clove and HIV-Infections

To describe the epidemiological situation of the HIV/AIDS epidemic and to identify the main drivers for vulnerability in Madagascar.. Literature review, qualitative research and situational analysis.. Search of electronic bibliographic databases, national repositories of documentation from 1998 to 2018. Search keywords included Madagascar, HIV, sexually transmitted infections, men who have sex with men (MSM), sex workers (SWs), transactional sex (TS), injecting drug users (IDUs), vulnerability and sexual behaviour. Qualitative sources were interviews and focus group discussions.. Studies focused on HIV and/or vulnerability of HIV in Madagascar in general, and key populations (KPs) and HIV/AIDS response were taken into account. National reports from key HIV response actors were included.. Madagascar is characterised by a low HIV/AIDS epidemic profile in the general population (GP) (0.3%) combined with a high prevalence of HIV among KPs (SWs, MSM and IDUs).An increase in HIV prevalence among KP has been observed during recent years. Hospital-based data suggest an increase in HIV prevalence among the GP. The vulnerability traits are inconsistent use of condoms, multipartner relationships and other contextual factors like widespread TS and gender inequality. A high prevalence/incidence of sexually transmitted infections could indicate a high vulnerability to HIV/AIDS. However, there are no reports of HIV prevalence of >1% in antenatal consultation.. There is not enough evidence to make a conclusion about the HIV epidemiological situation in Madagascar due to the scarcity of the epidemiological data. However, Madagascar may be closer to a turning point towards a high-prevalence epidemic with severe consequences, particularly when taking into account its socioeconomical fragility and underlying vulnerabilities. More precise epidemiological data and improved HIV/AIDS diagnosis and case management should be a public health priority.

Topics: Epidemics; HIV Infections; Humans; Incidence; Madagascar; Prevalence; Risk Factors; Sexually Transmitted Diseases

In this paper we summarise the parasitological, clinical and epidemiological characteristics of female genital schistosomiasis (FGS), a frequent manifestation of the infection with Schistosoma haematobium. Means to diagnose and treat lesions in the lower and upper genital tract are discussed. Based on clinical findings and available pathophysiological as well as immunological data it is conceivable that FGS of the cervix and vagina not only facilitates the infection with agents of sexually transmitted diseases, but presumably also alters the natural history of such infections. Two infectious agents are of particular concern: the Human Immunodeficiency Virus and the oncogenic Human Papilloma Viruses. Possible interactions and their consequences are discussed and research areas which should be addressed are outlined.

Topics: Africa; Animals; Female; Genital Diseases, Female; Genitalia, Female; HIV; HIV Infections; Humans; Madagascar; Papillomaviridae; Papillomavirus Infections; Prevalence; Risk Factors; Schistosoma haematobium; Schistosomiasis haematobia; Tumor Virus Infections; Uterine Cervical Neoplasms

To estimate the prevalence of IgG antibodies against six arboviruses in people living with HIV-1 (PLWHIV) in Madagascar, we tested samples collected between January 2018 and June 2021. We used a Luminex-based serological assay to detect IgG antibodies against antigens from Dengue virus serotypes 1-4 (DENV1-4), Zika virus (ZIKV), West Nile virus (WNV), Usutu virus (USUV), Chikungunya virus (CHIKV), and O'nyong nyong virus (ONNV). Of the 1036 samples tested, IgG antibody prevalence was highest for ONNV (28.4%), CHIKV (26.7%), WNV-NS1 (27.1%), DENV1 (12.4%), USUV (9.9%), and DENV3 (8.9%). ZIKV (4.9%), DENV2 (4.6%), WNV-D3 (5.1%), and DENV4 (1.4%) were lower. These rates varied by province of origin, with the highest rates observed in Toamasina, on the eastern coast (50.5% and 56.8%, for CHIKV and ONNV, respectively). The seroprevalence increased with age for DENV1 and 3 (

Topics: Antibodies, Viral; Arboviruses; Chikungunya Fever; Chikungunya virus; HIV Infections; Humans; Immunoglobulin G; Madagascar; Seroepidemiologic Studies; West Nile virus; Zika Virus; Zika Virus Infection

HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study.. We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.. The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and  circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar.. These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.

