Despite a high level of sexually transmitted infections (STIs) and multiple partners, Madagascar has low HIV prevalence compared to other southern African countries. Its effort to keep HIV rates low, through efforts like the Top Reseau network of youth-friendly health clinics created by PSI with funding from the Bill & Melinda Gates Foundation, was highlighted by the Boston Globe. STIs provide openings for HIV transmission because the ulceration and inflammation gives the viruses an easier pathway to enter cells.

Globe Foreign Correspondent John Donnelly reported that each doctor who joins the program receives training on how to counsel teenagers, encourage them to get tested for HIV and treat STIs:

"After little more than a year, 186 doctors and 123 clinics belong to the program, called Top Reseau, French slang for the "best network." It's a fast start for the program, but it is in only six cities and covers a small percentage of the country, whose population exceeds 15 million. Under the program, doctors agree to charge a lower fee for young people and they give discounts for partners of those with STIs for an exam at a Top Reseau clinic."

"Off a busy street in the capital, Dr. Rakotoniaina Raniriharisoa Voahirana said her business has boomed in the year since she joined. She said teenagers, who had made up 30 percent of her practice, account for nearly 70 percent now. She said the Top Reseau sign, and reputation, draws them in. 'People are starting to become afraid of AIDS here,' the doctor said in her tiny one-room office. 'They should be. Madagascar is so poor that if we don't really fight it, we will be lost. We are very, very late in this fight.'

The article quoted an STI specialist with the World Health Organization as saying that Madagascar could be headed for an explosion of HIV infections unless prevention efforts are expanded rapidly.