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Trends in Sexual Behaviors in the General Population of Madagascar: Increase in High-Risk Sex and Decrease in Condom
Ghys Peter Denis1, Andriamino Brusa2, Razafimiarantsoa Tovonirina Théodore3
1, Consultant, Tannay, Switzerland. ghysp@hotmail.com.
AIDS and Behavior
|November 2, 2025
Summary
Madagascar
Area of Science:
- Epidemiology
- Public Health
- Sexual Health
Background:
- Madagascar historically exhibits lower HIV prevalence compared to continental African nations.
- Recent trends indicate a rise in risky sexual behaviors, including multiple partners and non-marital sexual relations.
- Condom use has significantly declined among individuals reporting multiple or non-marital partners.
Purpose of the Study:
- To analyze trends in sexual behavior and condom use in Madagascar from 2003 to 2021.
- To identify potential drivers of the evolving HIV epidemic in Madagascar.
- To inform public health strategies for HIV prevention and control.
Main Methods:
- Analysis of data from Madagascar Demographic and Health Surveys (2003-4, 2008-9, 2021) and the Multiple Indicator Cluster Survey (2018).
- Statistical analysis of reported sexual behaviors, including number of partners and condom use.
- Trend analysis of behavioral changes over time.
Main Results:
- Significant increases observed in reporting sex with multiple partners and non-marital, non-cohabitating partners for both men and women between 2003 and 2021.
- Substantial decrease in condom use among men and women reporting multiple partners (2008-2021).
- Significant decline in condom use among men reporting non-marital, non-cohabitating partners (2003-2021).
Conclusions:
- Rising risky sexual behaviors coupled with declining condom use may be driving Madagascar's HIV epidemic.
- Further research, such as HIV prevalence studies in pregnant women, is recommended to understand the current HIV status.
- Public health interventions are needed to address changing sexual behaviors and promote consistent condom use.
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