Topics: Cities; Epidemics; Female; HIV Infections; Humans; Madagascar; Male; Prevalence

Topics: Adolescent; Adult; Cross-Sectional Studies; HIV Infections; Humans; Jails; Madagascar; Prisoners

Pregnancy triggers an alteration of the immune functions and increases the risk of developing the active tuberculosis (TB) symptoms in exposed women. The effect of pregnancy on the. We conducted a prospective cohort study on HIV-seronegative pregnant and non-pregnant women with compatible pulmonary TB symptoms addressed to TB healthcare facilities in Antananarivo, Madagascar. Active pulmonary TB was bacteriologically assessed with culture from sputum samples. Clinical data and blood samples were collected at inclusion and after 6 months of follow-up for each individual included. Whole blood samples were stimulated with QuantiFERON TB-Gold Plus (QFT-P) assay antigens. Plasma IFN-γ concentrations were then assessed by ELISA.. These results support the concept of specific immune priorities characterized by a concomitant reduction in inflammatory immunity during pregnancy and corroborate the important role of activating the

Topics: Adult; Cohort Studies; Cross-Sectional Studies; Female; HIV Infections; Humans; Interferon-gamma; Madagascar; Mycobacterium tuberculosis; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Tuberculosis, Pulmonary

After an epidemic outbreak, the infection persists in a community long enough to engulf the entire susceptible population. Local extinction of the disease could be possible if the susceptible population gets depleted. In large communities, the tendency of eventual damp down of recurrent epidemics is balanced by random variability. But, in small communities, the infection would die out when the number of susceptible falls below a certain threshold. Critical community size (CCS) is considered to be the mentioned threshold, at which the infection is as likely as not to die out after a major epidemic for small communities unless reintroduced from outside. The determination of CCS could aid in devising systematic control strategies to eradicate the infectious disease from small communities. In this article, we have come up with a simplified computation based approach to deduce the CCS of HIV disease dynamics. We consider a deterministic HIV model proposed by Silva and Torres, and following Nåsell, introduce stochasticity in the model through time-varying population sizes of different compartments. Besides, Metcalf's group observed that the relative risk of extinction of some infections on islands is almost double that in the mainlands i.e. infections cease to exist at a significantly higher rate in islands compared to the mainlands. They attributed this phenomenon to the greater recolonization in the mainlands. Interestingly, the application of our method on demographic facts and figures of countries in the AIDS belt of Africa led us to expect that existing control measures and isolated locations would assist in temporary eradication of HIV infection much faster. For example, our method suggests that through systematic control strategies, after 7.36 years HIV epidemics will temporarily be eradicated from different communes of island nation Madagascar, where the population size falls below its CCS value, unless the disease is reintroduced from outside.

Topics: Acquired Immunodeficiency Syndrome; Africa; Disease Outbreaks; Epidemics; HIV; HIV Infections; Humans; Madagascar; Models, Statistical; Population Density; Risk Factors; Stochastic Processes

Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts ≤200/μl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-αA (3 isolates), VNII-αA (4 isolates) or hybrid VNI/VNII-αAAα (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected patients. These findings will be used to raise the awareness of national authorities to strengthen the national HIV/AIDS control program.

Topics: Adult; Cross-Sectional Studies; Cryptococcus neoformans; Female; HIV Infections; Humans; Madagascar; Male; Meningitis, Cryptococcal; Middle Aged

The rate of change in key health indicators (eg, intervention coverage) is an understudied area of health system performance. Rates of change in health services indicators can augment traditional measures that solely involve the absolute level of performance in those indicators. Growth curves are a class of mathematical models that can parameterise dynamic phenomena and estimate rates of change summarising these phenomena; however, they are not commonly used in global health. We sought to characterise the changes over time in antiretroviral therapy (ART) coverage in sub-Saharan Africa using growth curve models.. This was a retrospective observational study. We used publicly available data on ART coverage levels from 2000 to 2017 in 42 sub-Saharan African countries. We developed two ordinary differential equations models, the Gompertz and logistic growth models, that allowed for the estimation of summary parameters related to scale-up and rates of change in ART coverage. We fitted non-linear regressions for the two models, assessed goodness of fit using the Bayesian information criterion (BIC), and ranked countries based on their estimated performance drawn from the fitted model parameters.. We extracted country performance in rates of scale-up of ART coverage, which ranged from ≤2.5 percentage points per year (South Sudan, Sudan, and Madagascar) to ≥8.0 percentage points per year (Benin, Zimbabwe and Namibia), using the Gompertz model. Based on BIC, the Gompertz model provided a better fit than the logistic growth model for most countries studied.. Growth curve models can provide benchmarks to assess country performance in ART coverage evolution. They could be a useful approach that yields summary metrics for synthesising country performance in scaling up key health services.

