In 2003, the first case of HIV was reported in Timor-Leste (commonly known as East Timor). As of 2009, there were 151 cumulative reported cases of HIV, among who were 71 females, 80 males and 14 children [1]. Also as of 2009, 20 deaths due to AIDS had been reported [1]. Almost all those known to be living with HIV reside in urban areas, predominantly in Dili [1]. Although HIV prevalence in Timor-Leste is very low, estimated to be less than 0.1% among adults aged 15-49 in 2008 [2], inadequate testing and insufficient research would likely mean that more people are infected than what is indicated in the current epidemiological data.
Family Health International (FHI), based on data collected in mid-2003, estimated the HIV prevalence as 3% among female sex workers (FSWs), 0.9% among men who have sex with men (MSM) and 0% among uniformed personnel and taxi drivers [3]. No comparable data on HIV prevalence among these groups have since been collected, making the current situation unclear. A Behavioural Surveillance Study (BSS) done in 2009 among these groups pointed to vulnerability factors and risk behaviours as making the key populations at higher risk [4].
The population size of FSWs in Dili was estimated to be about 120 in 2004 [5] and 250 in 2008 [6]. In addition to finding an HIV prevalence of 3% among FSWs in Dili in 2004, the FHI study – albeit including a relatively small sample size of 100 – found STI prevalence to be high among those sampled. Specifically, prevalence of each of gonorrhoea, chlamydia, syphilis/yaws and trichomonas ranged between 14%-16%, while the prevalence of herpes simplex (HSV-2) was 60% [3].
In 2008, 267 MSM were identified among MSM communities in Dili [6]. However, there is no estimate of the MSM population size. Similar to what was observed among FSWs, the 2004 FHI survey found very high prevalence of STIs among MSM (n=110) in Dili [3]. Fourteen per cent of MSM had gonorrhoea, 15% had chlamydia, 13% had syphilis and 29% had HSV-2. The HIV prevalence was 0.9% among this group.
Among the vulnerability factors include: a weak and limited health system [7]; low levels of knowledge about sexually transmitted infections in general and HIV in particular [8]; poor access to information about HIV and AIDS as most people live in rural areas particularly in small, dispersed villages [9]; limited condom availability and very low level of condom use among key populations at higher risk[8]; high levels of STIs [8]; endemic poverty and lack of livelihood opportunities in rural areas that continue to prompt rural-urban migration movement and mobility [8] thereby constituting a risk for higher rates of domestic violence and sexual assault [7]; and extremely high levels of gender based violence which undermines women’s ability to negotiate safer sex [1]. Furthermore, Timor-Leste being a post-conflict country and prone to internal violence, many people [around 50,000 and 100,000] have been displaced although an estimated 200,000 Timorese already had returned to their villages and communities after around a quarter (250,000) of the population fled to neighbouring West Timor in 1999 [10].
Sources:
[1] National AIDS Programme Timor-Leste. (2010). UNGASS Country Progress Report: Timor Leste
[2] WHO (2009). HIV and AIDS in the South East Asia Region
[3] Pisani E., and Dili Survey Team (2004). HIV, STIs and Risk Behavior in East Timor: An Historic Opportunity for Effective Action, Family Health International, 2004
[4] Timor-Leste, Behavioral Surveillance Study (BSS), 2009
[5] Kaldor, J., Worth, H., Henderson, K., et al. (2006). Impacts of HIV/AIDS 2005–2025 in Papua New Guinea, Indonesia andEast Timor: Final Report of HIV Epidemiological Modelling and Impact Study
[6] Lee, J., Rawstorne, P., & Worth, H. (2008). Behavioural Surveillance Survey and Capacity Development in Timor-Leste Mapping Exercise. Sydney: National Centre in HIV Social Research. University of New South Wales
[7] USAID, HIV/AIDS Health Profile (Timor-Leste). September, 2008. Available online.
[8] Earnest, J. & Finger, R (2006). Migration patterns survey and HIV Vulnerability assessment mapping in selected Districts of Timor-Leste, Centre for International Health Curtin University of Technology, Western Australia,
[9] National Statistic Directorate Census 2004, as cited by USAID, HIV/AIDS Health Profile (Timor-Leste). September, 2008. Available online.
[10] International Crisis Group (2011). Timor-Leste: Reconciliation and Return from Indonesia, Crisis Group Asia Briefing
