Heavy Toll For A Small Country

The first HIV/AIDS case in Kiribati was detected in 1991. Since then, the total number of people confirmed with HIV or AIDS has risen to 42, the majority of whom are men. The Ministry of Health reports that 19 people with the virus have died, while unofficial reports say that two more died in May, including a primary school student.

Kiribati seamen working on ships abroad and their wives top the list of diagnosed HIV-positive people, but there are also cases of overseas students, officials going abroad on official duties for training and workshops, and people visiting their friends outside and then returning home with the virus.

HIV transmission in Kiribati, like many developing countries, is principally heterosexual. Despite an active public awareness campaign by the government, the primary challenge remains getting people to change risky behavior that is spreading the virus in Kiribati through sexual contact.

Dr. Kabwea Tiban, the Ministry of Health's consultant for HIV/AIDS, says the high rate of HIV infection poses numerous challenges for Kiribati.

Although people in advanced stages of AIDS require expensive medicine, Kiribati has many other health priorities demanding priority funding and action. On a per-capita basis, the number of confirmed cases is high, but the small numbers in real terms means there is little sympathy from the public and government.

"We know from the little data that we have that the virus is spreading in the community and that the number we have is only the 'tip of the ice-berg,'" says Tiban.

The fact that children are growing up infected with the virus has brought a new dimension to the prevention work-that of treatment and the issue of anti-retroviral treatments.

Kabwea also worries that Kiribati could follow a similar fate of the African Sub-Sahara area and other parts of the world where HIV/AIDS was left too late to combat and it has spiraled out of control. "We don't want that to happen in Kiribati," he says. "We must act now."

Such a scenario would be devastating for a country like Kiribati with a population of just 80,000, Kabwea says. Yet one of the primary sources of transmission-through seamen working abroad-is difficult to counter because of the big economic incentive that attracts I-Kiribati to work on ships. Kiribati seamen sent home more than A$2 million annually as remittances to their families, and that figure could rise as the total number of I-Kiribati seamen working on foreign ships exceeds 1,700.

Nearly 100 new graduates are produced annually by the Marine Training Center and the Fishery Training Center. Families whose sons are seamen can be easily noticed not only on South Tarawa but the outer islands as well for their relative economic prosperity. They have concrete block houses, televisions and motorbikes, and operate shops and other businesses.

The Ministry of Health in collaboration with the National HIV/AIDS/TB Task Force is concentrating on prevention. A mass public awareness program is using the media, and through funds available from the Global Fund, new anti-retroviral drugs are being used for treatment to prolong lifespan.