Topics: Africa South of the Sahara; Bayes Theorem; Benin; HIV Infections; Humans; Madagascar; Namibia; South Sudan; Zimbabwe

Adherence to antiretroviral therapy (ART) may be influenced by knowledge, perception and perception regarding ART. The purpose of this study was to assess knowledge, attitude/perception and practice regarding ART among people living with HIV/AIDS (PLHIV).. We conducted a cross-sectional survey to assess knowledge, attitudes, perception and practices ART in PLHIV. The survey was suggested to all PLHIV of at least 18 years old and who were on ART for at least 1 month. PLHIV who were unable to answer questions correctly and those who did not complete the survey for any reason were excluded.. During the study period, 234 PLHIV were included. Participants were mostly men (75.2%). The median age was 33 years (IQR: 27-41). The median time since HIV diagnosis was 25 months (IQR: 9-56) and the median duration of ART was 18 months (IQR: 8-48). 87.6% had an overall good knowledge of ART. However, only 3.2% knew the name of their ART, 31.2% were aware that ART should be taken at a fixed time and 17.1% knew how to take ART in relation to food intake. 75.6% of participants had an overall positive attitude/perception of ART. However, 10.7% were convinced that other methods were more effective than ART for treating HIV and 42.7% thought that taking ART was shameful. The assessment of practices showed that in case of missed dose, 48.3% of participants routinely skipped this dose instead of trying to take it as soon as possible. In multivariate analysis, good knowledge of ART was independently associated with high level of education (aOR: 4.7, IC95%: 1.6-13.7, p = 0.004) and disclosure of HIV status (aOR: 2.7, IC95%: 1.1-6.6, p = 0.029).. This study showed an overall good knowledge and a predominantly positive attitude/perception of ART. However, accurate knowledge of ART intake was insufficient and the stigma associated with taking ART remained very present. Furthermore, very heterogeneous practices may reflect lack of instruction given by the physician regarding ART intake.

Topics: Adult; Anti-HIV Agents; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Madagascar; Male; Medication Adherence; Perception; Sexual Behavior; Social Stigma; Surveys and Questionnaires

Screening for HIV is recommended for all TB patients but it has not yet been initiated in some regions of Madagascar. In this study, our main objective was to determine the seroprevalence of HIV infection in TB patients and secondarily to determine the risk factors favoring TB infection in these patients. This prospective cross-sectional study took place in the pneumology department of the University Hospital of Tulear from January to April, 2017. We diagnosed 75 patients with tuberculosis, 96.05% of them new cases. The sex-ratio was 1.81. Patients' mean age was 35 years. Two patients (2.66%) were coinfected with HIV. Among the new cases diagnosed, 62.66% had pulmonary tuberculosis with positive microscopy (TPM +). Two patients reported a person with tuberculosis among their family or close friends. Living with someone in poor hygiene conditions was reported by 82.66% of the cases. Overall, 24% were unemployed. These patients had quite varied ethnic origins. The prevalence of HIV infection in TB patients was higher than in the general population. Low income and low educational levels were the main risk factors for TB infection in Madagascar.

Topics: Adult; Cross-Sectional Studies; Female; HIV Infections; Hospitals, University; Humans; Madagascar; Male; Prevalence; Prospective Studies; Risk Factors; Seroepidemiologic Studies; Tuberculosis

During the last few years, significant efforts have been made to improve access to antiretroviral therapy which led to dramatic reduction in AIDS-related events and mortality in HIV positive patients at the global level. However, current data in Africa suggested modest impact of widespread antiretroviral therapy scale-up especially regarding HIV-related hospitalization. In this study, we aimed to describe causes of hospitalization and factors associated with AIDS-defining events and inpatient mortality.. A retrospective study was performed on medical records of HIV positive patients admitted for at least 24 hours in the Infectious Diseases Unit of the University Hospital Joseph Raseta Befelatanana Antananarivo. Cause of hospitalization was considered as the main diagnosis related to the symptoms at admission. Diagnostic criteria were based on criteria described in WHO guidelines. AIDS-defining events were defined as diseases corresponding to WHO stage 4 or category C of CDC classification.. From 2010 to 2016, 236 hospital admissions were included. AIDS-defining events were the most frequent cause of hospitalization (61.9%) with an increasing trend during the study period. Tuberculosis (28.4%), pneumocystis pneumonia (11.4%), cerebral toxoplasmosis (7.2%) and cryptococcosis (5.5%) were the most frequent AIDS-defining events. Tuberculosis was also the most frequent cause of overall hospitalization. In multivariate analysis, recent HIV diagnosis (aOR = 2.0, 95% CI: 1.0-3.9), CD4<200 cells/μl (aOR = 4.0, 95%CI: 1.9-8.1), persistent fever (aOR = 4.4, 95%CI: 2.1-9.0), duration of symptoms≥ 6 weeks (aOR = 2.6, 95%CI: 1.2-5.4) were associated with AIDS-defining events. Overall inpatient mortality was 19.5%. Age≥55 years (aOR = 4.9, 95%CI: 1.5-16.6), neurological signs (aOR = 3.2, 95%CI: 1.5-6.9) and AIDS-defining events (aOR = 2.9, 95%CI: 1.2--7.2) were associated with inpatient mortality.. AIDS-defining events were the most frequent cause of hospitalization during the study period. Factors associated with AIDS-defining events mostly reflected delay in HIV diagnosis. Factors associated with mortality were advanced age, neurological signs and AIDS-defining events.

