Summary

While recorded HIV prevalence in Madagascar is lower than in other African countries, most probably thanks to the island's isolation and lack of available data, prevalence of other sexually transmitted infections (STIs) such as gonorrhoea and syphilis is known to be among the highest in the world, a factor that significantly increases the risk of a generalised HIV epidemic. A number of socio-economic factors increase the likelihood of high risk sexual encounters in Fort Dauphin including rising poverty, the marginalised status of women, traditional customs supportive of casual sex, and limited health services. The situation is particularly acute for communities in high risk zones such as tourist destinations, ports and mining sites. Indeed, it is estimated that HIV infection rates in the urban commune of Fort Dauphin have risen by 64% in the last 4 years, while 93% of the population in the Anosy region have never been tested for HIV and levels of awareness are lower than anywhere else in the country.

In 2006 Azafady started working with young people in Fort Dauphin to identify ways in which information about HIV/AIDS & STIs could effectively reach the maximum number of people. Several young people were empowered to act as peer educators and led a variety of communication strategies including home visits, focus groups and community events which educated and motivated other young people to make informed decisions about their sexual health.

The project was greatly expanded from 2008 thanks to support from the Big Lottery Fund, with the aim of to reaching over 19,000 young people across Fort Dauphin. Mass and interpersonal communication strategies (community events, school workshops, peer education) are being used with a variety of media (local radio, posters and leaflets, sporting and cultural events) so as to be accessible to even young people who are difficult to reach through mainstream channels, including out-of-school youth and young married women. The project seeks to empower young people to take control of their sexual health by establishing mutual support systems between schools, health services, youth associations and opinion leaders to promote youth-friendly care and support services (voluntary counseling and testing, accessible contraception, treatment drugs) and to sustain behaviour change.

Project Aim

To improve access to information about HIV/AIDS & STIs and the means of primary prevention among 13-24 year olds in the urban commune of Fort Dauphin through information, education and communication methods.

Objectives

1. Increased knowledge about HIV/AIDS & STIs, the modes of transmission and the means of primary prevention among young people, their parents and opinion leaders.

2. Increased perception of personal risk among young people and motivation to adopt practices for the prevention of HIV/AIDS & STIs.

3. A more supportive environment and reduction of stigma for young people with regards to HIV/AIDS & STIs.

Principal activities

Training and capacity building
Members of youth associations in Fort Dauphin are being trained in the modes of transmission and means of primary prevention of HIV/AIDS & STIs, and in various communication techniques. They are being empowered to act as peer educators within their community, acting as a source of information, advice, mentoring and encouragement for young people, and the link between the community and the project team.  

Information, education and communication
The project is using a number of communication channels and strategies - schools workshops, local radio broadcasts, community sporting and cultural events, focus groups and home visits – so that messages are accessible even to young people who are difficult to reach through mainstream channels, including out-of-school youth and young married women. Activities educate young people and their parents about HIV/AIDS & STIs, stimulate discussions about the risks, and empower young people to make informed decisions about their sexual health.

Improving access to products and services
Through links to products and service providers, the project is promoting voluntary counseling and testing, male and female condoms, and treatment drugs. This empowers young people to take control of their sexual health choices and sustains behaviour change.