We changed the picture on this article at the request of the Bairo Pite clinic. The original picture was first published in the United Nations media library.
More than a decade after its war of independence, Timor-Leste must ready itself for a new fight – against HIV. The government and the Catholic church are working to tackle the problem, but socioeconomic challenges are holding back progress.
By Victoria Wah
People in many countries are celebrating the fact that HIV is no longer a death sentence. But for nations who are barely hanging on, like Timor-Leste, people living with HIV suffer a punishment worse than death.
Following its independence, the country’s Catholic Church led a campaign to dismantle commercial sex districts. However, this only forced the sex industry to go underground and resulted in the proliferation of HIV cases. In fact, the number of cases reported has soared from less than 10 cases per year between 2003 and 2005 to a shocking seven-times higher figure from 2012 to 2014.
Among the thousands of underground sex workers are HIV-positive university students, says Christina Wolla. She is a nun caring for people living with the condition and says these young people will go to school during the day and sell sex at night – pushed into doing so by economic factors. Clients of these students will then go home to their wives and increase the chances of transmission among unsuspecting families.
Challenges in the system
But this is not an easy problem to manage. The nation’s weak infrastructures mean that 50% of the population live below the poverty line; many people become sex workers as their only avenue for income. Timor-Leste also has one of the lowest adult literacy rates in the world – 50% of her citizens cannot read and write – making opportunities to share information on avoiding HIV difficult.
Meanwhile, HIV is not Timor-Leste’s only public health challenge. A positive diagnosis can accelerate the progress of other serious infections, some of which cause cancer and can be fatal. And where there is a prevalence of tuberculosis cases in Timor-Leste, HIV accelerates its progress. As such, Dr Dan Murphy, a prominent doctor in Bairo Pite Clinic of Dili, warns that HIV is the number one health concern for the country. He explains, “Having HIV makes active tuberculosis ten times more likely.”
The government responded with an action plan called the National HIV/AIDS Strategic Plan in 2011. This roadmap seeks to reduce HIV and AIDS mortality in East Timor by widening access to identification and treatment services for the public. However, most people that know their diagnosis avoid or delay seeking help.
This is because having HIV in Timor-Leste carries with it a social stigma so infected individuals are stereotyped as having poor morals. This not only deters people from taking a test in the first place, but many innocent victims, like wives and children of those infected, find it hard to seek help. And so the chain continues down each generation. This delay or reluctance hinders the program’s effectiveness and prevents a decrease in the infection rate.
A lack of data
Furthermore, the government’s collection of inaccurately low HIV statistics has pacified the international community into believing the country’s epidemic is under control. This means that international efforts to combat this deadly disease have stagnated. In fact, not too long ago, the government and the World Health Organisation reported HIV prevalence as low as 0.2%. However, this is grossly inaccurate as it only focuses on high-risk groups, without a comprehensive national survey.
Furthermore, the country’s strong Catholic roots mean there is an unspoken yet widely eschewed custom of condemning the use of birth control. To tackle this, the Ministry of Health has engaged faith-based leaders who now say that birth control is not inherently evil, and can be used to prevent HIV transmission. This has not been widely accepted by the public yet.
Father Sebastian Gaguk, the rector of St Francis Assisi College in Timor-Leste, says that the church has been diligently providing sex education and HIV counselling through its vast network of Catholic schools. However, the problem was that this has not been effective due to a reluctance in accepting liberal beliefs. As a result, the statistics on increased contraception use are not encouraging.
As a general overview, national efforts to alleviate the rise of HIV and AIDS will always be limited if the government and community are only partially receptive. As such, it is hard to foresee a fall in the number of cases, or an increase in people seeking prevention or treatment. East Timor is a ticking AIDS time bomb.