Topics: Adult; CD4 Lymphocyte Count; Female; HIV Infections; Hospitalization; Humans; Madagascar; Male; Middle Aged; Retrospective Studies; Tertiary Care Centers; Treatment Outcome

The country received malaria-free certification from WHO in September 2016, becoming only the second country in the WHO South East Asia region to be declared malaria-free. Imported malaria cases continue to be reported, with 278 cases reported between 2013 and 2017. The diagnosis of a severe Plasmodium vivax patient co-infected with HIV and tuberculosis is discussed with an overview of the rapid response mounted by the Anti Malaria Campaign (AMC), Sri Lanka.. It is important to consider comorbid conditions and immunosuppression when a patient with a benign form of malaria presents with severe manifestations. Measures should be strengthened to prevent importation of diseases, such as malaria and AIDS through migrant workers who return from high-risk countries.

Topics: Adult; Case Management; Coinfection; Communicable Diseases, Imported; HIV Infections; Humans; Madagascar; Malaria, Vivax; Male; Sri Lanka; Travel; Tuberculosis

In Madagascar, prevalence of sexually transmitted infections (STIs) and unplanned pregnancies are high among adolescents. Limited reproductive health education is available.. In northern Madagascar, in 2014, we assessed the baseline knowledge, attitudes and self-efficacy regarding STIs/HIV and family planning among 155 adolescents, and designed and implemented a 6-week reproductive health curriculum for adolescents using complementary teaching methods. We evaluated the curriculum through pre- and post-curriculum surveys of adolescents using paired t-tests.. Pre-test survey revealed a general lack of knowledge regarding different types of STIs. Post-curriculum, there was a significant improvement in the following educational domains: general knowledge of HIV/AIDS, other STIs and family planning (49%±17% to 65%±15%) (p<0.001), self-efficacy and use of contraceptives (57%±26% to 70%±26%) (p<0.01), and the overall combined scores of knowledge, attitude and self-efficacy (53%±14% to 68%±14%) (p<0.001). Open-ended questions revealed significant misconceptions and stigma regarding oral and anal sex and usage of condoms.. Important misconceptions and knowledge gaps regarding reproductive health exist among adolescents. The comprehensive reproductive health curriculum with complementary teaching methods was feasible, well-received and effective, and could be considered for integration into the schools' curricula.

Topics: Adolescent; Curriculum; Family Planning Services; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Madagascar; Male; Program Evaluation; Reproductive Health; Self Efficacy; Sex Education; Sexually Transmitted Diseases; Young Adult

We aimed to describe the challenge faced by the national reference laboratory to support the national HIV/AIDS response in Madagascar.. Collaboration between the National Reference Laboratory of Madagascar (NRLM) and foreign partners (a laboratory and an international organization) on the basis of a tripartite agreement. The aim was to offer virological analysis to 259 HIV-infected patients.. An alarming proportion (13.9%) of drug resistance among HIV-infected patients was observed.. The NRLM contributed to improving the fight against HIV in Madagascar and led to the revision of national therapeutic guidelines. Strengthening reference laboratories has to be a priority in developing countries.

Topics: Adolescent; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Developing Countries; Drug Resistance, Multiple, Viral; Drug Resistance, Viral; Female; Government Agencies; Health Priorities; HIV; HIV Infections; Humans; International Cooperation; Laboratories; Madagascar; Male; Middle Aged; Practice Guidelines as Topic; Viral Load; Viremia; Virology; Young Adult

Topics: Budgets; Female; Health Expenditures; Health Services; Health Services Accessibility; HIV Infections; Humans; Madagascar; Malaria; Male; Plague; Poliomyelitis; Politics

We assessed the HIV-positive yield of offering provider-initiated HIV testing and counselling (PITC) for TB and the costs, in Madagascar, which has a low HIV prevalence and a high TB burden.. A cross-sectional study of routinely collected records from January 2010 to June 2011.. A total of 37 596 TB patients were registered in 205 TB centres. HIV testing was available in 95 (46%) of centres where 7524 (40%) of those offered testing accepted it. Only 35 (0.5%) individuals were found HIV positive. Initial costs were about US$1.4 million and annual recurrent costs about US$0.1 million.. There are concerns of cost investment for countrywide introduction of PITC in a low HIV prevalence setting.

