Introduction: There is a global call for structural approaches to HIV that go beyond awareness and HIV testing to approach prevention work via the social and economic drivers of the epidemic. Papua New Guinea is the epicentre of the HIV epidemic in the Pacific, with an adult prevalence rate of 0.9%. Since 2004, there has been a concerted response to HIV, with vastly increased rates of HIV testing and roll-out of antiretroviral therapy, and considerable funding for HIV prevention. Objectives: While incidence is slowing there are still a considerable number of new infections each year and many commentators are worried that HIV prevention is not working in that country. This article aims to critically examine HIV prevention programs in Papua New Guinea to show whether HIV prevention is effectiveness in reaching those most vulnerable to infection. Methods: Using data from HIV prevention programs and behavioural surveys this article will assess how HIV prevention has been carried out and the effectiveness of those programs. Results: There is little evidence to indicate that HIV prevention in Papua New Guinea, particularly among those most at risk of HIV has been successful. Conclusion: there is a dearth of HIV prevention interventions in Papua New Guinea that go beyond awareness-raising to deal with the structural drivers of the epidemic.
KeywordsHIV PreventionPapua New GuineaAids-AwarenessHIV DriversStructural Interventions
UNGASS, “Papua New Guinea Country Progress Report,” 2010.
National Department of Health (NDOH), “The 2010 STI, HIV and AIDS Annual Surveillance Report,” National Department of Health STI, HIV and AIDS Surveillance Unit, 2011.
H. Worth, J. Rule, H. Buchanan, K. Browne, A. Amos, G. Roberts, R. Taylor and A. Razzaq, “HIV and Human Resources Challenges in Papua New Guinea (An Overview),” HRH Hub and IHRG, School of Public Health and Community Medicine, University of New South Wales, Sydney, 2012.
R. M. Granich, C. F. Gilks, C. Dye, K. M. De Cock and B. G. Williams, “Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: A Mathematical Model,” Lancet, Vol. 373, No. 9657, 2009, pp. 48-57.
M. Das, P. L. Chu, G. M. Santos, et al., “Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco,” PLoS One, Vol. 5, 2010, Article ID: e11068. doi:10.1371/journal.pone.0011068
J. S. Montaner, V. D. Lima, R. Barrios, et al., “Association of Highly Active Antiretroviral Therapy Coverage, Population Viral Load, and Yearly New HIV Diagnoses in British Columbia, Canada: A Population-Based Study,” Lancet, Vol. 376, 2010, pp. 532-539. doi:10.1016/S0140-6736(10)60936-1
AusAID, “Evaluation of the Australian Aid Program’s Contribution to the National HIV Response in Papua New Guinea,” Draft 2, Office of Development Effectiveness, AusAID, Canberra, 2011.
AusAID, “Evaluation of the PNG National HIV/AIDS support Project,” Review Series No. 38, AusAID, Canberra, 2005. http://www.hivpolicy.org/Library /HPP000726.pdf
AusAID, “The 2010 Papua New Guinea—Australia HIV and AIDS Program: Civil Society Engagement Case Study,” Office for Development Effectiveness, AusAID, Canberra, 2011.
Heywood and S. Martin, “Independent Evaluation of Tingim Laip,” Draft Final Report, 2007.
Independent Review Group on HIV/AIDS, “Report from an Assessment Visit 22 April-5 May 2010,” Papua New Guinea, 2010.
Independent Review Group on HIV/AIDS, “Report from an Assessment Visit 28 April-13 May 2011,” Papua New Guinea, 2011.
AusAID, “Evaluation of the Australian Aid Program’s Contribution to the National HIV Response in Papua New Guinea,” Draft 2, Office of Development Effectiveness, AusAID, Canberra, 2011.
International Federation of Red Cross and Red Crescent Societies, “Standards for HIV Peer Education Programmes,” Geneva, 2009.
E. Bruce, L. Bauai, A. Masta, P. J. Rooney, M. Paniu, et al., “A Cross-Sectional Study of Reported Symptoms for Sexually Transmissible Infections among Female Sex Workers in Papua New Guinea,” Sexual Health, Vol. 7, No. 3, 2010, pp. 71-76. doi:10.1071/SH09093
J. Gare, T. Lupiwa, D. Suarkia, M. Paniu, A. Wahasoka, H. Nivia, J. Kono, W. Yeka, J. Reeder and C. Mgone, “High Prevalence of Sexually Transmitted Infections among Female Sex Workers in the Eastern Highlands Province of Papua New Guinea: Correlates and Recommendations,” Sexually Transmitted Diseases, Vol. 32, No. 8, 2005, pp. 466-473. doi:10.1097/01.olq.0000161177.21639.96
A. Kelly, M. Kupul, Y. N. Wing, S. Nosi, N. Lote, P. Rawstorne, G. Halim, C. Ryan and H. Worth, “Askim na Save (Ask and Understand) People Who Sell and Exchange Sex in Port Moresby,” University of New South Wales, Sydney, 2011.
