HIV Australia: Published 29 June 2010

The rise of positive champions in Papua New Guinea ¹

By Robert Baldwin

Poro Sapot (PSP) Banner, Port Moresby, PNG. Photo courtesy PSP

PSP GIPA Audit Team: Maura, Nick and Dorothy in the PSP Port Moresby Memorial Garden, April 2010. Photo courtesy Robert Baldwin.

Positive PSP staff perspective: feedback from Nick and Dorothy We were both very pleased to be part of the GIPA Audit Team, a process which gave us the opportunity to discuss current and possible future PSP work with our PSP staff and volunteer colleagues. We also got to meet with several fellow HIV-positive staff and volunteers to talk about their needs and ideas. Those conversations mostly occurred in private: one-on-one meetings outside the work environment. . Most positive people within PSP are still very secret about being HIV positive. We intend to continue to keep close contact with our new friends. We learnt much from being part of the GIPA Audit Team, including how to plan and conduct a review process. It was also a first to work in an all HIV-positive team. We increased our skills and confidence, and Nick learnt much about logistics by being the key person responsible for organising Team travel and meetings. It was great to hear the thoughts and opinions of many people, including our PSP partners, and we now have many new ideas about how to work with positive people in the future.   Dorothy’s story: the experience of being HIV-positive In November 2003, I decided to go for an HIV test at Anglicare StopAIDS because I was feeling really sick with chest infections, and was losing a lot of weight. I had also lost a lot of hair. After counselling and having a blood test, I was asked to come back to collect my results in two weeks. When I did return for my results, the male counsellor that I went to see, referred me to a female counsellor. She was very nice in the way she approached me and greeted me. She brought me into one of the rooms for counselling and then asked me if I was ready for my results. I said I was ready. She told me that I was HIV-positive. I did not know what to do and started crying. While crying I thought to myself that it was the end of my life and the world. When I stopped crying, the female counsellor comforted me and said she was also living with HIV. That was ashock to me because I was thinking that I was the only person who had HIV.The counsellor asked me if I wanted to meet with other HIV-positive people. I said I really wanted to meet them so the counsellor showed me the Drop-in Centre and introduced me to the positive people there. They all shared their experiences with me which really gave me hope and strength to live on.

The Poro Sapot Project (PSP) is an HIV/AIDS behaviour change intervention project based on peer outreach, primarily targeting female sex workers and men who have sex with men, including transgender people. ³ Importantly, it uses a peer outreach model to reduce the negative impact of HIV. Poro Sapot basically means ‘friends supporting friends’.

Implemented by Save the Children PNG in Port Moresby, Lae, Goroka and Kainantu, PSP addresses the needs of target populations who engage in high risk behaviours, and who are not easily reached by traditional activities promoting HIV/STI prevention and care. One indication of the success of PSP’s peer approach is the number of current PSP staff who first came into contact with the service as clients, and who then became volunteers and employees. They know what it means to be sex workers and men who have sex with men in PNG: an understanding crucial to PSP’s work.

The July 2008 review of PSP found that:

… due to the good work of the project in reaching female sex workers and men who have sex with men, and promoting voluntary counselling and HIV testing,
many more HIV-positive female sex workers and men who have sex with men are becoming involved in the project. ⁴

The review recommended that PSP, in collaboration with partners, develop innovative programs to ‘support holistic health and well-being needs of HIV-positive female sex workers and men who have sex with men’. On the basis of those findings, PSP initiated a GIPA (Greater Involvement of people living with HIV [PLHIV]) Audit.

Undertaking a GIPA Audit

The PSP GIPA Audit was conducted in April 2009 by a team of four people living with HIV: two current PSP staff members (Nick and Dorothy), the GIPA Advocacy Officer from Sanap Wantaim (Maura, PNG AusAID agency) and an international consultant (Robert). Nick, Dorothy and Maura are all past Board Members of Igat Hope, the PNG PLHIV network. Between them, the four members of the team had nearly fifty years of combined experience of living with HIV.

