If you were to consider the statistics alone, you would not believe that HIV infection was particularly problematic in Timor-Leste. Current figures are modest, with a total of 294 confirmed cases recorded by the national hospital's testing service.
Yet the testimonies of organisations working to address associated stigma and discrimination as well as the need for effective prevention, tell another story. As they prepared for World AIDS Day, I spoke to three Progressio partners about the issues that they are tackling in the country today.
The hidden truth
"We try hard to convince people to get tested because we believe that the cases may be more than 294," Atanasio de Jesus, Programme Officer at the National AIDS Commission (NAC) tells me. "But no one wants to get tested voluntarily, so this is a problem."
Timor-Leste has only been recording incidence of HIV infection since 2002. The picture of actual cases is certainly becoming clearer, however there is still some way to go until an accurate figure can be obtained. Freddie Mawanda, our Development Worker supporting NAC, explains to me just one reason why the numbers aren't quite adding up:
"The information I'm hearing is that about 80% of these cases have been confirmed through the ante-natal clinics - so women coming for ante-natal check-ups and tests. But they don't know where the men are - that's why this total number of cases doesn't really show a true picture of the HIV cases in Timor-Leste."
The problem of stigma
Despite the hidden nature of HIV prevalence, examples of stigma and discrimination are easy to find. "Communities see people living with HIV as dead people," says Ines Lopes, Executive Director of Progressio partner Estrela+. "If they know someone has HIV, they will think bad things," she explains.
Many people living with HIV find themselves subject to abuse and ostracism; some are even chased out of their homes. Added to this, Ines tells me, is the general suspicion of antiretroviral (ARV) treatments used to manage HIV. Given that the medication is not recognised by traditional medicinal knowledge, there is significant mistrust for doctors recommending such vital drugs. As a consequence, a number of HIV and AIDS related deaths have been attributed to these attitudes.
Amongst the most ostracised and at risk groups are sex workers and men who have sex with men. Fundasaun Timor Hari'i (FTH) implements work directed at these specific target groups. Programme Coordinator Apricio de Oliveira explained that it is often best to reach these groups through peers who are trained to provide key information on prevention of HIV infection and access to support services.
"We found it really effective [to recruit peer volunteers] from these two groups because they know each other better than us and they can disseminate the information to others more effectively than staff. The information that we give them is how to prevent HIV and AIDS; we build their knowledge on HIV and AIDS and we encourage them to use a condom with their partners because they are groups that have a risk because they have a lot of sex partners."
Peer educators also encourage sex workers and men who have sex with men to visit dedicated drop-in centres located in Dili and a number of outlying districts. These centres offer the opportunity for clients to receive counselling and testing services. Apricio tells me that attendance at the centres is improving - "they come for the services and some come to visit every day."
World AIDS Day 2012
Though the work of Progressio partners NAC, Estrela+ and FTH is on-going all year round, the opportunity to reach even further into Timorese society and address key issues on World AIDS Day was not to be missed.
At the NAC, plans were in place to address stigma and discrimination through joint activities with the Ministry of Health. "We will invite all the students from schools and disseminate information to them regarding HIV and AIDS through a competition," Atanasio explains. Pupils will make posters with relevant slogans relating to key messages concerning people living with HIV and AIDS. "The objective that we will reach through this competition is that stigma and discrimination is a bad thing."
Elsewhere, FTH were preparing an event for their key target groups to address HIV and AIDS knowledge as well as stigma and discrimination against sex workers and men who have sex with men. "We will be doing a concert that can deliver a message on this issue in all five districts," Apricio tells me. "Every year we always do this and a lot of people come and participate."
Wishing for the future
When I asked some of our partners and development workers what they hoped to achieve on World AIDS Day this year, their first concern was always for a good turn-out at planned events. But Apricio went a step further with a wish that resonates. "We hope that all the entities in this country support this (HIV and AIDS) programme because it does not only belong to FTH as an organisation to do all activities regarding prevention, but it is a responsibility for all in the country."
Support for organisations such as our Timorese partners in the fight to eradicate HIV and AIDS as well as address key issues of stigma and discrimination is vital in order for real progress to be achieved.
With thanks to Alfonso for his translation assistance.
Isabel Gammie is Progressio's Programmes Officer.
Photo: Progressio development worker Benedict Mukamba (left) - supporting FTH - and Apricio de Oliveira, Programme Coordinator at FTH (right)