Programs

All FHI activities in East Timor are based on the evidence of four important pieces of research. This allows precise targeting of activities designed to impact different parts of society.

FHI supported the East Timor Study Group to undertake a qualitative assessment of the response of so cial and political institutions to HIV/AIDS in East Timor. The study considered the status of HIV/AIDS policy, perception, resources and factors that support or hinder HIV/AIDS programming in East Timor and found important weaknesses. One key result was the late 2003 inauguration of the National AIDS Council, designed to champion the needs of AIDS programmers.

Formative research was completed, mapping the communities considered to be at highest risk—men who have sex with men (MSM) and sex workers (SW). The study replaced supposition about these two marginalized groups with facts about the size of the communities, their meeting places, social and sexual behavior and issues. Long–distance bus drivers, truck drivers, taxi drivers and two battalions of the military were also investigated. Of these groups the first two were found to have relatively little risk behavior.

A significant biological and behavioral study provides the first reliable data on the behavior of risk groups in East Timor—MSM, SW, the military, students and taxi drivers, in the capital, Dili. This study showed significant levels of unprotected, non–marital sex, and high levels of sexually transmitted infection among SW and MSM. It points clearly to the need for carefully targeted HIV prevention services, including screening and treatment for STIs in high risk communities.

Formative research is used to design behavior change communications targeting different communities. Before production, communication pieces—brochures, posters, radio and TV messages—are tested with members of the target community and revised and retested.

Three Prevention Strategies Used in East Timor

HIV prevalence in East Timor is still concentrated among people with clearly identified risk behaviors. The most urgent activities are designed to prevent the further spread of HIV within these groups and to a wider population.

FHI has designed three prevention modules:

• Abstinence: FHI encourages abstinence as a very secure means of avoiding HIV and STI; this is particularly appreciated in a conservative Catholic country.
• Being Faithful: Equally, FHI supports the work of the church and other groups in promoting fidelity within marriage as a safe way of avoiding HIV and STI. Again, this is highly valued in East Timor.
• Condoms: When abstinence or being faithful are not being practiced, people are at risk. Accordingly, FHI provides them with information about their exposure to risk and with the means to protect themselves by using condoms with all non–marital partners.

FHI Works Effectively with Topical Strategies

Behavior Change Communications Strategy: FHI has introduced a comprehensive Behavior Change Communications strategy which helps to guide the development, implementation and monitoring of communication interventions targeting high risk groups. FHI uses the strategy—combined with the evidence of quality research—to impact different communities with carefully targeted communications designed to encourage safe behavior.

Voluntary Counseling and Testing: FHI has provided voluntary counseling and testing (VCT) training to several clinics, including the private sector, the public sector and the military. VCT for HIV is acknowledged within the international arena to be an effective and pivotal strategy for both prevention and care in HIV/AIDS.

Effective BCC creates demand for VCT (people want to know if they are infected with HIV). Those who test negative have a powerful incentive to modify their behavior, particularly with good counseling. For those who test positive, VCT represents an important entry point for care and support.

Care and Support: As the epidemic progresses, there is increasing need for treatment and care of people living with HIV/AIDS and STI. FHI has strongly promoted the development of policy and systems advice and commends the work of MoH and WHO in policy development.

Treatment and Care Services: In 2003, FHI with WHO provided training in the management of STIs to around two hundred health workers. FHI is procuring antiretroviral drugs to care for people living with HIV /AIDS. FHI intends to establish services where quality STI management and voluntary testing and counseling are available. The services will be referred to in behavior change communications (so people know where to go). Health practitioners, too, will know they can refer clients to a reliable service which is supported by good diagnostic facilities and systems.