FHI East Timor HIV-AIDS Support Project
HIV/AIDS and Sexually Transmitted Infections in East Timor
In East-Timor, before September 1999, there was no proper surveillance system and laboratory facilities for HIV testing. In the absence of these facilities, it is difficult to retrospectively conclude as to when the infection was introduced in East Timor. High incidence of sexually transmitted infections (STI) such as gonococcal infection and syphilis cases among East-Timor population were reported during 1996-1998 (East Timor Health Profiles published during 1996-1999 by the Indonesian health authorities). Prevalence of high rates of STI during the period would possibly enhance the risk for spread of HIV infection among East-Timor population. Trends could be similar to other parts of Indonesia. No official data is available about screening for HIV infection and AIDS cases in East Timor. However, pre-independence Indonesian data reported at least one suspected death in East Timor due to AIDS. With the establishment of an epidemiological surveillance system by WHO in East Timor, the reports received from different clinics from all the districts indicated STI are not uncommon among sexually active age group.
Since September 1999, East-Timor receives properly screened blood supplies from Australia to meet its requirements. At the same time, to meet emergency requirements for blood supply, “replacement donors” are being used. Persons who donate under this scheme, prior to acceptance of blood donation, are screened for HIV and Hepatitis-B Virus (HBV) using rapid tests. Available data from Baucau and Dili Central Hospitals indicated that since February 2000, 531 blood donors were screened for HIV infection. Of those screened, five males and two females in the age group of 26-35 and 18-35 respectively, were found to be positive for HIV infection. High incidence of STI before the crisis period and rumour about one suspected death in East Timor due to AIDS, gives indirect evidence that HIV infection existed in East Timor before the 1999 crisis.
In East Timor today factors are present which can contribute to an epidemic developing. This includes, the disruption to society which occurred in 1999, a lack of information as to what constitutes risky sexual behaviour and on sexually transmitted infections, low level of HIV/AIDS/STI awareness, poverty, and large groups of young men and women who are unemployed/not in school or involved in other rehabilitation activities.
Presence of large number of young, predominantly male expatriates and their possible sexual interaction in the territory may also attribute to the increased risk for HIV transmission.
Realizing the urgent need for initiating timely steps to prevent the spread of infection in East Timor, the Division of Health Services, together with WHO, UNICEF, UNFPA, UNDP (core group of UNAIDS), has evolved prevention and control measures focussing on health education, dissemination of information, promotion of safe sexual behaviour among the population, counselling HIV positive persons, establishment of facilities for early identification and treatment of STI and provision of safe blood transfusion services.
An Interagency HIV/AIDS/STI Mission to East Timor was undertaken during 12-24 November 2000. The Mission consisted of representatives from UNICEF, WHO, UNFPA, Family Health International, USAID and UNAIDS. The work programme of each UN Agency was clearly identified. Under the responsibility of WHO, strengthening of HIV surveillance, support for the establishment of safe blood transfusion services, laboratory diagnosis for HIV/STI, training for treatment and establishment of other curative services for STI have been identified. As a follow-up, WHO is in the process of recruitment of experts in the field of STI Syndromic Management, HIV Testing Policies and Guidelines and HIV/AIDS Prevention and Control.