The GIPA Audit aimed to:

• assess how PSP has worked with people living with HIV, including the strengths and weaknesses of that work
• deepen PSP's understanding of the concepts of GIPA and 'positive prevention'
• recommend ways to incorporate these concepts into ongoing work share experiences
  develop local skills required to perform such an audit, and
• pilot this method for use by other civil society organisations within PNG.

The audit process involved consultations at all four project sites with staff, female sex workers and men who have sex with men outreach volunteers, local PLHIV leaders and project partners.
Findings of the GIPA Audit

The GIPA Audit Team found:

• several activities by and for HIV-positive people had already been successfully conducted at PSP
• a wide variety of ongoing care activities for HIV-positive female sex workers and men who have sex with men had been willingly conducted by staff and volunteers, usually beyond their job descriptions and often utilising their own resources
• most positive staff and volunteers within PSP seemed to be hidden behind a veil of secrecy around being HIV-positive, and
• since the PSP Review in mid-2008 there had been four deaths of HIV-positive volunteers and clients.

Sadly, since the 2009 Audit there have been a number of other deaths at PSP from HIV-related illness, including a much-loved member of the PSP senior staff, Jason.

The GIPA Audit Team also found that while overall there was a low level of theoretical knowledge about GIPA and 'positive prevention', ⁵ there was general agreement by PSP staff, volunteers and partners on the need to meaningfully involve people living with HIV as equal partners in the project and to work collaboratively to empower positive people to improve their health and well-being. The Audit Team was particularly impressed that despite the project being formally defined as HIV prevention focused, there was clear willingness of PSP staff and volunteers to incorporate care and support activities for positive female sex workers and men who have sex with men within their project,: 'This was outstanding to me. Something great is coming up and I'm very proud'. ⁶

Progressing inclusivity

To progress the PSP's goals of inclusivity, the GIPA Audit Team made a number of relatively simple recommendations, although these will require significant effort to effectively implement.

The Audit Team recommended the development of a PSP Code of Conduct that specifically addresses issues relating to working with people living with HIV, including confidentiality and non-discrimination. The Audit Team also recommended development of a workplace policy on chronic illnesses, including HIV, to cover both staff and volunteers.

The continuing veil of secrecy around being HIV-positive in PNG is a real challenge to everyone's health and well-being. The Audit Team supported recognition of 'GIPA Champions' within PSP: those HIV-positive staff and volunteers who are able and willing to be open about their HIV status to some degree and who take on an active role in promoting GIPA and provide peer support to other positive staff, volunteers and clients.

PNG's National HIV Prevention Strategy has recognised the limits of medicalised approaches to HIV support:

Programs must move from a narrow medical approach to a life cycle approach to positive living,
involving a series of strategies to increase the confidence, motivation, and ability of people living
with HIV to manage and protect their own health, sexual life, and relationships. ⁷

The PSP Audit Team recommended that:

• the holistic health and well-being needs of positive female sex workers and men who have sex with men be confirmed, promoted and funded in the PSP Workplan
• existing welfare/charity funds be formalised at all project sites, and
• simple positive prevention activities be commenced such as healthy cooking and exercise classes.

It was recommended that PSP work with partners to increase efforts to promote GIPA Principles, join in partnership with local PLHIV networks, and promote the fair treatment of positive female sex workers and men who have sex with men by HIV health services.

The Audit recommendations also include the setting of long term goals:

• working with Sanap Wantaim to encourage uptake of the Code of Good Practice for NGOs Responding to HIV/AIDS by all NGOs working on HIV issues in PNG
• creating PSP Positive Peer Support Worker positions to provide support to HIV-positive female sex workers and men who have sex with men, and
• working towards an environment within PSP that encourages all staff and volunteers to regularly monitor their HIV status.

PSP recognises its obligation to develop a formalised program providing access to holistic care and support to female sex workers and men who have sex with men who are living with HIV. The GIPA Audit clearly demonstrated that many PSP staff and volunteers were already providing care and support to positive female sex workers and men who have sex with men. PSP aims to build on this good work.

Moving forward

The GIPA Audit Team believes that if the Audit recommendations are implemented in a timely manner, there will be increasing leadership by positive people and access to good quality care both within PSP, and hopefully to some degree, within all NGOs working on HIV issues in PNG.

