Madagascar: 1.1%: the number that rewrote Madagascar's HIV response

Not too long ago, across Madagascar, in regions facing severe drought and extreme poverty, some young girls were in dire straits, unable to buy basic necessities, some-times having to exchange unprotected sex for commodities as commonplace as a single tomato. For many years, Madagascar's HIV response was focused primarily on key populations including men who have sex with men, sex workers, people who use drugs and prisoners. But on the ground, warning signs were emerging that the picture was changing. "We began seeing clear indications that the epidemic was no longer confined to traditionally defined key populations but was increasingly affecting bridge populations and the wider community," said Jude Padayachy, Secretary of State, Ministry of Health, Seychelles and former UNAIDS Country Director for Madagascar, Seychelles and Comoros. By 2024, Madagascar had recorded a 151% increase in new HIV infections since 2010. At the same time, HIV treatment coverage remained at just 24%, among the lowest in the region and far below UNAIDS' target of 95%. Weak surveillance systems, low HIV prevention and limited capacity to test for HIV meant that the country did not have a clear picture abou

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