Madagascar

HIV/AIDS epidemiological summary

Recent information from Madagascar indicates that HIV prevalence is still very low in the country. Sentinel surveillance data have been available from Antananarivo, the major urban area, since 1990 and through 1996. No evidence of HIV infection among antenatal clinic women has been found. Outside Antananarivo, HIV sentinel surveillance among antenatal clinic women has been conducted since 1990. Out of 15 sentinel surveillance sites, only one site, Toamasina, found evidence of HIV infection among antenatal clinic attendees in 1995; 0.2% of women tested were HIV-positive. In 1996, three-out-of-ten sites reporting found evidence of HIV infection. In Toamasina, 1% of antenatal clinic women tested positive. In Antsiranana and Maroantsetra, less than 1% of antenatal clinic attendees tested were HIV-positive.

HIV prevalence among sex workers in Antananarivo increased from 0.3% of women tested in 1995 to 1% in 1998. In 1995 and 1996, outside Antananarivo, evidence of HIV prevalence among sex workers was found in only two sites. In Antsiranana, 1-2% of sex workers tested HIV-positive. In Toamasina, less than 1% of sex workers tested were HIV-positive in 1995.

In Antananarivo, less than 1% of STI clinic patients tested HIV-positive in 1995 and no evidence of HIV infection was found in 1996. In 1998, 2% of STD clinic patients in one clinic in Antananarivo tested HIV-positive. Outside of Antananarivo, 14 sentinel surveillance sites reported in 1995. HIV prevalence ranged from no evidence of infection to 7% in Antsiranana. Nine of the 14 sites found no evidence of HIV infection among STI clinic patients. In 1996, however, HIV prevalence ranged from no evidence of infection to only 0.7% from 12 reporting sites. In 1996, less than 0.5% of STI clinic patients in Antsiranana tested HIV-positive. In 1998, HIV prevalence information was only available from two clinics, where no evidence of HIV infection was found.

Estimated number of people living with HIV/AIDS, end 1999	Adults and children	Adults (15-49)	Adult rate (%)	Women (15-49)	Children (0-14)
Source: UNAIDS/WHO, June 2000	11 000	10 000	0.15	5800	450
Demographic impact of HIV/AIDS		Year	Estimate	Source
Children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic		1999	2600	UNAIDS/WHO, June 2000
Estimated AIDS deaths		1999	870	UNAIDS/WHO, June 2000
Behavioural indicators		Year	Age group	Male	Female
Reported condom use during most recent intercourse with a non-regular partner (%)		-	-	-	-
Reported non-regular sexual partnership over a 12-month period (%)		-	-	-	-
Measured HIV prevalence		Year	Median	Min.	Max.
Women in antenatal care clinics - major urban areas (%)		1996	0.0	0.0	0.0

Figure

Economic impact of HIV/AIDS

Summary of the economic impact of HIV/AIDS

No empirical data on the economic impact of AIDS in Madagascar were found in the literature review carried out. However, a modelling exercise carried out for the World Bank calculated the annual costs of scaling-up AIDS programmes to meet the current need to be between US$ 35 million and US$ 53 million, or approximately 1.5% of GDP. In the area of education, a UNAIDS/UNICEF model shows how increasing mortality rates have led to discontinuity, with many pupils losing or having a change in their teachers. The current primary school enrolment is nearly 59%. This discontinuity, along with increasing numbers of orphans and children’s growing responsibilities as a consequence of AIDS in the household, is likely to erode the achievements in this area, reducing enrolment and, hence, literacy rates. The potential impact on other sectors including agriculture, households and firms, shown in other African nations to increase costs and expenditure, reduce savings and shift productivity patterns due to labour losses, need to be carefully monitored in future studies to ensure an appropriate policy response.

