Chris McGrath / Getty Images Tourists and locals crowd around surf boards on Bali's Kuta Beach

Tanned, lean and looking for fun — Bali’s “Kuta cowboys” are the stuff of many a titillated travel article and scandalized e-mail home. These affable playboys spend the day hawking sodas and surfing lessons, but also offer a sideline in romance to the throngs of foreign single women who come each year to this tropical Indonesian island in search of emotional, and corporeal, rejuvenation. “The girls want to have a good time and so do we,” says Didi, a grinning 22-year-old in fake Ray-Bans who has worked on the beach for over a year.

These women — dubbed Eat, Pray Lovers after the hit novel and film — do not mind buying clothes, meals or even motorbikes for their fleeting gallants. In turn, their sandaled lotharios will lavish them with affection, attention and perhaps something more. The Kuta cowboys — named after Bali’s most popular tourist beach — deny they are gigolos, but after the 2010 documentary Cowboys in Paradise blew the lid off “female sex tourism” on the island, 28 young men were arrested in an antiprostitution raid.

These days, though, it isn’t simply immorality that’s worrying the authorities. It’s also the threat of disease. HIV/AIDS figures for Bali vary wildly. The government puts the number of infected at around 10,000. But an estimate of 26,000 is described as the “tip of the iceberg” by Emily Rowe, program manager at the Kerti Praja Foundation, which runs a medical clinic in the provincial capital of Denpasar, and there are reports of 100 new HIV cases every month. “Bali has a huge HIV burden,” warns Rowe.

Many cases occur among local female prostitutes, with recent estimates claiming that one-fifth of Bali’s sex workers carry the virus. But it’s feared that the Kuta cowboys are among a number of groups, including taxi drivers and construction workers, who help spread HIV — in the Kuta cowboys’ case, to women who should know better.

Amit Virmani, director of Cowboys in Paradise, tells TIME of “a guy in the film whose [Western] partner at the time was a ‘yogi,’ She didn’t want him to wear a condom because she could tell his energy was clean. That’s incredibly stupid.”

Didi, for one, denies using prostitutes — he is apparently too popular to pay for sex — but admits some of his friends might. “This is Asia and that kind of thing is everywhere,” he says.

(MORE: Gigolos on the Beach: Cracking Down on Bali’s ‘Kuta Cowboys’)

“That kind of thing,” can take the form of someone like Lisa, a 32-year-old HIV-positive sex worker. Lisa didn’t know anything about HIV when she arrived in Bali from her small village in neighboring Java, and that goes for many of her fellow migrants. While more worldly-wise Balinese clients often bring condoms, parochial Javanese construction workers, brought to the island to toil in the tourist-driven building boom, outright refuse.

“If the guy doesn’t want to wear a condom, I’ll try to persuade them by offering to do a little striptease or something if they do,” she says. “But if they refuse, well …”

The migrant-worker influx “don’t really understand,” adds Rowe. Religious and cultural beliefs about contraception severely hamper safe-sex programs, as does the more mundane belief that condoms reduce the enjoyment of sex. As a result, philandering husbands are increasingly passing HIV onto wives and, by extension, their newborn babies.

Foreign males are another at-risk group. Swarms of Australia-based miners jet off to Bali for a few days or weeks of excess in between long stints at work. Many rent villas that have prostitutes included in the price, says Rowe.

If they end up having unprotected sex, tourists often go to her clinic looking for postexposure prophylaxis. “It’s basically giving antiretrovirals for a month after a possible exposure, but we’re not allowed to give these [under such circumstances], so we just have to tell them to go home. We have quite a few tears from young guys.”

Locals don’t have much choice either. Indonesia offers free antiretrovirals with help from international donors, but only the very basic drugs; those who stop for a day or are even late taking a dose by just half-an-hour can become resistant and even more sick, and then there are no options. “A client of ours turned up the other day [after stopping treatment], and he was like the walking dead,” Rowe says.

The clinic has more than 500 names registered on its books, and also has a sewing workshop to provide patients with an additional small income. Many face stigma and ostracism, made worse by one of the side effects of treatment — a distinctive rash. “As people are learning about HIV, they are starting to spot the rash and suspect if someone’s infected,” Rowe says. “It’s especially a problem with the girls and the transgender sex workers as their looks are everything.”

Back under the blazing midday sun of Kuta Beach, where pasty tourists meekly shuffle into the tumbling waves, such problems seem a world away. “I like working out here with my friends,” says Didi, who currently boasts of Scottish and Swedish girlfriends on the go. “I don’t know what else I could do.” But if Bali’s HIV/AIDS crisis continues to escalate, this carefree lifestyle will not last long.

Some names have been changed to protect the identity of those quoted.

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