The tiny nation of East Timor could face a deadly AIDS epidemic, with promiscuity among youths, low condom use and general ignorance leading to a steep increase in reported cases, doctors said.
"Most likely it will be a disaster in the near future," said Dr. Daniel Murphy, founder of Bairo Pite Clinic, one of four voluntary AIDS testing centres in Dili.
East Timor is considered a low prevalence country for HIV, but government statistics point to a significant increase in the number of registered cases, rising from six in 2003 to 117 in April this year -- a 20-fold leap.
The actual number of people living with HIV in East Timor, however, could be much higher as many people don?t get tested, Murphy said.
"They think they have it under control," he said, criticising complacency in the government of Prime Minister Xanana Gusmao, a former guerrilla and hero of the struggle for independence from Indonesia.
"They should be going around the country and screening everyone. The benefit of being tested is you can get to grips with the epidemic and start therapy earlier and slow the spread down."
A 2004 study compiled by Family Health International found an HIV prevalence of three percent among female sex workers in deeply Catholic East Timor and one percent among men who have sex with men.
The study found that a lot of men who had unprotected anal sex with other men also had sex with women.
But knowledge of HIV did not equate to safe sex, it found. About 40 percent of sex workers didn?t know what a condom was while none asked clients to use one.
More than 40 percent of East Timor?s population of 1.1 million are under 15 years of age. Women have, on average, eight children, while about 40 percent of men in East Timor are illiterate, and misconceptions about HIV are rife.
Of the 117 registered HIV cases, most were transmitted through heterosexual activity and the most affected demographic is 15-29-year-olds, health ministry HIV/AIDS officer Narciso Fernandes said.
"Most young people have a misconception about the transmission of HIV," he said.
In 2006, a UNAIDS-funded survey found that only seven percent of respondents had ever used a condom. Some 57 percent didn?t know how to use one and 35 percent were unaware condoms could prevent HIV.
A United Nations Children?s Fund survey of more than 1,000 youths aged 15-25 in 2007 found that although 61 percent had heard of HIV, about half thought transmission could occur through mosquito bites or sharing clothes.
Only a quarter of those surveyed knew condoms could prevent HIV.
"This is why this is happening to the young people, because they don?t get education," Fernandes said.
National Aids Commission member Francisco Jeronimo said data gathered from a loose network of organizations all over the country indicated the real rate of infection could be some 40 times higher than officially reported.
"The number of registered cases is about 120, but the estimate is in excess of 5,000," he told AFP.
"A lot of the work being done is to find those people who are being hidden from the official register to make sure we get the correct picture about the reality of the prevalence of this disease."
Kit Ming Leung, technical advisor on HIV/AIDS for the East Timor Red Cross, said the government should rethink its strategy, adopted from successful campaigns in other Asian countries, of targeting high-risk groups.
"It seems many of the HIV cases that are being presented at hospitals are mostly not from high-risk groups," she said.
"My concern is that the current response model is looking primarily at high-risk groups and missing the general population -- particularly young people."
For the people living with HIV in East Timor today, there are constant struggles. Many find themselves out of work and unable to support their families.
Maria da Costa (not her real name) is HIV-positive and part of the Esperanza (Hope) group in Dili. Formed in 2004, the group is made up of about 50 people living with HIV who met through Bairo Pite Clinic, where they go for counselling and medication.
"The important thing is for the ministry of health and clinics to spread information to all the people and go to rural areas," da Costa, 34, said.
"It even happens that nurses will spread information to the neighbours of people diagnosed with HIV. They tell them not to go close to this family and not to play with their children. They think that if they play together they will get infected."
Da Costa?s husband was diagnosed with HIV in 2003 and died last year. One of their children, a six-year-old boy, has also tested positive.
The church?s response is going to be crucial in East Timor, which is 95 percent Catholic.
Reverend Daniel Marcal works on the HIV/AIDS support programme of Church World Service, a charity formed by the National Council of Churches. He says loosened attitudes towards relationships, or "free sex", are commonplace.
"When I speak in the church, I say free sex is a sin, but I can?t guarantee all my members will have the same view as me," he said.
"In East Timor, the government doesn?t prioritise HIV. They prioritise dengue fever, tuberculosis and malaria.
"Now we are not taking the situation seriously enough to prevent it, so maybe more of the population of East Timor will soon be living with AIDS."