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Madagascar: Taking care and prevention to the people

A casual glance at the national prevalence rate in Madagascar doesn’t elicit much cause for concern: officially less than 1% of the population is HIV-positive, so it would appear AIDS is well under control.

So why do the Jesuits in Madagascar have a wide-ranging project dedicated to HIV/AIDS? As usual, there is much more to reality than the statistics, largely because there are hardly any HIV testing facilities in far-flung rural areas, where 80% of the Malagasy population lives.

In another indicator that all is not as it seems, there is a high prevalence of sexually transmitted infections (STIs) in Madagascar – in just one example, 6.5% of pregnant women tested positive for syphilis in 2010.

Fr Jean-Simon Ratsimbazafy SJ, who runs the project Christian action in the struggle against AIDS from the Arrupe Social Centre (CSA), believes official statistics don’t present the full picture.

He says risky behaviours are much in evidence: excessive alcohol consumption, drug use, multiple partners, early onset of sexual behaviour and sexual violence. Madagascar’s recent socio-political crisis has made the situation worse, with deepening poverty – described by Fr Jean-Simon as the root cause of STIs and HIV in the country – leading to an increase in activities that put people at risk.

But talking about sex remains taboo in Malagasy tradition, making it difficult to broach the topic to persuade people to change harmful behaviours.

Reaching people, to let them know the consequences of risks they may take, to give them the means to make different choices and to support them if they are already ill, are urgent needs.

Enter the Jesuit project which, within a few years, has managed to build a solid network of people who run programmes of HIV testing, prevention and care as well as rural development in isolated areas that would otherwise be quite forgotten.

“Our overall aim is to keep the HIV prevalence rate in Madagascar below 1%,” says Dr Marie Zoé Randriana, deputy to Fr Jean-Simon. “Our strategy consists of three integrated elements: the reduction of high-risk behaviours related to STIs and HIV through the promotion of éducation à la vie et à l’amour (EVA – education for life and love), health promotion and care, with testing campaigns and medical, psychosocial and spiritual support for people who have HIV and STIs; and improving the standard of living of people in rural areasthrough education, health and nutrition.”

EVA is a cornerstone of the project – this programme of value-based education, which encourages young people to make healthy life choices, is the weapon of choice recommended by the Catholic Bishops’ Conference of Madagascar to fight risk behaviours among young people. The EVA programme of the Jesuit project reaches both teenagers and their parents and also offers psychosocial support to those in need.

The project is mainly implemented in the missionary district of Andriampamaky, which is entrusted to the Jesuits and consists of 26 parishes and outstations in rural areas. The CSA is a hub for activities in the villages however many of the project’s training programmes and creative means of communications have a still wider reach.

“An impressive area of intervention of the Jesuit project in Madagascar is a weekly, one-hour radio broadcast on HIV/AIDS,” said AJAN Coordinator Paterne Mombe SJ. “Its impact is felt both in the city and in rural areas, where handcrank radios have been widely distributed. In one village, some people formed a group to listen to the programme, to discuss the information and to see how it can be applied. Listeners send questions via SMS and email and the number of questions is so high that only a fraction can be answered each week. This has prompted the CSA to start regular seminars to respond to the overflow of questions.”

Resource people from varied professions and backgrounds – doctors, psychotherapists, lawyers, animators, parents – make up the EVA team. “Being on the team has helped me to develop professionally and personally,” says Masy Razafindradama. “I’ve attended many training sessions and have learned to serve others and to be aware of the importance of our mission in this time of crisis in our country.”

Taking prevention and care to outlying rural areas is a key element of the project. The team works closely with people from the local Church to organise meetings, seminars, sports tournaments, cultural events featuring music and dance as well as testing campaigns.

To create a base for medical testing and care, a health centre was opened in Andranovelona in 2006. Dr Odon Rasolondraibe, the doctor in charge, is there two days a week. She treats people who present with generic complaints and STIs, administers HIV and syphilis tests, and deals with the District Health Service, which supplies the clinic with reagents insofar as it is able.

“Our clinic also carries out mobile testing in rural areas,” says Dr Odon. “This allows us to reach peasants who live very far from towns where most of the testing facilities are based. We have also chosen to offer medical care which is so difficult to access in these areas.”

The project has taken on the care of people with HIV in partnership with doctors and a private organisation. Getting treatment for HIV and related opportunistic infections is fraught with difficulty in Madagascar because of the very limited number of centres providing such care, the lack of funding for opportunistic infections and stockouts of antiretroviral medication (ARVs).

“People with HIV really panicked when there was a stockout of ARVs last year. Deaths resulted,” said Fr Jean-Simon, whom people turned to for support.

Despite the challenges, the project saves many lives. Saholy, an HIV-positive mother of three who was abandoned by her husband, said: “I was on the brink of despair when my family and society rejected me; your project has given us hope and has renewed our zest for life.”

The third element of the Jesuit project is rural development. Going by the rationale, “a hungry stomach has no ears”, the project gathered farmers into a group and offered training in agriculture and breeding techniques as well as seeds and tools to improve output.

Jean Paul Randremanana, the farming superviser, said: “At first, people weren’t used to the new techniques, but with experience and mutual support, they managed. They have increased the extent of the land they cultivate as well as their crops.”

“We are considered to be a model of best practice in the region of Andriampamaky,” says group member Lydia with justifiable pride, “because our productions and organisation have enabled us to improve our standard of living.”

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