No one expected that the reaction to empty condom dispensers on São Tomé and Príncipe would be so angry.

"I thought the country had run out of condoms - you people are fouling up too much," Palmira Torres, the owner of Alfa Restaurant, complained to Almerindo Ferreira and Desinela Barros, who work as peer educators for the Italian non-governmental organisation, Alisei.

Condom dispensers were installed throughout the archipelago off the coast of Gabon at the beginning of the year, as part of an initiative by the National Programme for the Fight Against AIDS (known by the Portuguese acronym PNLS), assisted by Alisei.

Alfa Restaurant, near the port in the city of São Tomé, capital of the largest island in the group, was one of the 376 restaurants, night clubs and stores to be equipped with a dispenser.

But a month-long interruption in supply occurred when the vehicle that distributes the condoms broke down. This, combined with a lack of personnel, left the dispensers empty in a number of districts.

"Last Sunday a young woman came in here, all nervous, looking for condoms, but there weren't any. Who knows what happened to her?" said Torres.

The restaurant, frequented by government workers, sailors and sex workers, is one of the condom distribution points Alisei considers "hot": it only takes two weeks for a bulk package of 144 to run out.

The demand for condoms, which has been triggered by the placement of the dispensers, is a new phenomenon for São Tomé and Príncipe.

The estimated 1.5 percent HIV prevalence among the country's 160,000 inhabitants is considered low for the African continent, but health officials say the number of people becoming infected is rising.

With funding from the United Nations Population Fund (UNFPA) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, each establishment with a dispenser receives a monthly supply of 432 condoms, which are available to the public free of charge. Nearly a million condoms were dispensed between January and June 2008.
Life savers

Early one morning at the beginning of July, the Alisei pickup truck brought a box of condoms to the Boca Loca restaurant, the first delivery in a month.
Nuno Santos, 25, who was eating breakfast, didn't wait to finish his meal. "The life savers have arrived," he joked, taking two packets from the dispenser.

"It was hard to function without the condoms," commented the Boca Loca barman, Valdemar Paquete. "All of the clients asked us a lot of questions because of the lack of them."

Also considered a "hot spot", the restaurant is open 24 hours a day, seven days a week. Business reaches its peak on Saturday and Sunday nights, when people leaving night clubs in the central part of the capital make a last stop at the Boca Loca.

"The condoms are sought after by everyone, but I think that younger customers are the ones who take the most. Girls also come here to get them," Paquete told IRIN/PlusNews.

PNLS Director Alzira do Rosário is heartened by the uptake, but said it remained to be seen whether people were actually using them. Nevertheless, the health authorities have applied to the Global Fund for additional funds to ensure they keep the demand for condoms supplied.

Alisei will also begin installing condom dispensers in more restaurants, stores and night clubs this month. The health authorities intend to have 400 distribution points set up by the end of the year, with the goal of guaranteeing greater access to condoms for the entire population.

PlusNews

Bars, restaurants and stores in the archipelago of São Tomé and Príncipe now have a new attraction: small brown wooden boxes containing 144 condoms each, placed in highly visible locations. Condoms have traditionally been distributed at healthcare centres, but under the government's new prevention campaign they are gradually becoming more accessible.

"This is the way we came up with for condoms to be brought closer to São Tomeans," said Alzira do Rosário, coordinator of the National Programme for the Fight Against AIDS (known by the Portuguese acronym PNLS). "You don't have to ask anyone for anything - if you need one, all you have to do is take it."

The archipelago off the coast of Gabon, with some 160,000 inhabitants, has a seroprevalence of 1.5 percent, considered low on the continent. Nevertheless, health officials are concerned about the growing epidemic on the island.

"With every day that goes by, the situation becomes more complicated. AIDS is no longer a joke," warned Ângela Costa, coordinator of the Office for the Promotion of Women and Family at Manuel Quaresma Dias da Graça Costa Hospital, in a condom use promotion campaign.

Surprise

The initiative was launched by the PNLS in December 2007 on the island of Príncipe, where the boxes were placed in 34 strategic locations. The goal is to distribute 400 condom dispensers with the assistance of Alisei, an Italian non-governmental organisation (NGO). By December 2007 they had delivered 230 on the two islands.

In 2007, with financing from the Global Fund to Fight AIDS, Malaria and Tuberculosis, Alisei carried out the first-ever survey of the sex industry in São Tomé, interviewing a total of 120 people. Among the findings was a need for more places where condoms could be obtained, especially those open at night.

On a December afternoon, a pickup truck from Alisei entered the Benga neighbourhood on the outskirts of the city of Neves, 27km from the capital, São Tomé, with the condom boxes. One of the locations was the popular restaurant, Complexo Escala, where a poster advertising "Free condoms available here" was placed at the entrance.

The poster took a group of customers entering the restaurant for lunch by surprise. "This is great. Now, if we get ourselves a prostitute, we have condoms just one step away," public servant Leovigildo Bragança, 54, said jokingly. Restaurant owner Hélder Menezes told IRIN/PlusNews that he participated in the project "because this way I'm contributing to the fight against AIDS".

Alisei coordinator Mariangela Reina believes the initiative will also encourage women to become condom users. "Young people, especially, are embarrassed to go the pharmacy or health centre to get condoms. That's where the idea for the condom dispensers came from," she said.

The project has the support of the United Nations Population Fund, the US-based Global Fund to Fight AIDS, Tuberculosis and Malaria, and the São Tomé and Príncipe Federation of NGOs.

