PUBLIC HEALTH

Basing policy on evidence: low HIV, STIs, and risk behaviour in Dili, East Timor argue for more focused interventions

E Pisani¹, H Purnomo³, A Sutrisna³, A Asy², M Zaw³, C Tilman², H Bull³ and G Neilsen¹

¹ Family Health International, Asia Regional Office, Bangkok, Thailand
² Ministry of Health, Republic of East Timor
³ Family Health International, East Timor Country Office, Dili, East Timor

Correspondence to:
Correspondence to:
Elizabeth Pisani
London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; pisani{at}ternyata.org

Background: East Timor is a newly independent, poor nation with many internally displaced people and foreign peace keeping forces. Similarities with Cambodia, which now has Asia’s worst HIV epidemic, caused donors to earmark money for HIV prevention in East Timor, but no data were available to plan appropriate programmes.

Objectives: To determine levels of infection with HIV and other sexually transmitted infections (STIs) and associated risk behaviours in Dili, East Timor, in order to guide resource allocation and appropriate prevention and care strategies.

Methods: In mid-2003, a cross sectional survey of female sex workers, men who have sex with men (MSM), taxi drivers, and soldiers was conducted. Participants provided biological specimens and all answered structured questionnaires.

Results: HIV prevalence was 3% among female sex workers (3/100), 0.9% among MSM (1/110), and zero in the other groups. All the HIV infected sex workers reported sex with foreign clients. Partner turnover reported by all groups was among the lowest in Asia, so was condom use. Access to basic HIV prevention services, including condoms and STI services, was extremely low in all groups.

Conclusions: A few sex workers are infected with HIV in East Timor, but the virus is not circulating widely among their clients, and sexual networking is limited. The risk of a generalised HIV epidemic in East Timor is minimal. HIV can be contained by the provision of basic services to the small minority of the population at highest risk, preserving resources for other health and development needs.

Abbreviations: EIA, enzyme immunoassay; MSM, men who have sex with men; PCR, polymerase chain reaction; RPR, rapid plasma regain; SEALS, South Eastern Area Laboratory Services; STI, sexually transmitted infections; TPHA, Treponema pallidum haemagglutination assay

Keywords: HIV seroprevalence; sexual behaviour; homosexual; prostitution; Asia

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