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Madagascar

Attention to HIV in Madagascar has literally exploded in the past two years. From a very limited governmental response, Madagascar now receives funds from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank’s Multi-country HIV/AIDS Program for Africa. HIV is also clearly a government priority and is rarely out of the news. Since 2004, the government has focused on reinforcing and supporting local responses by community-based organisations.

In 2003, a survey recorded a national average HIV rate among pregnant women in antenatal clinics of 1.1%. This prompted a re-orientation of the national strategy, as, according to UNAIDS, an HIV rate of over 1% represents a generalised epidemic. This has been reflected in a shift away from focused efforts with specific populations (with the exception of people living with HIV), towards an objective of reaching every individual in the country with essential information on HIV.

The Alliance began operating in Madagascar in 2001 through Pact Madagascar. In June 2004, the Alliance established a country office in Antananarivo.

What we do

The main components of the Alliance’s programme are technical and financial support to Malagasy non-governmental organisations in the government’s 20 designated priority zones, to get them working on HIV for the first time. We also provide technical support to sex worker associations to help them build partnerships and networks with other stakeholders and institutions; build collaborative approaches to programming; and share good practice and lessons learned. Collectively, these activities have been referred to as the ‘Koragna’ project.

In September 2003, the Alliance developed a two-year programme of support to the local AIDS committees set up in the government’s 20 priority zones. The programme has ended up having separate staff, a wider geographical spread (including, but not limited to, all of our existing Koragna sites) and much closer working relationships with different partners. It is now seen as a separate but complementary project – called ‘Mahefa’.

An overview of the Alliance ‘layered’ programme

The Alliance provides a number of different layers of support within the 20 national priority sites.

In all 20 government national priority sites, the Alliance is providing support to strengthen local AIDS committees. In nine urban sites, the Alliance is also working to strengthen the rights and prevention roles of sex worker associations. The Alliance has provided leadership training, and recently supported all of the associations to carry out participatory needs assessments to identify factors that contribute to and negatively affect the well-being of sex workers in each of the nine current sites.

In four of these nine urban sites, the Alliance is also giving technical and financial support to local non-governmental and community-based organisations to carry out more co-ordinated site programming.

Finally, the Alliance programme also shares experiences and lessons learned, and carries out influencing and advocacy activities.

What we have achieved

The Alliance’s programme is helping to co-ordinate local responses, and provide more comprehensive programming and more efficient use of resources at a local level. It is also allowing greater involvement of local institutions in the planning and implementation of responses to HIV.

Our work with sex worker associations is increasing their ability to interact with and influence their social, economic and political environment. It is also helping to give them greater participation in national and local responses, and greater access to services, while reducing discrimination and reducing the number of new infections among sex workers.

More comprehensive, co-ordinated and sustainable site-level responses should lead to fewer new infections and stronger care and support services for people living with HIV. Advocacy and communications work aims to improve the national environment for local and community responses to HIV. Some of the tools we have developed have already had a wide-reaching impact – being adopted by the facilitation programme for induction of non-governmental and community-based organisation candidates for multisectoral project for the prevention of HIV (PMPS) funding.

The Alliance’s layered approach to support in Madagascar is allowing programme activities to strengthen each other. For example, strengthening collaboration between local non-governmental and community-based organisations helps the local AIDS committees function better and provides sex worker associations with a stronger network of other civil society organisations to work with. At the same time, greater sex worker participation enhances the work of the committees and non-governmental organisations. The committees also provide a forum where civil society organisations can more easily negotiate partnerships and collaboration with other sectors.

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