The HIV prevalence rate in Sao Tome and Principe could treble over the next five years as tourism and the development of offshore oil bring thousands of people flooding into the remote island state in the Gulf of Guinea, a prominent local AIDS campaigner has warned.
Antonio Amado Vaz, executive director of the Sao Tome Association for Family Protection (ASPF), an NGO heavily involved in the local campaign against AIDS, told a press conference last week: "Unless immediate preventative measures are taken, the number of HIV positive people in the country could treble in less than five years."
At present, the government's AIDS control programme in the twin-island state 300 km off the coast of Gabon is floundering.
Amado Vaz, a Cuban-trained doctor, quit as director of the government's National Programme to Fight Aids (PNLS) in December in protest at bureaucratic wrangling that is holding up the disbursement of a World Bank grant to help fight AIDS in the country.
He protested last week that although Brazil had provided antiretroviral (ARV) drugs last January to treat 100 people living with AIDS free of charge at a special clinic in Sao Tome's main hospital, poor organisation meant that fewer than 30 patients were so far receiving these medicines, which can improve the health of people living with AIDS and prolong their life.
Although the HIV prevalence rate is Sao Tome is officially estimated at a modest one percent, Amado Vaz said recent evidence suggested it was much higher.
He said there were 159 officially registered cases of HIV/AIDS on Sao Tome island, with none so far declared on its small sister island of Principe, 150 km to the north.
But Amado Vaz said it was likely that between 3,000 and 6,000 people in Sao Tome and Principe were HIV positive.
That would represent between two and four percent of the islands' 140,000 population.
STRONG DEMAND FOR FREE VOLUNTARY TESTING
Recent AIDS testing, however, indicates a lower HIV infection rate of less than two percent.
Amado Vaz said that between 400 and 500 people per month were voluntarily tested for HIV free of charge at the main hospital in Sao Tome city, the capital of this former Portuguese colony. Of these, between 1.8 and 1.9 percent tested HIV positive, he added.
Many of these were young couples who were planning to marry, Amado Vaz said.
Charles Lehembre, the Resident Representative of the United Nations Development Programme (UNDP) in Sao Tome, meanwhile told PlusNews that a sentinel survey of pregnant women who underwent voluntary testing at antenatal clinics earlier this year, showed an HIV prevalence rate of 1.5 percent.
But whatever the real figure, Amado Vaz and the United Nations are concerned that infection rates will climb rapidly with a rising influx of foreign visitors.
Echoing a similar concern, the United Nations Children's Fund (UNICEF) said in a report issued last year; "A sharp increase in the prevalence of HIV infections is expected for the next few years when it may reach five percent of the general population."
TOURISTS AND OILMEN
Tourists are increasingly attracted to Sao Tome by big game fishing in the islands' well-stocked coastal waters, a handful of exclusive beach resorts and the unspoilt scenery and endemic bird life of the island's volcanic mountains, which are covered in tropical forest.
But there are concerns that some of those arriving on flights from Portugal and South Africa are simply attracted by the easy attitude to sex in Sao Tome and Principe, where polygamy is a way of life and many men have multiple sexual partners.
A Portuguese paedophile was jailed in Sao Tome last year and there are fears that many other visitors to the country are also attracted to the country by the prospect of easy sex with children.
At present, Sao Tome is linked to Europe by two flights a week to Lisbon and a weekly charter to Johannesburg.
But as more hotels spring up on the country's pristine beaches fringed with coco palms, Amado Vaz fears that the present trickle of a few dozen tourists each week could soon rise to several hundred, increasing the island's exposure to sexually transmitted infections.
He is also concerned about an imminent invasion of Sao Tome by oilmen drilling the deep offshore waters of the Joint Development Zone shared with Nigeria.
"The country is not prepared for this in any way whatsoever," he said.
The first block in the Joint Development Zone, which is widely viewed as an extension of Nigeria's prolific offshore oilfields, was awarded to a consortium led by Exxonmobil in February.
The US-based multinational plans to start drilling in 2007 and is already putting up a new office block among the Portuguese colonial style buildings that grace Sao Tome's city centre.
Meanwhile the US government is promoting plans to extend the runway of Sao Tome's small airport and build a new deep-water port on the island at an estimated cost of US $500 million - as much as Sao Tome would earn from 100 years of cocoa exports, its traditional foreign exchange earner.
So far, no-one has proven that there is a single barrel of commercially exploitable oil in the deep Atlantic waters which surround Sao Tome and Principe. But its nearest neighbours, Nigeria, Equatorial Guinea and Gabon have all found offshore oil and the optimists speak of a new Kuwait.
On the AIDS front, health workers fear that Sao Tome could suffer a similar fate to nearby Equatorial Guinea, where the HIV infection rate has soared to 7.2 percent since the country started producing oil in 1991. According to the UN World Health Organisation (WHO) the HIV infection rate in Equatorial Guinea is continuing to rise fast and will soon hit 10 percent.
Meanwhile, there are fears that rising rural poverty and a steady migration of people from Sao Tome's largely abandoned cocoa plantations to the island's capital are leading to social breakdown and an increase in sexual abuse.
A local judge told PlusNews privately that there was an alarming increase in the number of rape cases and prosecutions for incest and the sexual abuse of minors in his court.
SOCIAL STIGMA HIDES THE PROBLEM
Amado Vaz highlighted the strong social stigma attached to HIV/AIDS in Sao Tome, where no living individual has admitted to having the disease and no association of people living with AIDS has so far been formed to provide mutual support and help break the taboos surrounding the pandemic.
People living with HIV/AIDS in the country are generally rejected by the communities in which they live and are shunned by their own families, he said.
The fact that homosexuality remains illegal in Sao Tome and Principe, as in many other African countries, does not help efforts to control the spread of AIDS either, the head of ASPF added, since gay sex existed, but had simply been driven underground.
Meanwhile, the AIDS clinic at the Ayres Menezes hospital in Sao Tome, supported by the French medical charity Medecins du Monde, provides free HIV testing for all, the treatment of opportunistic infections associated with AIDS and free ARV treatment for the lucky few.
And ASPF tries to spread the AIDS awareness message through a network of volunteer activists in the country's towns and villages, distributing free condoms as it does so.
Nevertheless ignorance of AIDS remains dangerously widespread in the sexually active segment of Sao Tome's population and according to UNICEF only 30 percent of the population use any form of contraceptive.
One 18-year-old girl interviewed in the street said she was not sure how the disease was transmitted, adding that she simply used condoms with her boyfriend to avoid getting pregnant.
The first case of AIDS was confirmed in Sao Tome in 1987, but there was a sudden increase in the number of people infected with the disease in 1998, when Gabon decided to expel all 3,000 Sao Tomeans living in the country and send them home.
Gabon has a relatively high HIV infection rate of 8.1 percent.
Unusually for Africa, Amado Vaz said, more men are HIV positive in Sao Tome than women, reflecting the fact that many male emigrants were possible returning from abroad already HIV-positive.