Like his neighbours in the southern Ethiopian district of Yirgacheffe, Birhanu Gizamu is a smallholder coffee farmer. Unlike the rest of the community, however, he has no hesitation in whipping out a crumpled blue card from the clinic which proclaims his HIV status.
"I tested negative," the 42-year-old proudly noted, handing over the card for verification. "I went for [an HIV] test in 2005 after my wife pushed me, so we went together; I'd been in the military before becoming a coffee farmer, so I knew I was at risk."
The outbreak of war between Ethiopia and neighbouring Eritrea between 1998 and 2000 swelled the army's ranks to about 350,000 soldiers, who spent months at a time in border areas where commercial sex work flourished. When the fighting ended, most of these men were demobilised and returned to their rural homes to continue farming.
In Ethiopia, where 85 percent of the country's 71 million people live in the still conservative countryside, Birhanu's openness in discussing AIDS is far from the norm.
"HIV is not at all common here in these rural areas," he said. "I do encourage other farmers to go for testing - I think that's important - but I've never heard of anyone who has HIV or AIDS."
The ministry of health estimates rural HIV prevalence at 1.9 percent, compared with the national average of 3.5 percent. However, awareness is low and testing is rare in the hinterland, prompting concern that the actual prevalence could be higher.
The government has acknowledged the need to focus attention on the countryside, particularly the coffee industry, which supports 20 percent of the Ethiopia's population.
"There are two types of coffee farmer," said Gashaw Mengistu, coordinator at the HIV/AIDS Resource Centre in the capital, Addis Ababa. "The smallholder farmer and the farmer working on a state-owned coffee farm who lives in a camp onsite; it's in these camps where conditions are ripe for the spread of the virus."
According to Gashaw, farming populations gravitate towards these coffee farms from miles around in search of work. Men often leave their wives and families behind and take on another wife or girlfriend in the camps. More than 100,000 people are accomodated on the farms, where entertainment is scarce and sex is one of the few available recreational activities.
"The government enterprise is reporting many of their staff is dying of HIV/AIDS on these coffee farms; many are dying and many are vulnerable," Gashaw said, adding that HIV was also a growing threat among smallholders.
"A smallholder coffee farmer in Yirgacheffe may deny that HIV/AIDS is a problem, but the transfer of the disease from urban to rural areas is growing, and many people are dying," he said.
Low awareness means stigma and discrimination are high, with half the rural women interviewed in a 2006 demographic health survey admitting they would not want to care for a relative with HIV in their own home. As a result, many HIV-positive people remain in denial rather than seeking treatment.
"The government has voiced their concerns, yet little is being done to change the situation," Gashaw noted. "The lack of studies and preventative programmes in these coffee-growing regions is very concerning."
Acknowledging the seriousness of the situation, Sisay Asrat, manager of Ethiopia's Coffee Plantation Development Enterprise, told IRIN/PlusNews the ministry of labour had made the coffee industry a priority area in the fight against HIV/AIDS, and work was underway to raise levels of awareness and promote condom use.
"The problem is very serious in these areas," he said. "Most people working on them [the farms] are uneducated, but we are trying to provide them with information on how to protect themselves."
The coffee industry earns Ethiopia more than US$300 million a year and accounts for 54 percent of its gross domestic product.