Madagascar has a low level of HIV prevalence, and managing its AIDS programme should present no major difficulties. But the apparent advantage of a low infection rate, combined with the ongoing political crisis, has brought its own challenges. Madagascar, and the neighbouring islands states of Comoros, Mauritius and Seychelles, are anomalies in the context of HIV/AIDS in Africa. Prevalence is very low - around 0.37 per cent, or 24,000 confirmed cases - and restricted to a few sections of the population. Recent research has revealed that the groups most infected are men having sex with men (14 per cent), intravenous drug users (7 per cent) and prison populations. HIV prevalence among female commercial sex workers is relatively low.