Africa-based AIDS specialist who advises Ravalomana on combating the disease.

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