Topics: Adult; AIDS Serodiagnosis; Community Health Services; Cost-Benefit Analysis; Counseling; Cross-Sectional Studies; Health Care Costs; HIV Infections; HIV Seropositivity; Humans; Madagascar; Mass Screening

Topics: Africa South of the Sahara; Asia; Endemic Diseases; Histoplasma; Histoplasmosis; HIV Infections; Humans; Madagascar

This paper aims to analyze the representations of premarital sexuality among young people in a context where they are strongly encouraged not to engage in premarital sexual relations. This link between prevention messages, representations and behaviours has been studied among a student population in Madagascar. The analysis is based on a socio-demographic survey conducted in 2006. Results show that young men and women share the ideal of abstinence before marriage. The promotion of premarital sexual abstinence within AIDS programs reinforces gender differences. It is mainly young women who are urged to be abstinent, whereas young men have the means--condom use--to transgress the taboo of premarital sex and protect themselves against health risks. Thus, young men have a dual strategy. On the one hand, they attach great importance to premarital abstinence with their future wife; on the other hand, they can have sex with occasional partners and are then protected by condoms.

Topics: Attitude to Health; Condoms; Contraception Behavior; Female; HIV Infections; Humans; Madagascar; Male; Sexual Abstinence; Sexual Behavior; Socioeconomic Factors; Surveys and Questionnaires; Young Adult

Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow-up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy.. Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow-up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays.. Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum.. Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.

Topics: Adolescent; Adult; Child; Female; Health Services Needs and Demand; HIV; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Madagascar; Mass Screening; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Retrospective Studies; Rural Population; Seroepidemiologic Studies; Syphilis; Syphilis Serodiagnosis; Treponema pallidum; Young Adult

The objective of our study was to describe the discrimination profile of healthcare personnel towards people living with HIV/AIDS (PLWHA) in medical settings in Madagascar.. A prospective, multicentric, descriptive, and analytic study was made with a questionnaire filled in anonymously, between February and August 2009, in 17 Madagascar hospitals (public and private).. Thirty-six percent of PLWHA reported that they had been confronted with discrimination in the medical field. The age (30-40 years) and the level of education had an impact on discrimination in our study (p<0.05). Paramedics were the most responsible for discrimination (n=8/13) (61.5 %). Discrimination in the medical field was listed as: refusal of the patient to be managed in the hospital (n=5/27) (18.5 %) because of the fear of discrimination (n=4/5) (80 %) and sharing serological status with healthcare providers. Discrimination by the medical staff was listed as the unjustified use of some tools (stethoscope, tensiometer, thermometer) and by the refusal to manage PLWHA (p>0.05). Fifty-three percent of healthcare providers answered the question on HIV transmission mode correctly. Fifteen percent replied that HIV was transmitted by saliva, and 20 % by physical contact.. As elsewhere, discrimination of PLWHA in the medical field is present in Madagascar. Fighting discrimination should be included in the strategy against propagation of HIV infection.

Topics: Adult; Allied Health Personnel; Attitude of Health Personnel; Confidentiality; Diagnostic Tests, Routine; Fear; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Hospitals, Urban; Humans; Infectious Disease Transmission, Patient-to-Professional; Madagascar; Male; Middle Aged; Personnel, Hospital; Prejudice; Refusal to Treat; Retrospective Studies; Social Stigma; Students, Medical

Women's perceived control over condom use has been found to be an important determinant of actual condom use in some studies. However, many existing analyses used cross-sectional data and little quantitative information exists to characterize the relationships between perceived control and actual condom use among sex worker populations.. We assessed the association between measures of perceived condom use control and self-reported use of male condoms employing data from a longitudinal pilot study among 192 sex workers in Madagascar.. In multivariable models, a lack of perceived control over condom use with a main partner and having a main partner ever refuse to use a condom when asked were both associated with an increased number of sex acts unprotected by condoms in the past week with a main partner (RR 1.86; 95% CI 1.21-2.85; RR 1.34; 95% CI 1.03-1.73, respectively). Conversely, no measure of condom use control was significantly associated with condom use with clients.. Perceived control over condom use was an important determinant of condom use with main partners, but not clients, among sex workers in Madagascar. Programs working with sex workers should reach out to main and commercial partners of sex workers to increase male condom use.

