Fact file: The AIDS problem in Papua New Guinea

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Fact file: The AIDS problem in Papua New Guinea

Papua New Guinea, Australia’s closest neighbour, is dealing with an HIV/AIDS epidemic. A high incidence of sexual aggression, violence against women, the impact of alcohol and drugs on sexual behaviour and commercial sex are just some of the reasons for the level of HIV infection in the country.

On World Aids Day on December 1, 2014, Foreign Minister Julie Bishop said PNG was a particular focus for the Australian Government.

She says the Government is providing $200 million over three years to The Global Fund – “the largest amount that any Government has ever provided” – because “we can’t be complacent when it comes to the fight against AIDS”.

“Although HIV infections and deaths have declined pretty dramatically around the world, the fact is that more people are receiving treatment, including more than 11,000 people in Papua New Guinea, and that’s a particular focus for me,” she told ABC Radio National.

On the same day, Stuart Watson, the UNAIDS country coordinator from Papua New Guinea, agreed there was no room for complacency.

He said there was still cause for concern, although PNG had not followed the problems of sub-Saharan Africa, as feared a decade ago.

“While we have made quite a bit of progress and we have brought the rate down… there is now beginning to be an increase and that’s very worrying,” he said.

ABC Fact Check takes a look at the HIV/AIDS problem in Papua New Guinea.

The virus spreads

According to a 2009 United Nations report, HIV was first diagnosed in PNG in 1987. In the late 1980s, PNG accounted for 21 per cent of all new cases of HIV in the Pacific.

According to the World Health Organisation, HIV was the leading cause of death at Port Moresby General Hospital in 2005. It found that the “high incidence of sexual aggression and other forms of violence against women appear to be fuelling the growth of the epidemic”.

By 2008 PNG accounted for 99 per cent of new cases in the Pacific. The UN report estimated that 54,000 people in PNG were living with HIV in 2008 and that unprotected sex was the main mode of transmission of AIDS across all countries in the Pacific.

It found that the primary reasons for HIV infection were gender inequality, gender-based violence, the impact of alcohol and drugs on sexual behaviour, and commercial sex.

PNG’s HIV problem has been described by the Joint United Nations Program on HIV/AIDS (UNAIDS) as a “concentrated” epidemic, with certain key population groups and geographical locations affected disproportionately.

A study of 593 sex workers in Port Moresby in 2010 found 17 per cent were HIV positive.

Prevalence or incidence?

The prevalence of a disease is the proportion of a population with a disease at a specific point in time. It includes all cases of the disease – people who have had the disease for many years, as well as newly diagnosed cases. This is different from incidence, which is the number of new cases diagnosed in a population over a particular time period, often over 12 months.

UNAIDS has traditionally used measures of prevalence to monitor the patterns and trends of HIV epidemics around the world.

But UNAIDS says using prevalence can be problematic because as more people with HIV survive longer, due to antiretroviral medications, the prevalence can appear to increase, despite a country improving its HIV/AIDS strategies. It now says looking at incidence, or new infections, is a better guide. 

According to a 2013 UNAIDS report on the global AIDS epidemic, the estimated adult HIV prevalence in PNG is 0.5 per cent.

The report says there are approximately 25,000 people of all ages living with HIV in PNG. The numbers have improved: in 2001 prevalence was 0.7 per cent, and an estimated 22,000 people were living with HIV.

In 2012 there were less than 1,000 new HIV cases reported, compared to 3,500 new infections in 2001. 

Australia’s prevalence is between 0.1 and 0.2 per cent.

The federal Health Department estimates that 26,800 Australians were living with HIV at the end of 2013. But the number of new HIV infections diagnosed each year in Australia in on the up. In 2013, 1,236 new cases were diagnosed, the highest since the early 1990s.

How is PNG faring?

Based on the UNAIDS statistics, an estimated 1,300 people died from HIV in PNG in 2001, compared to less than 1,000 in 2012.

In 2012, 84 per cent of adults who needed HIV antiretroviral medications received them, compared to 18 per cent in neighbouring Indonesia. But only 39 per cent of children in PNG who needed HIV medications received them.

Education and safe sex programs appear to have made some impact, with the percentage of sex workers using a condom with their most recent client going from 50 per cent in 2009 to 80 per cent in 2012 and 63 per cent of men used a condom for sex with a male partner in 2012, compared to 51 per cent in 2009. 

HIV testing of pregnant women in Papua New Guinea has also improved, with the number of testing facilities increasing from just 17 in 2005 to 178 in 2009.

A 2011 academic review of the HIV epidemic in Papua New Guinea found there has been real progress in recent years.

More low-risk people are being tested alongside higher-risk groups, which paints a more accurate picture of the true community prevalence.

The review found the formation of a National AIDS Council, a clamp-down on HIV-based discrimination, the introduction of AIDS control committees in every province, education and promotion of safe sex strategies, such as condom use, participation of churches, and increases in antiretroviral medication coverage have all helped decrease transmission.

And it said the reason a real reduction in HIV cases may have occurred is interventions helped by foreign aid. The review says the formation of a National AIDS Council, a clamp-down on HIV-based discrimination, the introduction of AIDS control committees in every province, education and promotion of safe sex strategies, such as condom use, participation of churches, and increases in antiretroviral medication coverage have all helped decrease transmission.

According to a US government review of AIDS relief in Papua New Guinea, foreign donors provided 89 per cent of the total in-country spending on HIV/AIDS in Papua New Guinea in 2009, with Australia the largest donor.

Hopes for the future

Experts contacted by Fact Check said the signs from PNG were encouraging.

John Kaldor, program head at The Kirby Institute, an HIV research organisation based at the University of New South Wales, said good progress has been made, “but it’s far from a situation where you could say the health system has HIV under control”.

Professor Kaldor said substantial increases in testing and access to treatment have occurred, but warned the situation in Papua New Guinea is not entirely stable.

“There is some degree of uncertainty around the impact of economic factors – for example, the new liquefied natural gas project is putting a lot of money in people’s pockets,” he said, explaining that this may stimulate travel or the commercial sex industry – an industry where workers have far higher HIV rates than the general population.

Michael Toole, deputy director of International Program Strategy at the Burnet Institute, a Melbourne medical research and public health organisation, said new strategies and policies had helped reduce stigma and increase access to treatment, with a decreased prevalence among pregnant women seen between 2005 and 2010.

But he said the decrease in prevalence does not necessarily reflect a true decrease in HIV, with at least part of the decline explained by better data collection because the number of people tested for HIV has increased dramatically, from 32,000 people in 2007 to 138,000 in 2010. This has resulted in data that reflects a more representative sample of the wider population. 

Professor Toole said that he didn’t think the HIV epidemic in Papua New Guinea would get worse, as long as programs continue to be adequately resourced. He said that legalising sex work and homosexuality would open the door for further progress to be made.

Dr Darren Russell, director of sexual health at Cairns Base Hospital and a former president of the Australian Federation of AIDS Organisations, agreed that progress has been made, with increased testing and treatment, better condom distribution and involvement of churches.

However, he said the factors driving the epidemic in Papua New Guinea are still present, meaning the future is uncertain. “PNG ranks 134 out of 148 on the UN’s 2012 Gender Inequality Index… women often don’t feel they have the right to ask for a condom,” he said.

Along with gender disparity, the practice of having multiple sexual partners, a high number of other sexually transmitted infections that increase the risk of acquiring HIV and a low rate of full circumcision among men continue to drive the epidemic, he said.

Sources