Macroeconomic impact

Not available

Economic impact of HIV/AIDS on households

Not available

Economic impact of HIV/AIDS on agriculture

Not available

Economic impact of HIV/AIDS on firms

Not available

Economic impact of HIV/AIDS on education

Supply: A model developed by UNAIDS and UNICEF in 2000 shows that, of around 2 million primary school students, 273 would have lost a teacher to AIDS in 1999 (1).

Demand: Not available

Economic impact on the health sector

Supply: Not available

Demand: Not available

Resource gap: The annual cost of scaling-up HIV/AIDS programmes is estimate to be between US$ 35 million and US$ 53 million (2).

Management and implementation of the national response to HIV/AIDS

Policy formulation

Existence of national HIV/AIDS policy (either a written document or part of one)

Yes	No
X

Comments/Key elements: Current NSP covers 1996 - 2000
Source: CPA report
Date: December 1999

Existence of HIV/AIDS policy in the following sectors:

Sector	Yes	No
Agriculture	X
Education	X
Health	X
Military	X
Workplace
Sports	X
Others: justice, population	X

Comments/Key elements: MTP II.
Source: CPA report
Date: December 1999

Existence of HIV/AIDS-specific legislation against discrimination on the grounds of HIV

Yes	No

Comments/Key elements: Unknown
Source: UNAIDS
Date: July 2000

Organizational structure

Existence of high-level structure in support of the national response

(e.g. National AIDS Committee/Commission, Inter-Ministerial Committee, Presidential-level bodies)

Yes	No
X

Comments/Key elements: CNLS chaired by the MOH includes 11 Ministers
Source: CPA report
Date: December 1999

Planning and programming

Existence of national strategic plan on HIV/AIDS

Yes	No
X

Comments/Key elements: MTP II (1996-2000)
Source: CPA report
Date: December 1999

National strategic plan on HIV/AIDS includes clearly identified priorities

Yes	No

Comments/Key elements: Not available
Source: UNAIDS
Date: July 2000

Existence of budget for implementation of the national strategic plan

Yes	No

Comments/Key elements: Not available
Source: UNAIDS
Date: July 2000

General demographic and socioeconomic indicators

Demographic indicators	Year	Estimate	Source
Total population (thousands)	1999	15 497	UNPOP
Population aged 15-49 (thousands)	1999	7197	UNPOP
Annual population growth (%)	1990-1998	3.2	UNPOP
% of population urbanized	1998	27	UNPOP
Average annual growth rate of urban population (%)	1990-1998	5.2	UNPOP
Economic Indicators	Year	Estimate	Source
GNP per capita (US$)	1997	250	World Bank
GNP per capita average annual growth rate (%)	1996-1997	1.5	World Bank
Human Development Index rank (HDI)	2000	141	UNDP
% population economically active	-	43.8	ILO
Unemployment rate	-	-	-
Education Indicators	Year	Estimate	Source
Total adult literacy rate	1995	81	UNESCO
Adult male literacy rate	1995	88	UNESCO
Adult female literacy rate	1995	73	UNESCO
Male secondary school enrolment ratio	1996	12.8	UNESCO
Female secondary school enrolment ratio	1996	12.7	UNESCO
Health Indicators	Year	Estimate	Source
Crude birth rate (births per 1000 pop.)	1999	39	UNPOP
Crude death rate (deaths per 1000 pop.)	1999	10	UNPOP
Maternal mortality rate (per 100 000 live births)	1990	490	WHO
Life expectancy at birth	1998	58	UNPOP
Total fertility rate	1998	5.4	UNPOP
Infant mortality rate (per 1000 live births)	1999	80	UNICEF/UNPOP
Contraceptive prevalence rate (%)	1990-1999	19	UNICEF/UNPOP
% of births attended by trained health personnel	1990-1999	47	UNICEF
% of one-year-old children fully immunized-DPT	1995-1998	68	UNICEF

References

(1) UNICEF. The Progress of Nations 2000. Background paper. New York, UNICEF, 2000.

(2) World Bank and UNAIDS. Costs of Scaling HIV Programmes to a National Level for Sub-Saharan Africa. Draft report, April 2000.