Topics: Adult; Cohort Studies; Condoms; Cross-Sectional Studies; Female; Health Behavior; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Madagascar; Risk-Taking; Safe Sex; Sex Work; Sexual Partners; Sexually Transmitted Diseases; Surveys and Questionnaires; Urban Population; Women, Working; Young Adult

Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the past 48 h and detection of prostate-specific antigen (PSA), a biological marker of recent semen exposure. Multivariable logistic regression revealed that self-reported unprotected sex was associated with three factors: younger age, having a sipa (emotional partner) in the prior seven days, and no current use of hormonal contraception. The sole factor related to having PSA detected was prevalent chlamydial infection (adjusted odds ratio, 4.5; 95% confidence interval, 2.0-10.1). Differences in predictors identified suggest that determinants of unprotected sex, based on self-reported behaviors, might not correlate well with risk of semen exposure. Caution must be taken when interpreting self-reported sexual behavior measures or when adjusting for them in analyses evaluating interventions for the prevention of HIV/STIs.

Topics: Adolescent; Adult; Age Factors; Biomarkers; Condoms; Data Collection; Enzyme-Linked Immunosorbent Assay; Female; HIV Infections; Humans; Logistic Models; Madagascar; Male; Prostate-Specific Antigen; Risk-Taking; Self Report; Semen; Sex Work; Sexual Partners; Sexually Transmitted Diseases; Unsafe Sex; Young Adult

Increasing evidence indicates that sex workers use condoms less consistently with regular (i.e., nonpaying) partners than with clients. Few studies have examined the extent to which these 2 categories are mutually exclusive. In an ethnographic study of women's sex work in Antananarivo, Madagascar, we examined how the meaning of women sex workers' sexual relationships could shift among 3 different forms of sex work. Condom use was less likely in forms in which the distinction between client and lover (sipa in Malagasy) was fluid. For many sex workers, therefore, relationships they understood to be intimate imparted the greatest health vulnerability. It is important to examine the influence of the meaning of sexual relationships on condom use for HIV prevention. Policy implications for HIV prevention work with sex workers are considered.

Topics: Adolescent; Adult; Condoms; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Madagascar; Risk-Taking; Sex Work; Sexual Partners; Young Adult

Persistent high levels of sexually transmitted infection (STI) in Madagascar indicate current prevention strategies are inadequate. STI/HIV prevention based in social venues may play an important role in reaching individuals at risk of infection. We identified venues where people meet sexual partners and measured the need and potential for venue-based prevention.. Interviews were conducted in 7 Madagascar towns with 1) community informants to identify social venues, 2) individuals socializing at a sample of venues to assess sexual behavior among venue patrons, and 3) venue representatives to assess the potential for venue-based intervention.. Community informants identified numerous venues (range: 67-211 venues, depending on the town); streets, bars, and hotels were most commonly reported. Among 2982 individuals socializing at venues, 78% of men and 74% of women reported new sexual partnership or sex trade for money, goods, or services in the past 4 weeks and 19% of men and 18% of women reported symptoms suggestive of STI in the past 4 weeks. STI symptom levels were disproportionately high among respondents reporting either sex trade or new sexual partnership in the past 4 weeks. Twenty-eight percent of men and 41% of women reported condom use during the last sex act with a new partner. Although 24% to 45% of venues had hosted STI/HIV interventions, interventions were deemed possible at 73% to 90% venues according to 644 interviews with venue representatives.. Venue-based intervention is possible and would reach a spectrum of populations vulnerable to STI/HIV including sex workers, their clients, and other high-risk populations.

Topics: Adolescent; Adult; Communicable Disease Control; Female; HIV Infections; Humans; Madagascar; Male; Middle Aged; Risk Reduction Behavior; Sex Work; Sexual Behavior; Sexually Transmitted Diseases

Although the number of known HIV-infected students in Madagascar increased significantly between 1989 and 1995, very little is known about student behaviour with regard to AIDS. The study objectives were: to describe Malagasy students' sexual behaviour and condom use; to document students' perceptions about condoms; and to study the relationships between students' socio-demographic characteristics, their perceptions about condoms, and their condom use. The survey used a cross-sectional design and was conducted at the Antananarivo's university campus sites. Anonymous questionnaires were self-administered to 320 randomly selected students. Descriptive statistics and 95% confidence intervals were calculated. Logistic regressions were performed to identify the predictors of condom use. Participants' average age was 24 years. Approximately 80% of the participants reported sexual experiences, and the average age at sexual debut was 19 years. Only 5.7% reported consistent condom use. Common reasons for non-use were steady relationships (75.6%), the perception that condoms were useful only during ovulation periods (8.7%), and the decrease of pleasure (6.4%). The predictors of condom use were male gender, and the perception that condoms were useful during ovulation periods. Risky sexual behaviours with regard to AIDS were prevalent in this community. An HIV prevention programme is recommended.

