“There is not a single AIDS patient in our country," read state-run North Korean newspaper Minju Choson last year. The proud announcement coincided with World AIDS Day on Dec. 1.

Despite the bold claim, a new report submitted to the medical archive service medRxiv reveals a starkly different reality. The notoriously closed-off country actually had more than 8,300 HIV-positive individuals in 2018, and could be on the verge of an epidemic, Science magazine reported.

According to the team of researchers from North Korea and the United States behind the report, the country has been struggling to deal with HIV, which can lead to AIDS, for some time.

Last year’s AIDS-free proclamation marked the second time the country has declared itself free of the disease. North Korea made the same claim in 2015, though that same year its Center for Disease Control had documented a steady rise in HIV infections.

Government officials attributed their “achievement” last December to widespread HIV prevention and testing efforts, and World Health Organization (WHO) staff joined in the celebration of the milestone, according to Science.

But Taehoon Kim, co-founder of New York-based nonprofit DoDaum — which runs health and education projects in North Korea, including the project that enabled this research — painted a very different picture.

“Reliably diagnosing and treating patients remains an elusive goal,” Kim told Science. Just three labs in the country use modern medical methods to screen for HIV.

Kim’s organization has already helped approximately 3,000 HIV-positive North Koreans begin antiretroviral therapy, but not without significant challenges. North Korea does not produce the necessary drugs, so they must be imported. However, the country faces strict international sanctions and, as a result, 30% to 40% of the drugs don’t make it past the China-North Korea border, Kim said.

Without an effective way to treat its increasing HIV problem, the report warns the government may attempt to crackdown on the virus and AIDS in oppressive ways, undertaking “austere measures to contain the disease.” These could include the criminalization of people living with HIV as well as their detention or deportation.

HIV is spread through contact with certain bodily fluids of a person living with HIV, including blood, breast milk, and fluids that may be transmitted during sex. The virus not airborne, and cannot be transmitted through the exchange of saliva, nor through sneezing, kissing, or sharing bathroom facilities. Frequently, it is transmitted through unprotected sex and the sharing of used needles.

North Korea’s National AIDS Commission says the virus is most commonly passed through blood transfusions and the sharing of needles for drug use, Science reported.

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With effective treatment, people living with HIV today can lower their risk of transmitting the virus to others — in fact, they can virtually eliminate the possibility of transmission — and can lead healthy lives. But without access to these treatments and stringent prevention efforts, the disease is in danger of spreading further in North Korea.

But it’s not just international sanctions and access to treatment that hinders the country’s ability to contain HIV. Its censorship and limits on free information also pose a threat.

The North Korean government had initially asked DoDaum and its researchers to keep their findings to themselves. But as a dire public health issue became apparent, the team and its North Korean liaison, Kim Mun Song, a physician and external affairs director at the Ministry of Public Health in Pyongyang, decided they needed to share their findings.

“On the one hand, reporting the existence of these patients may lead to a backlash from the central government, as they are very much afraid of communicable diseases in general,” Kim Mun Song, who is also a physician and external affairs director at the Ministry of Public Health in Pyongyang, told Science.

“On the other hand, not reporting and not recognizing the existence will perpetuate the issue of not having treatments,” he added.