Timor-Leste, the world’s newest democracy, is one of the least developed countries in
the world. The violence following the 1999 referendum destroyed most of the country’s
economic and social infrastructure. The country today faces enormous challenges in the
rebuilding of infrastructure, strengthening civil administration and generating jobs for
its young people. Currently, East Timorese have a life expectancy of 57 years, a high
rate of illiteracy, poor nutritional levels, extremely high rates of infant and maternal
mortality and the highest rate of poverty and worst health indicators in Asia.
Until recently very little was known about HIV and associated risk behaviours in East
Timor-Leste. Research in 2004 showed it to be a low prevalence country. The country is
faced with a combination of vulnerability factors that include: displacement, very low
access to knowledge about sexually transmitted infections (STIs) and HIV, lack of
condom availability for STI/HIV prevention, lack of access to treatment for STIs,
cultural taboos, and high-risk behaviour among particular groups. In 2002, when the
National AIDS Strategy was developed, reliable information about the spread of
HIV/AIDS in Timor-Leste did not yet exist.
Around the world, research and experience have shown that migration and mobility
increases vulnerability to engaging in HIV-risk behaviour. In the case of Timor-Leste,
mobility is particularly relevant due to massive population movements in recent years
associated with the post-referendum conflict. During the violence of 1999, it is
estimated that approximately 250,000 people, or one quarter of the population, fled to
neighbouring West Timor. Since the cessation of violence, nearly 200,000 Timorese
have returned to their villages and communities. However, endemic poverty and lack of
opportunities in rural areas continue to contribute to rural-urban migration movement
and mobility.
The overall aim of this study was to provide baseline data on mobility patterns,
HIV/AIDS awareness and vulnerability in Timor-Leste and comprised of two parts - the
Migration Patterns Survey and Vulnerability Assessment Mapping. The objectives
of the Migration Patterns Survey were to: estimate the proportion of the local population 5
that travels elsewhere as migrants; measure the relative age, gender, socio-economic
status and education level; get a reliable estimate of where the population is migrating
to and from; identify push and pull factors for mobility and to measure basic HIVrelated
behaviour and knowledge among migrants. The objectives of the Vulnerability
Assessment Mapping were to: identify locations of support (VCT, health promotion and
education etc) and HIV-risk behaviour; identify factors that increase personal and
societal HIV vulnerability and to map mobility patterns. This research was carried out
from September to December 2005 in the six districts of Dili, Baucau, Liquica,
Bobonaro, Cova Lima and Oecussi.
As anticipated, a considerable number of high-risk locations were identified in Timor
Leste’s most populated district, Dili. A range of HIV/AIDS health and education
services were identified as being provided in Dili and some of the districts. All
workshop discussion groups acknowledged the work being done by the Ministry of
Health and Faith-based organisations to address HIV/AIDS in Timor Leste. In addition,
several different UN agencies, International and National NGOs were identified by
participants as providing valuable HIV/AIDS programs. A comprehensive list of mobile
populations and typical travel routes was prepared by participants. The key emerging
themes from personal and societal vulnerability discussions during the workshops were
poverty, education, gender roles, marriage practices, stigma and taboo regarding sex,
influence of the church, westernisation, domestic violence, the environment, the
political system and homosexuality. By examining personal and societal vulnerability,
the focus group discussions provided an insight into barriers perceived by participants
that increase vulnerability and impede access to information and general health care
services.
Analysis of the data from the survey identified that the main language spoken in most
households was Tetum. Only 65% of survey respondents had some schooling. Evidence
from this study suggests that many rural residents are travelling to urban areas in search
of employment, to study and/or to escape family problems. The additional impact of
international development agencies also increases migration and mobility, particularly
to the capital city Dili. 6
A significant proportion of respondents were still moving around, within or out of the
districts. Examining relations between demographic and socio-economic factors to
migration and mobility behaviour, the following interesting relations and trends were
found. Of all the districts, the largest proportion of migrants was enumerated in Dili.
More than half of the respondents in Dili were migrants to the capital. Overall, there
was a trend for 18-30 year olds to migrate. A trend to migrate could be found among
those who had some schooling. Pull and push factors cited as reasons for migrating
were poverty, having to support large families, and family problems.
Nearly 85% of respondents had left their homes during the conflict in 1999. Displaced
persons, regardless of whether displaced within or out of Timor-Leste, returned mostly
within the first 6 months after the conflict. The proportion of respondents displaced
during the conflict varied within the 6 districts with Oecussi and Cova Lima having the
largest proportions of displaced persons in this sample during the conflict.
Both the Vulnerability Assessment Mapping workshops and Migration Patterns Survey
documented a very low knowledge and awareness of HIV/AIDS. Misconceptions were
very prevalent during the workshop and the mode of infection/transmission rather
unclear. Of the 1213 survey respondents, 60% had heard of HIV/AIDS, but were not
sure whether there was any in Timor-Leste. Knowledge and usage of condoms was
extremely low. An issue which emerged strongly at all workshops was the traditional
role of women in East Timorese society being an impediment to HIV/AIDS and sex
education.
The patriarchal structure of East Timorese society makes women vulnerable, as they
cannot negotiate safer sex and often have no say in family planning matters. Illiteracy,
poverty and a lack of employment and income generating opportunities further worsen
this situation. People lack the capacity to access information and have a low level of
knowledge about sexual health. More long-term research needs to focus on possible
behaviour change projects to improve the situation of women in Timor-Leste. Cultural
factors often impede programmes targeting sensitive issues such as sexual health and
HIV/AIDS. These factors (the patriarchal nature of Timorese society, the dowry
system, the role and status of women, cultural beliefs and taboos) will need to be
addressed in a sensitive and culturally appropriate way. There is a lack of data, and a 7
reliable estimate of HIV prevalence in the general population in Timor-Leste.
Information about HIV prevalence would greatly assist in prioritizing and allocating
funds and resources.
This study is the first systematic, in-depth study of Migration and Mobility patterns and
Vulnerability Assessment in the transitional society of Timor-Leste. The context of the
conflict ridden transitional society of Timor-Leste is unique as changes since 1999 have
been rapid, radical and complex. This study represents conclusions based on rigorous
fieldwork and a robust methodology that used both quantitative and qualitative
methods. The challenge for the Government of Timor-Leste, the Ministry of Health and
the international community lies in the country’s ability to respond to the
recommendations proposed in the study and address the multiple social, cultural,
political, economic and educational realities.