RESUMEN

Madagascar is still among the rare states of low prevalence of HIV. The seroprevalence rate is nevertheless rising. The aim of this study is to show the current view of the epidemic, its future tendency, its economical and social impact on people and what measures to be taken at the national scale. In Madagascar, we can state by 1995 20 cases of notified AIDS and probably 130 cases of non-notified AIDS. Seroprevalence data are collected every year by the National Reference Laboratory STD/AIDS. But, they are insufficient to estimate the number of infected people. So, they had been completed by a serosurveillance study of AIDS and syphilis in middle of 1995 and at the beginning of 1996. Pregnant women, persons with STDs and prostitutes are been screened in the six biggest cities of the Island. Results show, not only a high prevalence of syphilis, but also indicate that now, we have about 5,000 seropositive people in the country. Besides, by the number of people with STDs, it is estimated that one million Malgasy adults risk to be infected. Based on estimates of the epidemic, be it the cases of a high scenario, (Kenya) or of a low one (Thailand) by the year 2015, the seroprevalence rate could represent 3% or 15% of adults. Demographic consequences of the epidemic will be serious, particularly if HIV spreads quickly. Nevertheless, it does not stop the increase of population. Therefore, there will be more infected people with the disease, especially young people between 15 and 49 years old. The increase of dead people will be serious. Social consequences of the epidemic (case of high scenario) will be gravely felt, in particular by the rise of the number of AIDS orphans. Tuberculosis outbreak can be observed too. This disease is already a serious problem in Madagascar. At last, the epidemic will bring with it a high increase of money spent on health and will have grave consequences on agriculture, industry and commerce. Nevertheless, Madagascar still benefit a big luck which is the prevention of the epidemic not to be exploded in a near future. For this, struggle against it is particularly effective on its start. In addition to counselling given to infected people and care-given to patients, means of prevention of AIDS contamination in all target groups must be set up quickly. It is about broadcasting information on AIDS, community education, controlling other STDs e.g. (importance of medicaments' program), promoting the use of condoms and screening HIV new cases. Only an urgent coordination of everyone's efforts can control the epidemic of AIDS.

PIP: Studies were conducted in mid-1995 and at the beginning of 1996 in six sites in Madagascar on the seroprevalences of HIV and syphilis with the goal of estimating how many people were infected with HIV countrywide. The studies were conducted in Antananarivo, Fianarantsoa, Antsiranana, Toamasina, Toliary, and Mahajanga. 3135 pregnant women seeking prenatal care were included in the study, as well as 3047 sexually transmitted disease (STD) clinic clients, and 2227 prostitutes not registered with the STD services, but recruited in bars, hotels, and on the street. Study data together with epidemiological surveillance data led to the estimation that 0.07% of adults in the country were infected with HIV as of 1995, compared with 0.02% in 1989. There were 150 people with AIDS, 5000 people infected with HIV, and 1 million people at risk of exposure to the virus. In Madagascar, HIV is transmitted sexually in 96.8% of cases, perinatally in 2.4% of cases, and through blood transfusion in 0.8% of cases. As many men as women are infected, and 64% of all people infected with HIV are 20-39 years old. Projecting the course of the epidemic into the future, 3-15% of the country¿s adults could be infected with HIV in the year 2015, bringing seriously negative demographic and socioeconomic consequences. Madagascar¿s population will, however, continue to grow even should HIV be widely disseminated throughout the country. It is not too late for Madagascar to take measures to avert a major HIV/AIDS epidemic among its peoples.

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RESUMEN

The HIV seroprevalence per 100,000 adults Malagasy rose from 20 in 1989, to 30 in 1992, and to 70 in 1995. In that year, the total number of HIV infected people in the Big Island was estimated at 5,000, the number of people sick with AIDS at 130, and the people at risk at more than 1,000,000. The latter are the persons infected with other STDs and individuals (or their partners) with risky sexual behaviour (e.g. numerous sexual partners, occasional sexual partners, and/or sexual contacts with commercial sex workers). The HIV prevalence rate is low as compared with those of other countries. Nevertheless, the spread of the HIV infection is alarming in some parts of the country and the risk factors are also present, namely: the high prevalence of STDs, numerous sexual partners, the low use of condoms in all groups, the development of tourism, the development of prostitution associated with social and economical problems, and internal and international migrations (with risky sexual contacts). Therefore, the still low but rising HIV prevalence in 1995 does not warrant complacency. To estimate the trend of HIV prevalence within the population, it is useful to know two different assumptions, as follows: firstly, a controlled evolution of the epidemic (low epidemic) and secondly, a very fast spread of the epidemic (high epidemic). If we consider the 5,000 individuals seropositive in July 1995, the Aids Impact Model (AIM) projection model shows that HIV seroprevalence rates among adults in 2015 might be between 3% (when the progression course of HIV epidemic is low) and 15% (when the progression course of HIV epidemic is high). By 2015 AIDS could have severe demographic, social, and economic impacts. Then, it is necessary to take measures to prevent contamination. Five major interventions are required: public information about AIDS, HIV transmission mechanism, and its prevention, communities education via the respected people and the notabilities to promote moral values, reduce the number of sexual partners, delay visit of sexual activity, and advice for infected couples; screening of blood donors and the supposed high risk group; control of STDs; reduction of the number of sexual partners; promotion of condom use, abstinence, and fidelity. To sum up, the fight against AIDS is not only the health professional workers' problem. It concerns all Malagasy people. Therefore, successfullness in prevention efforts to slow the epidemic needs concerted, collective, and long lasting actions from all sectors of the society for the nation's future and the well-being of the rising generations.

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The prevalence of Toxoplasma antibodies by ELISA was studied in Antananarivo area, in the Republic of Madagascar, among a population of 599 pregnant women. The overall prevalence is 83.5%. From the age of 19 years old, 75% of the pregnant women have already antitoxoplasma antibodies. The ethnic factor, the foods habits or the presence of a domestic cat do not seem to have an influence on prevalence of toxoplasmosis among the studied population.

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