Topics: Adolescent; Adult; Condoms; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Madagascar; Male; Patient Acceptance of Health Care; Risk-Taking; Sampling Studies; Sex Factors; Sexual Behavior; Socioeconomic Factors; Students; Surveys and Questionnaires; Universities

The objective of this study was to identify the key determinants of condom use with regular and casual partners among youth in Madagascar. Data stem from a reproductive health survey conducted in October-December 2000 among a representative sample of 2440 youth aged 15-24 living in Toamasina province. Following theoretical models of behaviour change, logistic regression was used to assess the effect of AIDS awareness,personal risk perception, condom access, perceived condom effectiveness,self-efficacy and social support on condom use. Among sexually experienced youth, only about four in ten males and two in ten females have ever used condoms. Fewer than 15% of youth used a condom in last intercourse with their regular partner. Whether youth will try condoms appears to depend largely on the perceived effectiveness of condoms for family planning, access to a nearby condom source, parental support for condom use, and patterns of risky sexual behaviour. Young males' likelihood of using a condom with a regular partner increases significantly if they perceive condoms to be effective for family planning (OR=11.4; p=0.019). For females, it increases with level of self-efficacy (OR=2 1; p=0.042) and having discussed HIV prevention with someone in the last year (OR=2.8; p=0.022). Among males,condom use with casual partners is significantly higher among those who perceive themselves to be at high risk of sexually transmitted infections(OR=2.3; p=0.014), who believe condoms are effective for family planning(OR=2.8; p=0.048), who have good access to condoms (OR=2.9; p=0.002)and who perceive their parents support condom use (OR=1-7; p=0.048). In conclusion, very few youth in Toamasina are using condoms, highlighting the need to continue and expand adolescent reproductive health interventions. In this low HIV prevalence setting, it is important for these programmes to emphasize that condoms are effective for both pregnancy prevention and STI/HIV prevention.

Topics: Adolescent; Adult; Condoms; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Interviews as Topic; Logistic Models; Madagascar; Male; Self Efficacy; Social Support

Sexually transmitted infections (STIs) in Madagascar have primarily been monitored in selected groups of patients attending STI clinics in major cities as part of the HIV surveillance program in Madagascar.. The aim of the study was to provide complementary data related to STI prevalence in a general rural population.. STIs were investigated in 643 subjects aged 15 to 49 years as part of a cross-sectional morbidity study of urogenital schistosomiasis. Infection rates were reassessed 3 weeks and 6 months after systematic STI treatment at baseline.. Neisseria gonorrhoeae (Ng), Chlamydia trachomatis (Ct), Mycoplasma genitalium (Mg), Trichomonas vaginalis (Tv), and/or antibodies to Treponema pallidum (Tp) were diagnosed in 125 (37.5%) of 333 women and in 83 (26.8%) of 310 men. In addition, 49% of the women and 28% of the men were infected with herpes simplex virus-2. Six (0.9%) subjects were found HIV-antibody positive. Between the 3-week and 6-month follow-up surveys Ng, Ct, and/or Mg prevalence increased most prominently in women aged 15 to 24 years.. Study findings suggest that rural areas in Madagascar should be as closely monitored and assisted in STI and HIV control as their urban counterparts. Following the current consensus, young adults should constitute a priority target group in the control programs.

Topics: Adolescent; Adult; Age Distribution; Disease Outbreaks; Female; HIV Infections; Humans; Madagascar; Male; Middle Aged; Rural Health; Sex Distribution; Sexually Transmitted Diseases; Socioeconomic Factors

Sex work is frequently one of the few options women in low-income countries have to generate income for themselves and their families. Treating and preventing sexually transmitted infections (STIs) among sex workers (SWs) is critical to protect the health of the women and their communities; it is also a cost-effective way to slow the spread of HIV. Outside occasional research settings however, SWs in low-income countries rarely have access to effective STI diagnosis.. To develop adequate, affordable, and acceptable STI control strategies for SWs.. In collaboration with SWs we evaluated STIs and associated demographic, behavioural, and clinical characteristics in SWs living in two cities in Madagascar. Two months post-treatment and counselling, incident STIs and associated factors were determined. Evidence-based STI management guidelines were developed with SW representatives.. At baseline, two of 986 SWs were HIV+; 77.5% of the SWs in Antananarivo and 73.5% in Tamatave had at least one curable STI. Two months post-treatment, 64.9% of 458 SWs in Antananarivo and 57.4% of 481 women in Tamatave had at least one STI. The selected guidelines include speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk-based treatment during 3-monthly follow-up visits. SWs were enthusiastic, productive partners.. A major HIV epidemic can still be averted in Madagascar but effective STI control is needed nationwide. SWs and health professionals valued the participatory research and decision-making process. Similar approaches should be pursued in other resource-poor settings where sex work and STIs are common and appropriate STI diagnostics lacking.

