Papua New Guinea – epicenter of HIV in the Asian Pacific region

By Sharyn Casey

Papua New Guinea (PNG) is the epicenter of HIV/AIDS in the Asia Pacific region. With an estimated annual increase of 15-30 per cent in numbers infected[i], HIV represents one of the most significant threats to the country’s social and economic growth.

HIV prevalence in PNG is estimated at up to 2 pe cent of the total 15-49 year-old population[ii]and the World Health Organisation’s Dr Yves Renault predicts that given the current infection rates and the rate of increase, HIV prevalance could reach one million by 2015.[iii]

Currently, heterosexual transmission is the predominant means of infection, with approximately equal numbers of men and women affected. Since 2003, more than twice as many young women aged 15-24 have been diagnosed with HIV than young men; whereas males tend to have higher infection levels in older age groups.

Significant HIV prevalence rates are found not only in large urban areas, for example the capital Port Moresby, but also in rural pockets typically around primary industry sites. The similarity of sexual behaviour patterns in PNG and Sub-Saharan Africa suggests that PNG's epidemic has the potential to reach Sub-Saharan African levels.

The resulting impact of HIV on PNG's economy and society could be devastating. PNG currently receives a significant amount of international aid from countries including Australia and the US. Australia announced earlier this year it would contribute $18.5 million over four years to help fight HIV/AIDS in China, Vietnam and PNG in collaboration with the US Clinton Foundation. The money will be used to increase the countries' supplies of antiretroviral drugs and support their national health systems. However, foreign aid will not provide a long term solution to the crisis. By 2020 it has been estimated that PNG’s labour force could be 13-38 per cent lower than expected without HIV and its budget deficit could increase by between 9 per cent and 21 per cent. [iv]

Although homosexual transmission has not been the major route for transmission to date, working with men who have sex with men (MSM) is crucial given the country’s unique society and its highly sexual culture. Almost two-thirds of the population is Christian and the use of condoms has historically not been supported or encouraged by the Catholic church in particular. Homosexuality is illegal, and many MSM also have female partners. Coupled with this, there are high migration rates which also set the stage for a potentially rapid spread of HIV.

Working with at risk populations

Save The Children is the only organization in PNG to work openly with MSM. The program is centered on MSM in Port Moresby and Lae and promotes condom use and HIV testing through peer education and an MSM support group. The organization also works with female sex workers and educates police on the issues of discrimination facing these marginalised groups. With funding from the US Agency for International Development (USAID), an STI (sexually transmitted infections) clinic was opened earlier in 2006 in Port Moresby. The first of its kind, the centre provides confidential STI testing or people at risk, particularly MSM. The centre is staffed by two registered doctors and two lab technicians and was established in consultation with the PNG National Department of Health.

Although the STI clinic is a major step forward there is a lot of judgment around MSM making it difficult to encourage testing, says Peter* who manages the MSM project in Port Moresby and Mike* who manages the program in Lae.

Mike and Peter both identify as gay, giving them a first hand insight into the issues facing MSM in PNG.  Peter is openly gay to his family and living with his male partner in Port Moresby - a risqué thing to do in such a conservative society. Mike lives in Lae near his family and although they know he is gay, it’s not something openly discussed.

In PNG, MSM activities are usually hidden under the umbrella of mateship. “In smaller communities, like Lae, if you had a male partner, people would just think you are best mates,” Mike said.

“It’s the attitude of judging that makes it hard (for MSM to be open),” Mike said. “Christianity teaches about love but a lot of people who call themselves Christian are very judgmental. Homosexuality is a taboo subject. They know they (MSM) exist, but the community does not talk about it.” 

Peter and Mike facilitate two-week training programs for peer educators, arming them with information on HIV transmission and the impact of drugs and alcohol on HIV transmission. “We emphasise most strongly the use of condoms and lots of lubricants,” Mike said. 

In talking about sex, peer educators are trained to be discreet. “To buy a condom is seen to promote sin. So when we talk to people, we need to be sure that we are not too confrontational. Most of the time, condoms are supplied through social workers and our peer educators tell people where to get condoms where there is no shame,” Mike said.

Because of the silence around MSM activities, reaching MSM communities, particularly outside the capital, was initially difficult. Sexual activities take place in a beat culture and group sex is not uncommon.

“Chances are MSM sex will take place outside of the home,” Peter said. “It could take place at a bus stop, a market or in the bush. Group sex also happens often - we call it lineups - where usually a group of boys would line up for sex with one girl or a boy with or without their consent. These lineups can be sporadic or organised, with organised lineups taking place in hotels, guest houses or even picnic venues.”

There is also growing use of marijuana and “steam”, a home made brew with an alcohol content close to 100 per cent. Marijuana and steam are often used together and the combination seems to be highly addictive, Mike and Peter say. Aside from the health problems of ingesting such a high alcohol content, there is also a high risk of unsafe sex associated with substance abuse. “When you get like that in the head you don’t know if you use a condom or not and you often have no control to stop and think about using a condom,” Peter said.

The only way to stop the spread of HIV among vulnerable communities such as MSM and the wider heterosexual population they may also come into sexual contact with is to get people talking. “We need people to open up about sex. To do this, people need to feel able to be open about being gay,” Mike said. However, this is unlikely to happen unless homosexuality is decriminalized. “Only then will attitudes change and people feel safe to talk about it.”

Decriminalizing homosexuality might be a pipedream, but Peter and Mike plan to keep plugging away. “From the PNG perspective, HIV is one hell of a battle…it’s still a long way ahead of us.

 “Our challenge is to get people openly talking about sex. Because of the epidemic, we don’t care who, where or when. The most important things is to know that there are services available and that the safe sex message is out there.”

Sharyn Casey is the editor of HIV Australia.