The HIV prevalence rate in the island nation of Madagascar may be lower than its neighbouring Southern Africa countries, but the levels of stigma and discrimination are just as high. Activists and government officials are hoping that a recently introduced law will alleviate the problem.
"Finally, we will be able to generalise and apply the law," said Fenosoa Ratsimanetrimanana, executive secretary of the National AIDS Committee (CNLS). The legislation stipulates fines for acts of discrimination of up to 400,000 ariary (US$200), and up to 1,000,000 ariary ($500) for disclosing the status of a patient.
"The spirit of this law is non-discrimination, easing the fight against HIV via prevention and information," said Minister of Health Robinson Jean Louis, who thinks the legislation will limit the "risk of explosion" of the virus.
Yves Bourny, a UNAIDS official, welcomed the move, describing it as a "strong message sent by the Malagasy government, who clearly support and recognise people living with HIV/AIDS".
Madagascar is still relatively unaffected by the virus: the CNLS estimates the national infection rate at 0.95 percent. However, the four percent prevalence rate for sexually transmitted infections (STIs) is much higher and, in the eyes of the Health Minister, this represents a possible "entry way for the HI virus."
No prominent Malagasy figure has publicly acknowledged being HIV positive, but Madagascar's President Marc Ravalomanana was tested in February 2006.
UNAIDS estimates there are about 39,000 HIV-positive people in the island, but only 89 are receiving antiretroviral treatment. The government hopes the legislation will encourage HIV-positive people to come forward and make use of HIV services, and that more people will be tested, avoiding unknowingly transmitting the virus.
Not everyone is convinced, particularly about a clause that allows for up to two years in jail for transmitting HIV through "clumsiness, imprudence, carelessness, negligence, or failure to observe the rules".
"A law was necessary, but it is too unclear and not strong enough. In any case, it will not encourage me to publicly disclose my status," said an infected Malagasy who wished to remain anonymous.
It also remains to be seen how effective the legislation will be in a country where widespread stigma and discrimination persist, and few HI-positive people are willing to be open about their status.
"We have very important sensitisation work to do: some health workers refuse to treat these patients or use the [HIV/AIDS] material," said Hanta Razafiamanana, a welfare officer.
"The most important is not the law; it will be to make it known and make it respected," a person living with the virus pointed out during a support group meeting.
Efforts are underway to educate people about HIV/AIDS: the government hopes to have distributed 400,000 HIV test kits throughout the country by the end of 2007, the CNLS has set up smaller decentralised units in 22 regions, and screening centres in 116 districts.
Local development leaders, nominated by President Ravalomanana, and 17,000 Fokontany chiefs, who each head an administrative district, will be directly involved in efforts to battle the disease. These leaders will hold a two-day meeting, of which two hours will be devoted to discussing HIV/AIDS prevention.
The reformed church of Fiangonana Jesosy Kristy Madagasikara (FJKM), or the Community of Jesus Christ in Madagascar, which has 4,000 places of worship, has agreed to devote five minutes at the end of each Sunday mass to fighting discrimination against those infected with HIV.
"We have been working on this issue for a long time; this is just a new stage," said Pastor William Razafimahatratra, president of the FJKM's committee to combat AIDS.
"We preach abstinence and fidelity, but we are neither for nor against the condom," he said. "We regard it as a drug, and leave the education to the doctors."