Time-Bomb In The Atoll

Hers was a lonely, forlorn death. Abandoned by her family and friends, the young woman was neglected with no single relative visiting her in hospital.

The ostracism didn't end even at her death. No-one came to claim her body, so a few concerned people had to pay for a decent burial. The woman's crime?

She was HIV positive.

Though true, such tragic stories are rare in Kiribati. Yet given the high ratio of HIV positive people in proportion to its population, I-Kiribati will just have to get use to living with the pandemic.

Forty-two people is the official number of HIV positive cases in Kiribati.

That is going to change soon, according to the head of the HIV programme at the Ministry of Health in Tarawa and the leading advocate in the fight against the disease in the island republic, Dr Kabwea Tiban.

He said more positive results have been obtained. But any announcement will await the receipt of verifications from Australia.

In the global context, a two-digit figure of people living with HIV is way too small to be concerned about. That is wrong and it is exactly this type of silly notions that Tiban and his team are struggling to fight.

"Yes, the number is still small when we compare that with figures seen in other parts of the world. But in the region, the figure places us in the top five countries with the highest burden per population," Tiban explains.

"If we remove Guam, New Caledonia and French Polynesia whose epidemic is different from that list, then it pushes us even nearer to the top, just after Tuvalu.

"In the region, while our figures are still in the double digit, we have a relatively higher burden (based on population) than even some of the other bigger countries." The very fact that Kiribati is still in the double-digit range ought to be the very reason why resources must be deployed now to fight the pandemic. It will require so much less than if left for another day because as the experience of other bigger countries in Africa and Asia has shown, the AIDS crisis will get worse not better.

Is the government getting the message? Tiban does thinks so. "I have the confidence that they do understand the enormous economic and developmental fallouts if we as a country decide to wait for the numbers to increase before we act!" But understanding and acting are two entirely different things. Kiribati is no different from other islands of the Pacific who say they appreciate the enormity of the crisis but won't allocate a specific budget for it.

The doctor believes that the day such a vote is given will be "another bold step forward" for Kiribati. This is not to say that nothing has been done at all by the national government. Kiribati, according to Tiban endorsed the UN General Assembly special session on HIV/AIDS in 2001 and reiterated its support at the Pacific Islands Forum Summit in Auckland in 2003.

"Here in Kiribati, they have issued a communiqué committing their support to HIV work in Kiribati.

"In August this year, our leaders again will meet and one of the documents they will discuss and propose to be endorsed is the Regional Strategy on HIV/AIDS.

"It is a document they (Pacific leaders) had requested during the last Forum meeting to be prepared for them. We in Kiribati as well as our colleagues all over the islands and the people living with the virus are confident they will support and endorse it wholeheartedly." There is, of course, a strain in the on-going HIV/AIDS debate about the need to allocate money to the disease given that resources are already scarce as they usually are in the Pacific.

"HIV is a developmental and economic issue. The small number is not a reason to withhold or commit resources. There is every indication that the small numbers can result in a greater transmission. We have a young population, a very sexually active population, the number of sexually transmitted infections is increasing every year and alcohol use as well as the use of cheaper forms of alcohol are readily available through numerous outlets (many illegal!) and the virus is already present.

"Many of the countries experiencing devastating epidemics now were once having Œlow and insignificant' numbers compared to other health priorities and they therefore did not see any need for allocation of support to their HIV work.

"Look at where they are now. We in the Pacific do not want to go down that path.

"It will be cheaper for our governments to dedicate funds to HIV work rather than to wait for the numbers to increase before they become convinced about it." Already working since its formation in the mid-1990s is a 30-member taskforce on HIV/AIDS in Kiribati that takes the lead in raising awareness.

Tiban said the taskforce was an intentional departure from the traditional "have all-know all" role of the Health Ministry.

"When the taskforce was created, it placed the HIV question back into the community. It emphasises the fact that it is a community problem, therefore the community (all sectors including government ministries) must work together to identify the issues and come up with solutions.

"The Ministry plays an important supportive role to the whole process." Represented in the taskforce are mainstream churches like the Roman Catholic and the Kiribati Protestant, non-governmental bodies like Foundation of the Peoples of the South Pacific, Red Cross, Kiribati Family Health Association, Kiribati Associations of NGOs, Boys Scouts, Te Itibwerere Drama Group, Kiribati United Youth, Kiribati Trade Union Congress, Kiribati Islands Overseas Seafarers Union, Ministry of Education Youth & Sports, Broadcasting & Publications Authority, Ministry of Health & Medical Services, specifically its TB and HIV Desks, Ministry of Finance & Economic Planning, Aia Maea Ainen Kiribati, representative of people living with HIV/AIDS (a relative), and donor agencies like AusAID and WHO.

Apart from conducting awareness programmes in the community, the taskforce also tries to provide support for people living with the virus and their families. But Tiban agrees that sad stories like the one in the introduction indicate that a lot more needs to be done.

"Discrimination at home is sad and I feel it needs more patience and sensitivity and I hope that some of our churches can initiate some community based activities that will address the need to educate the community as well as being available to assist the victims in whatever way possible.

"Discrimination occurring in government institutions can happen but should not be tolerated and we are hoping that legislation protecting the dignity and rights of PLWHA will be enshrined and such incidences prevented." Churches like KPC (Kiribati Protestant Church) are heeding that call already. In its sprawling Antemai headquarters in May, the church held a week-long workshop for 300 young people who are members of its youth fellowship in the central islands of the Gilbert group.

These are the islands of Nonouti, Kuria, Aranuka, Abemama, Maiana and those from south and north Tarawa. High on the agenda for discussions is HIV/AIDS.

Organiser and editor of the church's Mauri weekly newspaper Batiri Bataua said KPC organises similar workshops for its young members in the other atolls.

That and basic I-Kiribati's caring values can be tapped too in the fight, Tiban believes.

"Members of their families and communities having the virus can then still find a place where they can be truly at home without fear of being neglected as I have personally seen recently with a patient. They also need to work together, collaboratively wherever they are to keep each other informed and assist their young people especially as they travel the treacherous path between childhood and adulthood."