29 February 2016 – You have an amazing team! Above all, keep your enthusiasm and courage alive! The team of the Centre Social Arrupe (CSA) in Madagascar fully deserve this praise showered upon them by AJAN Director Paterne Mombe SJ.

A visit to the CSA projects in Madagascar in early February filled both Fr Paterne and the team with hope. While deeply saddened by the recent loss of Fr Jean-Simon, they are motivated by his inspirational example and eager to build on his legacy.

At the CSA, which is situated in Antananarivo, the AJAN Director met the staff who implement a long-running AIDS project as well as those responsible for healthcare and family ministries. All work together to implement wide-ranging initiatives, especially in community-based healthcare, value-based education, and rural development.

“There are many good perspectives here, especially geared towards bringing health to the community,” said Fr Paterne. 

Masy Razafindradama, one of the stalwarts of the CSA, said: “The words of hope of Fr Paterne resonate in our hearts as we seek to put our plans into action.” 

Together with Fr Paterne, the team assessed the current situation of HIV and AIDS in Madagascar and concluded that much more needs to be done to raise awareness about testing, to enhance access to treatment for people living with HIV and – the bold global target – to make the epidemic history by 2030.

The last available data, from June 2014, indicates that 976 people living with HIV, including 541 on ART, are being followed up in Madagascar, out of an estimated 54,000 people who have the virus. The question begs: what about the rest? Are they not going to health centres? What sort of support are they getting? How are they managing to get by?

The national strategic plan for HIV and AIDS in fact includes many recommendations about improving the collaboration between clinics and associations of people living with HIV, to seek out patients who have been lost-to-follow-up.

The real picture is far from clear. Although official statistics put the HIV prevalence rate in Madagascar at no higher than 1%, it is no secret, to those with some knowledge of the situation, that this figure is far from the reality.

“Given the reality, the question for us is what role we can play, as the CSA, to bring more healthcare to communities, and to make HIV testing and treatment, as well as treatment for related illnesses, more accessible,” says Masy. 

The CSA is already doing plenty, working in close collaboration with local parishes and with the Association des médecins catholiques malgaches (Association of Malagasy Catholic doctors) to promote healthcare in urban and rural Antananarivo.

The way ahead lies in making better use of the vast network of the Church, present across the country, even the most isolated and rural areas.

Masy said: “In partnership with AJAN, the Catholic Church, through its decentralised structure and its many institutions, including the CSA, is looking to make its interventions for people living with HIV more effective and more widespread. Right now, these efforts are still scattered and sporadic.”

Fr Paterne, the AJAN Director, said: “Church healthcare institutions in Madagascar could make an enormous difference if they were entrusted with the means – that is testing kits, CD4 count machines and antiretroviral drugs (ARVs) – to reach out to a greater number of people living with HIV and to ensure zero infection.”

Especially valuable, he continued, are mobile clinics such as one run by the CSA to bring healthcare to communities, especially the most vulnerable.

During his visit, Fr Paterne visited three clinics that are partners of the CSA, including the first HIV testing centre set up in Madagascar, which is situated in urban Antananarivo. Dr Hervé, who is responsible for HIV care at the centre, said that between 10 and 20 people went for testing every day and four new cases were registered in January 2016.

The other two clinics are run by the AMCM and attached to the parish infrastructure. Situated in rural areas, they offer care without distinction to all who come, for a very low price, at less than $1.

One constant problem mentioned by doctors in all three clinics was shortfalls in testing reagents supplied by the government. Just a week before Fr Paterne’s visit, there was a disruption in supply and so those patients who wanted to do a test had to wait patiently!

Meanwhile the CSA remains fully committed on other fronts of the struggle against AIDS, especially value-based education. The team has developed an expertise in EVA (Education à la Vie et à l’Amour – Education for Life and for Love), for young people and their parents and educators, and implements the program through parishes, schools and media. One key channel of communication is the Don Bosco Radio, which reaches many dioceses of Madagascar.

The visit of Fr Paterne left the team encouraged and eager to enhance and expand its many programs, in order to reach more people living with HIV, to ensure they have the care and treatment they need, and to do all they can to make AIDS history!