PNLS data from 2005 indicates that 95 percent of the population has knowledge regarding condom use, but only 45 percent use them in their sexual relations. The initiative hopes that by making condoms more readily available, this behaviour will change.

Night falls early along the equator. When darkness creeps across the bay of Santa Ana and sets over the town of Sao Tome, the girls appear in twos or threes, or alone. They wait for clients behind the Farol bar and the Dolores disco, the hubs of evening buzz in the capital of the tiny archipelago of Sao Tome and Principe, which straddles the equator off the coast of Africa.

Around 7 p.m., Angela*, robust and friendly, wearing a black tank top, tight jeans and beads in her short dreadlocks, has just hit the street. Her usual clients are "Portuguese construction workers, sailors from Malabo [Equatorial Guinea], and Saotomese," she tells IRIN/PlusNews.

Her best clients are sailors from the foreign fishing fleets. "They come onshore, hot for wild sex and with gifts of dry fish, rice, clothes and toys," she says. But the Portuguese hold the best promise: "If one fell in love with me, I could leave this life and move to Portugal."

Angela, 28, has a 7-year-old child. She started selling sex at the age of 14, following in her older sister's footsteps. She stopped when she got pregnant and lived with the father of her child until his sudden death three years ago. Her current boyfriend has been in jail for five months, so Angela is back on the streets.

Not for long, she hopes. "I am getting too old, men prefer the young ones. We get wet when it rains, some nights we earn nothing ... not a nice life," she says ruefully.

Growing sex trade

Seroprevalence on the islands is relatively low at 1.5 percent in a population of some 150,000. However, the growing influx of oilmen, sailors and fishermen from neighbouring countries is causing concern, especially considering that half the population is poor, according to the United Nations.

Locals agree that prostitution in the capital has risen the last three years. More girls hang around the streets at night; more men prowl the bars and discos, coming alone and leaving accompanied.

An observant client of some sex workers might notice that they take a condom out of a pretty box crafted from a local precious wood, which means they have been through the sexual health education programme the Italian non-governmental organisation (NGO), Alisei, has been running since 2006.

"The box is something special that says, 'I am special, I take care of myself'," said Alisei coordinator Mariangela Reina.

The diffuse nature of sex work in Sao Tome makes it hard to reach the meninas (girls in Portuguese), as the young sex workers are known, with life-saving, AIDS-preventing information. Alisei has problems recruiting and retaining peer educators.

"The meninas don't want to be associated with sex work or AIDS," said Reina. "It is a hidden phenomenon, and reaching them requires time and patience."

Reina distinguishes between the "mobiles" - the more upmarket sex workers who sell sex occasionally - and the "fixed", or regulars, who are more obvious about what they do and are easier to reach with condoms and information.

Streetwalkers are found only in the capital. Elsewhere, sex work is mainly done out of bars and discos, with the variant of "maritime prostitution", which is tied to the arrival of ships in the capital and the fishing ports.

First ever survey

This year, Alisei, with funding from the Global Fund to Fight AIDS, Malaria and Tuberculosis, interviewed 120 people in the first ever survey of the sex trade in Sao Tome. The information will form the cornerstone of a strategic protection plan for sex workers.

The study found that the overall knowledge of AIDS was high, and nine out of 10 respondents mentioned the male condom as the preferred protection against sexually transmitted infections (STIs) and unwanted pregnancy.

In more than half the sexual encounters both partners had brought condoms. However, mistrustful of men, most women surveyed preferred to use their own. Ten percent reported problems fitting a drunk or older man with a condom.

The women obtain condoms from health posts and NGOs but would like to have them available in shops, bars and discos that are open at night. Worryingly, 17 percent of the women surveyed had agreed to have sex without a condom and 24 percent usually drank alcohol before sex. Roughly half said they did not feel good about earning a living from sex.

Most were aged between 15 and 24, and most of the younger workers viewed commercial sex as temporary until they could find a man or a job or had acquired some possessions.

One-third reported having one client per day; another third had two or more clients per day, and the rest had a variable number of clients daily. Just under half said they had foreign clients, but most clients were local.

In focus groups, the sex workers listed European tourists as the best clients. "They pay in forex, do it faster, are more romantic, and pay for drinks, food and breakfast without discounting it from the total price," said Alisei educator Babica Dias. Prices varied from US$8-10 for a local client to US$20-30 for foreigners.

The Associacao Saotomense de Planejamento Familiar (ASPF), a local NGO, occasionally distributed condoms among customs officers at the capital's harbour, but none in the fishing ports. "We should have programmes there," said Amado Vaz, head of ASPF.

Pink clogs and gold earrings

Tete*, 18, hangs out at a tiny but lively bar near the Alisei office in Sao Tome and rents a room in a nearby house. She wears shocking pink clogs, denim shorts, a white-and-gold top and big gold earrings, and has followed her older sister into the sex trade.

The Alisei staff has gained her trust, and Tete has gained information and condoms. She has tested twice for HIV: "I was afraid," she says.

Alisei's Dias and Dina Zolda Cruz, a peer educator, pursue the meninas with dogged patience and good humour, in spite of their initial reticence and failure to keep appointments. "They are shy, they don't want to talk and don't want to listen," says Dias.

Eventually trust sets in and peer educators teach them negotiating skills. According to Cruz, "The best moment to discuss a condom is once [they are] inside the car, but before sex. The best approach is to emphasise the client's protection."

Equipped with these skills and their pretty boxes, the meninas will be safer when night falls in Sao Tome.

* Not her real name