At a recent follow-up GIPA consultation meeting with PSP staff in Port Moresby (13 April, 2010), Nick and Dorothy outlined some of the excellent progress that has been made to date. Their successes have included progress on developing the PSP Code of Conduct; the establishment of small but vibrant peer support groups of positive women and men in Lae and Port Moresby; an increase in collaborations between PSP and local PLHIV groups; and the building of a memorial garden at PSP in Port Moresby to remember their many lost friends. Since the GIPA Audit, several more PSP staff and volunteers are now more open in their workplaces about being positive and are keenly working together to provide support to other positive staff, volunteers and clients.

Additional notes on PSP

In addition to Poro Sapot's work with sex worker, MSM and transgender populations, the Poro Sapot Project (PSP) is undertaking ground-breaking community mobilisation work, advocacy, and capacity building with police. A 2010 scoping exercise funded by AusAID ⁸ described PSP's education of police at five provincial locations, and HIV training to some new police recruits at the national training college.

Poro Sapot aims to promote mutual understanding between the police and sex workers, by facilitating meetings between the parties to develop respect and improve the approach of police to sex workers. Training of police is conducted on HIV and human rights, gender and violence, stigma and discrimination and other issues facing vulnerable populations. In a pilot intervention in 2007, the project conducted a four day workshop for over 100 new recruits at the national police training college. The project also delivers gender violence workshops for police, resourced by the Law and Justice Sector Partnership.

Poro Sapot is funding a Community Liaison Officer at Goroka police station, to assist in improving policing of sex workers. The project is important to the policy response, in that it generates evidence of vulnerability of sex worker and MSM populations, and senior project personnel are able to influence the policy agenda and advocate for change based on front line experiences. The project reports frequent discrimination against MSM who seek clinical services from mainstream clinics. Project peer educators accompany MSM to mainstream clinics to ensure that they receive non-discriminatory services. The project works closely with clinics to address discrimination.

The scoping exercise found:

that NGO collaboration with police has worked, and that sensitisation is more effective when understood and supported by the police hierarchy and when it involves members of vulnerable populations who testify about their experiences. Police interactions with sex workers and MSM have improved in those communities where police sensitization has taken place.

AFAO is delivering an MSM Community Leadership Pilot Project in partnership with the PSP and the PNG-Australia HIV and AIDS Program (Sanap Wantaim).

References

1 Enquiries welcome to Robert Baldwin tuntablecreek@bigpond.com

2 Comment from a PSP staff member during the GIPA Audit.

3 Many men who have sex with men we spoke to preferred to use words such as ‘sistagirls’ or ‘palopas’ to describe their sexual identity, many viewed terms such as ‘gay’ as an insulting term when used by society in general, and some men who have sex with men said they had no term to describe their sexual identity. The term ‘straight’ was often used by the men who have sex with men we met to describe men who ‘would have sex with us’. Generally the men who have sex with men we met said they were not publicly open about their sexual practices or identities. Sexual activity between men in PNG remains illegal.

4 Shaw, L. and Baldwin, R. (2008). Review of Poro Sapot Project.

5 It is acknowledged that there is a continuing discussion at the global level, lead by GNP+ (Global Network of PLHIV), about ‘positive prevention’: both the terminology and the components. There is still much contention about the use of the term ‘positive prevention’, mainly because it implies a strong focus on ‘controlling’ PLHIV to not transmit the virus, rather than supporting PLHIV to prevent them becoming unwell and to encourage them to maintain safe behaviours and healthy living. More recently the term ‘Positive Health, Dignity and Prevention’ has been coined, though at APN+ (Asia Pacific Network of PLHIV) we prefer to use the term ‘positive health’.

6 From GIPA Audit Report

7 National AIDS Council of Papua New Guinea. (2009). Papua New Guinea National Prevention Strategy 2008–2013: Expanding and Scaling up the Response, p10, Draft: 09/02/2009.

8 Godwin J.,(2010).Support for Strengthening the HIV Legal and Policy Enabling Environment: Scoping Exercise Stakeholders Phase 2 Report, Health Resource Facility, Australia

Robert Baldwin is a volunteer advisor for Asia Pacific Network of PLHIV (APN+).