Vulnerable groups in Madagascar need specific and open services, says report
02 May 2007
Alliance-led research in Madagascar has identified characteristics, attitudes and behaviours of vulnerable groups such as sex workers, men who have sex with men and injecting drug users that impact on HIV prevention priorities and feed into Madagascar’s national strategic plan.
The Alliance in Madagascar presented the research to stakeholders at a meeting on 27 February, along with recommendations for each population group. They asked for specific and open services for vulnerable groups to be developed alongside existing primary healthcare services. They also highlighted the need to fight against stigma and violence, and for legislation to be better used as a prevention tool.
The research, carried out within the framework of the Programme Acceleration Fund, has shown that men who have sex with men in Madagascar face increasing vulnerability to sexually transmitted infections, including HIV. Stigma remains a key factor fuelling their vulnerability, leading to violence and discrimination against them. Although the men have a good understanding of how sexually transmitted infections, including HIV, are spread, only half of those participating in the study use condoms.
The study, which surveyed 1,351 people in Antananarivo, Mahajanga, Antsiranana, Fort-Dauphin, Andilamena, Ilkaka and Toamasina, also revealed high rates of unprotected sex among injecting drug users, with syringe sharing also a common high-risk activity. In Madagascar, injecting drug users face the same legal penalties as dealers. As a result, they are forced underground, increasing their vulnerability and making them harder to reach.
Sex workers remain a highly vulnerable group, with poverty a key factor in their failure to negotiate regular condom use with clients. Although the informality of sex work means that it is difficult to report accurately on the number of sex workers in Madagascar, an Alliance census in 2006 noted a high concentration in urban areas, and continued marginalisation. Access to healthcare facilities and the price of medication remains a challenge for many sex workers, although awareness of sexually transmitted infections, including HIV, is greater in urban sites.
