Is Madagascar at the edge of a generalised HIV epidemic? Situational analysis

作者：Mihaja Raberahona, François de Monge, Rijasoa Harivelo Andrianiaina, Mamy Jean de Dieu Randria, Andosoa Ratefiharimanana, Rivo Andry Rakatoarivelo, Lanto Randrianary, Emma Randriamilahatra, Liva Rakotobe, Chiarella Mattern, Volatiana Andriananja, Hobimahanina Rajaonarison, Mirella Randrianarisoa, Elliott Rakotomanana, Dolorès Pourette, Hery Zo Andriamahenina, C. Deze, Narjis Boukli, Laurence Baril, Xavier Vallès · 发表于：Sexually Transmitted Infections · 年份：2020 · DOI：10.1136/sextrans-2019-054254 · 被引用次数：23 · 研究领域：HIV/AIDS Research and Interventions、HIV, Drug Use, Sexual Risk、Sex work and related issues

OBJECTIVES: To describe the epidemiological situation of the HIV/AIDS epidemic and to identify the main drivers for vulnerability in Madagascar. DESIGN: Literature review, qualitative research and situational analysis. DATA SOURCES: 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. REVIEW METHODS: 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. RESULTS: 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 ...