Dili: In January 2023, the World Health Organization, in collaboration with the Ministry of Health and Asosiasaun Komunidade Progresiva—a non-profit working with key population (KP) groups—implemented pilot projects for HIV Self-Testing and Pre-exposure Prophylaxis (PrEP) medication. So far, nearly 1000 HIV self-tests have been made available, and more than 200 KP individuals have begun PrEP in Timor-Leste's capital, Dili.
Although Timor-Leste experiences a low-level HIV epidemic, an increasing number of new cases are being identified among the general population attending antenatal clinics, STI clinics, and among patients with tuberculosis. A joint TB-HIV external review mission observed that over the last two years, half of the newly detected cases were among people in Key Population (KP) groups, including female sex workers (FSWs), men who have sex with men (MSM), transgender persons (TG), as well as clients and partners of FSWs. This indicates a significant role of KP groups in HIV transmission and spread.
These pilot projects serve a crucial role in supporting the implementation of a combined HIV prevention approach, which involves the simultaneous implementation of multiple interventions targeting the most affected populations.
Since their inception, the pilot projects have been well received by KP groups, sparking a demand for a consistent rollout of self-tests and PrEP through the government.
"I hope the Ministry of Health makes the self-test available to us every three months," said Jeremy*, a 32-year-old peer educator who took the test in February 2023. "I also had my partner take the self-test in April 2023," he added.
HIV self-testing involves individuals collecting their own specimen by swabbing the gums and using a rapid test kit to obtain results in about 20 minutes. This self-testing allows individuals to perform the test in the comfort and privacy of their homes. However, for the Timor-Leste pilot study, participants conduct the self-test under the observation of medical personnel in a designated drop-in center. Beneficiaries receive comprehensive pre-test and post-test counseling. In case of a positive result, they are directed for a confirmatory test at the nearest government healthcare facility.
"The counseling was extremely helpful, and the drop-in center felt safe for the test," Jeremy shared, highlighting the comfort of this non-invasive test.
The uptake of PrEP medication through the pilot project has also been encouraging. PrEP is an HIV medication that, when used consistently, reduces the risk of HIV infection during sex by over 90%. It's prescribed to people who do not have HIV but are at risk of exposure through sexual activity or injection drug use.
"Being on PrEP has given me a sense of safety and security," said 51-year-old Nina*, a transgender individual on the medication since February 2023 under the pilot project.
Nina admitted to irregular condom use during sexual encounters despite being aware of the risks. "Access to condoms is an issue due to stigma and cost," Nina explained, noting that free condoms are distributed by the association of KPs only in five out of the 13 municipalities in Timor-Leste. "In other areas, people have to pay around $2 for a pack of three condoms, which not everyone can afford."
Timor-Leste remains one of the world's poorest countries, with nearly 42% of the population living below the national poverty line. In 2022, almost 14% of the employed population had purchasing power parity below $1.90 a day.
Dr. Arvind Mathur, WHO Representative to Timor-Leste, stated that the pilot projects for HIV self-testing and PrEP will pave the way for wider implementation of these interventions among the Timorese population. "Both HIV self-testing and PrEP play a crucial role in HIV prevention among populations, and WHO is committed to supporting the Ministry of Health in expanding access," Dr. Mathur added.
*Names of the beneficiaries have been changed.