S. Mgone, M. Passey, J. Anang, W. Peter, T. Lupiwa, B. D. Russel, et al., “Human Immunodeficiency Virus and Other Sexually Transmitted Infections among Female Sex Workers in Two Major Cities in Papua New Guinea,” Sexually Transmitted Disease, Vol. 29, No. 5, 2002, pp. 265-270. doi:10.1097/00007435-200205000-00003
H. Aruwafu, F. Kupe and F. Akuani, “Bio-Behavioural Sentinel Surveillance Survey among Men and Women Attending Lae Friends STI Clinic 2008 Port Moresby,” NRI and NDoH, 2012.
S. Kippax, E. Reis and J. D. Wit, “Two Sides to the HIV Prevention Coin: Efficacy and Effectiveness Source,” AIDS Education and Prevention, Vol. 23, No. 5, 2011, pp. 393-396. doi:10.1521/aeap.2011.23.5.393
J. Ogden, G. Gupta, W. Fisherc and A. Warnerd, “Revolutionising the AIDS Response,” Global Public Health, Vol. 6, 2011, pp. S383-S395. doi:10.1080/17441692.2011.621965
J. Auerbach, “Transforming Social Structures and Environments to Help in HIV Prevention: Cost-Effective Interventions with Proven or Promising Results from Empowering Women to Providing Stable Housing for the Homeless,” Health Affairs, Vol. 28, No. 6, 2009, pp. 1655-1655. doi:10.1377/hlthaff.28.6.1655
G. Gupta, “HIV Prevention 4: Structural Approaches to HIV Prevention,” Lancet, Vol. 372, No. 9640, 2008, pp. 764-764. doi:10.1016/S0140-6736(08)60887-9
R. Parker, D. Easton and C. Klein, “Structural Barriers and Facilitators in HIV Prevention: A Review of International Research,” AIDS, Vol. 14, No. 9, 2000, pp. S22-S32. doi:10.1097/00002030-200006001-00004
M. Potts, D. Halperin, A. Swidler, E. Marseille, J. Klausner, N. Hearst, R. Wamai, J. Kahn and J. Walsh, “Reassessing HIV Prevention,” Science, Vol. 320, No. 5877, 2008, pp. 749-750. doi:10.1126/science.1153843
F. Maggiolo and S. Leone, “Is HAART Modifying the HIV Epidemic?” The Lancet, Vol. 376, 2010, pp. 492-493. doi:10.1016/S0140-6736(10)61057-4
T. Rhodes, M. Singer, P. Bourgois, S. Friedman and S. Strathdee, “The Social Structural Production of HIV Risk among Injecting Drug Users,” Social Science & Medicine, Vol. 61, 2005, pp. 1026-1044. doi:10.1016/j.socscimed.2004.12.024
E. Sumartojo, “Structural Factors in HIV Prevention: Concepts, Examples, and Implications for Research,” AIDS, Vol. 14, No. s2, 2000, pp. S3-S10. doi:10.1097/00002030-200006001-00002
R. Parker, D. Easton and C. Klein, “Structural Barriers and Facilitators in HIV Prevention: A Review of International Research,” AIDS, Vol. 14, No. 9, 2000, pp. S22-S32. doi:10.1097/00002030-200006001-00004
C. Beeker, C. G. Guenther and A. Raj, “Community Empowerment Paradigm and the Primary Prevention of HIV/AIDS,” Social Science and Medicine, Vol. 46, No.7, 1998, pp. 831-842. doi:10.1016/S0277-9536(97)00208-6
O. Tawil, A. Verster and K. O’reilly, “Enabling Approaches for HIV/AIDS Promotion: Can We Modify the Environment and Minimize the Risk?” AIDS, Vol. 9, 1995, pp. 1299-1306.
C. R. Waldo and T. J. Coates, “Multiple Levels of Analysis and Intervention in HIV Prevention Science: Examplars and Directions for New Research,” AIDS, Vol. 14, No. s2, 2000, pp. s18-s26.
C. Campbell, A. Foulis, S. Maimane and Z. Sibiya, “The Impact of Social Environments on the Effectiveness of Youth HIV Prevention: A South African Case Study,” AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, Vol. 17, No. 4, 2005, pp. 471-478.
L. Kathy, “Mobility, Violence and the Gendering of HIV in Papua New Guinea,” The Australian Journal of Anthropology, Vol. 19, No. 2, 2008, pp. 150-164. doi:10.1111/j.1835-9310.2008.tb00119.x