BBC News - December 28, 2005
Zoe Eisenstein, BBC News, Principe

For inhabitants of its larger sister island, Sao Tome, this became possible two years ago with the help of the aid organisation Medicos do Mundo.

Now a team from this organisation has taken the 45 minute plane ride from Sao Tome to start its screening work for Principe's 5,000 residents.

They began by explaining to people who came along to the hospital in the main town of Santo Antonio what the test involved.

Many there already seemed well informed about the disease.

"If we know that we're infected we can make sure that we don't infect others," says mother-of-four Madalena Santos, 39, who was one of the first to arrive for the tests.

"If we know we're not, we can make sure it stays that way."

But Medicos do Mundo co-ordinator Bruno Cardoso says the lesson of the NGO's work on Sao Tome is that knowledge does not always mean behaviour change.

"In our study people who know what HIV is and how it is transmitted don't act in conformity with their knowledge," he says.

"They don't use condoms, or they use them once but not every day; and that's not good. With HIV you have to have to use condoms every time you have sexual relations."

Multiple partners

Some 4,000 tests have been done on Sao Tome, which has a population of about 169,000 people, with a reported HIV prevalence rate of 2.4%

But Mr Cardoso believes the real rate is a lot higher as most testing was done in urban areas.

"The majority of tests have been done in the two major localities, where people are mostly young and informed," he says

"In the south of Sao Tome for example, the levels will be a higher because people have less access to condoms and have multiple partners."

At the end of the first day of HIV testing in Principe, two results came back positive from a total of 200.

"I'm very happy because I've just done the test and found out that I am HIV negative. Now I can make sure that I protect myself in the future," one man says.

Shock

While Principe's HIV rate is low when compared to elsewhere in Africa, it still comes as a surprise to many people on this religious island.

They had thought that their relative isolation in the Gulf of Guinea would have spared them the problems the virus has been causing across the rest of continent.

In fact, the archipelago - which hopes for huge dividends from oil deposits it will start exploring for off its coast next month - is one of the few African countries to offer anti-retroviral treatments to all who need them.

But Mr Cardoso said the challenges of combating the spread of the disease remain enormous in what is still an impoverished nation.

"This is a small country but the roads are bad and people don't have access to hospitals or health centres," he says.

"It can take two hours to walk to a place that has condoms so people often prefer not to use them.

"That's very dangerous."

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