Topics: Adolescent; Adult; Counseling; Decision Making; Evidence-Based Medicine; Female; Follow-Up Studies; HIV Infections; Humans; Madagascar; Middle Aged; Patient Participation; Practice Guidelines as Topic; Prevalence; Risk Factors; ROC Curve; Sex Work; Sexually Transmitted Diseases; Urban Health

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Behavioral Research; Blood Transfusion; Female; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Interviews as Topic; Madagascar; Male; Risk Factors; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Surveys and Questionnaires; Travel

Health care workers are key players in the prevention and management of HIV-infection. We surveyed HIV/AIDS-related knowledge, attitudes and practices of health care workers in Tamatave (Madagascar), to assess the feasibility of voluntary counselling and testing for HIV infection in antenatal care.. A Knowledge Attitude and Practice study was conducted during July 2000 in the antenatal health care centres and the hospital of Tamatave. The health workers completed a self-administrated questionnaire on HIV transmission, attitudes and practices regarding AIDS testing and counselling, HIV risk perception and attitudes regarding patients with HIV disease.. A 90% response rate was obtained, with completed questionnaires from 45 health care workers. The sample included physicians, midwives, nurses, medical students and nursing auxiliaries. Scientific knowledge about transmissibility of HIV infection was poor: transmission was believed possible by living together without having sex (7%), by breastfeeding a HIV-positive child (9%), by using toilets after a HIV-positive patient (13%) and by blood donation (76%). 73% of the health staff believed a child born of an HIV-positive woman would systematically be infected and interventions to reduce this risk were unknown. Sixty one per cent of the health-workers reported never having advised patients to be tested and less then 10% mentioned correct counselling precautions. Seventy nine percent believed that they were at risk of acquiring AIDS, mainly through occupational exposure. Negative attitudes towards HIV-positive patients were also noted: twenty per cent of the health workers mentioned that AIDS patients should be isolated in quarantine. Physicians and paramedical staff differed only in their better knowledge about transmissibility of HIV. Physicians had the same restrictive attitude towards patients with HIV as paramedical health workers and did not differ by their counselling practice.. Our study revealed gaps in the knowledge of health care workers about HIV infection. Before implementing voluntary counselling and testing in antenatal care, additional HIV/AIDS training for health staff seems necessary.

Topics: Acquired Immunodeficiency Syndrome; AIDS Serodiagnosis; Attitude of Health Personnel; Blood Donors; Breast Feeding; Chi-Square Distribution; Confidence Intervals; Counseling; Feasibility Studies; Health Knowledge, Attitudes, Practice; Health Personnel; HIV Infections; Humans; Infectious Disease Transmission, Patient-to-Professional; Infectious Disease Transmission, Vertical; Madagascar; Midwifery; Nurses; Nursing Assistants; Odds Ratio; Physicians; Professional-Patient Relations; Residence Characteristics; Risk Factors; Statistics as Topic; Students, Medical; Toilet Facilities

In 1994, Médecins du Monde opened a free health centre specialized in STD/AIDS in an ill-favored district of Antananarivo, the Malagasy capital of Madagascar. Besides the medical treatment of Sexually Transmitted Diseases (STD) and AIDS, the centre is responsible for the Information, Education and Communication activities (IEC) within and without the centre towards the residents of the 67 hectares district and the high-risk populations (prostitutes, truck-drivers and transvestites). The project aimed at both preventing the spreading of the VIH infection and reducing the incidence of STD. As the Ministry of Health directed, a syndromic method was applied since 1997 regarding STD. Results for 1998 showed the predominance of the association Neisseria gonorrhae-Chlamydiae among the consultants of both sexes. Negative results from 1,218 HIV serological tests carried out seemed confirm the low prevalence of the HIV infection in Madagascar. Yet, the percentage of positive syphilis serology among the tested consultants was lower than that mentioned in previous surveys. Finally, it appears that the syndromic method is of high interest for the countries with limited laboratory capacities.

Topics: Adult; AIDS Serodiagnosis; Community Health Centers; Female; HIV Infections; Humans; Incidence; Infant, Newborn; Madagascar; Male; Mass Screening; Poverty Areas; Prevalence; Risk Factors; Sex Work; Sexually Transmitted Diseases; Transvestism; Urban Health; Urban Health Services

Topics: Adolescent; Adult; Child; Female; HIV Infections; HIV-1; Humans; Madagascar; Male; Middle Aged

Topics: AIDS Serodiagnosis; Female; HIV Infections; Humans; Madagascar; Pregnancy; Pregnancy Complications, Infectious; Seroepidemiologic Studies; Syphilis; Syphilis Serodiagnosis; Tuberculosis

Topics: Enzyme-Linked Immunosorbent Assay; Female; HIV Infections; HIV Seroprevalence; Humans; Madagascar; Male; Prospective Studies; Risk Factors