MDG Six in Timor-Leste

Goal Six: Combat HIV/AIDS, Malaria & Other Diseases

Target 1: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Scorecard for Timor-Leste: Insufficient data/information
Target 2: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
Scorecard for Timor-Leste: Insufficient data/information
Timor-Leste is currently experiencing a low level HIV epidemic. Prevalence was less than one per cent in both the 2004 and 2007 studies conducted by WHO. There is also evidence of a low level epidemic in that the total number of HIV case detections so far in the country is less than two hundred. Health workers and community workers in Dili have noted that there are a few women widowed by AIDS and children orphaned by AIDS. Mother to child transmission of the virus has also been noted and children have died of HIV disease. These findings indicate that HIV has been present in the country for up to ten years. However, low HIV prevalence at present does not indicate that there is low HIV vulnerability. There are clear indications that Timor-Leste has many of the factors that increase vulnerability to HIV. Poverty and limited opportunities for income from employment, especially for women, push people into high-risk behaviour. This includes both commercial sex and transactional sex. Low levels of literacy make social mobilization and HIV prevention education more challenging. Although it has other impacts on the epidemic, gender inequality increases both the supply and demand for commercial sex. Timorese women are driven to sex work by poverty and Timorese men have disposable income to purchase sex. Timor-Leste is reported to have extremely high levels of gender based violence. Sexual violence and gender-based violence undermine women’s ability to negotiated safe sex. There are anecdotal reports that trafficking of women into exploitative sexual situations occurs within Timor-Leste. There have also been unconfirmed reports of women trafficked to and from the country.
Prevalence of malaria in the country as well as the number of deaths associated with the disease was 10.7% in 2007. Urban dwellers are better equipped to prevent malaria than their rural counterparts where there is high risk of malaria incidence. Nevertheless, the proportion of people sleeping in insecticide-treated bed nets is still a matter of concern. Only about one fifth of urban population use treated mosquito nets. This situation had not improved much since 2001. Unless new malaria treatment strategies are effective and the population is fully covered, the target of 45% by 2010 and 60% in 2015 could be difficult to achieve.
Global Tuberculosis Control as the provider of such indicator estimated an increasing trend during 2005-2006. The prevalence rate was 713 cases per 100,000 people in 2005 and increased to 789 cases in 2006. Reports also indicate the number of deaths associated with tuberculosis up to 88 per 100,000 people in 2005 and hiked up to 98 cases in 2006. The government has targeted that this figure should be reduced to 874 in 2010 and, further, decreased to 644 in 2015. Aside from number of cases detected, decreasing trend was occurred in the proportion cured cases as well.
Timor-Leste has 56 reported cases of HIV/AIDS. The Government of Timor-Leste has adopted international procedures on HIV/AIDS such as international precautions, PEP, Mother to child transmission, GIPA etc. Given its global mandate of mainstreaming HIV/AIDS in development work, UNDP Timor-Leste has supported setting up of the National AIDS Commission (NAC) in 2006 and continues to assist strengthening NAC secretariat. NAC is composed of 22 members including National NGOs, National Parliament, Ministry of Health, Ministry of Justice, Ministry of Social Solidarity, Faith Based Organizations, clinical services, National Hospital, UNTG and CCM.
Malaria: Timor Leste developed a comprehensive response to reduce the burden of malaria through mobilizing resources, development and implementation of effective strategies. Malaria diagnosis and treatment has been improved and ITN distributed targeted for children under 5 and pregnant women in very high risk areas. Timor Leste is moving towards a wide scale and comprehensive malaria control programme to reduce the morbidity and mortality of malaria. The support of funding from GFATM (Global Fund for AIDS, Malaria and TB) will enable Ministry of Health to further enhance and accelerate the implementation of HIV/AIDS, malaria and TB programme in Timor Leste.
Tuberculosis: Timor-Leste has adopted the DOTS strategy for the control of TB in line with the global recommendations. Presently, the entire population of the country in the 13 districts have access to DOTS services. Sputum microscopy services are provided through a network of laboratories in the 18 DOTS centers. Treatment services have been integrated within the general health system and decentralized to Community Health Centers and other peripheral health facilities. The National TB Programme has been consistently achieving treatment success rates of about 80% among new sputum positive cases. The case detection rates based on earlier estimates of incidence of TB estimates have been low compared to the global targets. However, the proportion of case detection will be closer to the global targets following the revision of estimates of incidence of NSP cases by international experts and agencies. To mitigate constraints in implementation of TB control activities the NTP is mobilizing additional resources through Global Fund and other partners.
HIV/AIDS: The prevalence of HIV/AIDS in Timor-Leste is presently low. However, presence of risk factors like high levels of STIs, low community awareness, social dislocation and rapid social change have the potential to rapidly change the scenario. HIV has been accorded priority in the Health Sector Strategic Plan 2008 – 2012 developed by the Ministry of Health. The National HIV/AIDS and STI Strategic Plan for 2006 – 2010 focuses on prevention and education; voluntary counseling and testing; multi-sectoral response; and clinical services. The National Programme has initiated interventions on community awareness generation, role out of VCT services, targeted interventions among the most at risk groups in collaboration with civil society partners and STI services with fund support from Global Fund. KADALAK0003