By Prue Borthwick, HIV and AIDS Program, AusAID

Driving Papua New Guinea’s Highlands Highway is an up and down experience, literally and figuratively. The Highway winds through five provinces, rising over an endless number of ridges and plunging through deep ravines and valleys. It traverses some of the most densely populated areas of the country. The longest road in PNG, the Highway is critical to the movement of people and goods. It is also an artery which spreads HIV.

Highlands Highway (photo by John Gould)

In my recent trips along the Highway, I’ve noticed an increasing number of markets and entertainment venues which have sprung up to cater for passing traffic, particularly truck drivers. I shouldn’t be surprised. New developments in the area, like the much anticipated Liquefied National Gas (LNG) project, are attracting many people from the surrounding areas with the promise of well-paid work.

The problem is that more mobile men with more money means more alcohol, more sex workers and more opportunities to pass on HIV. It is estimated that 0.9 per cent of the PNG population aged 15-49 years are HIV positive. In the Highlands provinces and around Port Moresby, prevalence is more than one per cent. People from the Highlands account for 75 per cent of all new cases.

The concentration of HIV infection in the Highlands has prompted a targeted approach, with the focus on particular regions and groups of people. The majority of our work is supporting partners in civil society and the private sector to intensify HIV prevention, testing and treatment.

Mt Hagen World Aids Day event (Photo by John Gould)

Our partnership with the Catholic Church in PNG – which provides 50 percent of all outpatient health services in the country – has vastly improved access to HIV services. We are also working closely with Oil Search Limited, one of the companies in the LNG project. At the same time, we are helping strengthen PNG’s government health systems and support service delivery.

Lately, demand for HIV testing and antiretroviral treatment services has exceeded supply despite a major expansion in the number of testing centres in the past 6 years, many through Australian funding. In 2010, 135,234 men and women were tested for HIV, with over 50 per cent testing at one of the 111 testing sites supported by AusAID. Compounding the problem, many clinics are losing key health staff to higher paid work with LNG.

The different approaches to HIV prevention operate on different levels, but there is still a role for face-to-face engagement. Tingim Laip (Think About Life) is PNG’s largest HIV prevention project. With Australia’s support, they focus on high risk populations and high prevalence areas. Lack of access to condoms is often cited as a reason for not using them, so Tingim Laip outreach teams work in 36 locations across the country.

In the Eastern Highlands, at about the halfway point of the Highlands Highway, I joined a Tingim Laip team at Goroka’s Kakaruk market. It’s a busy market, even though the range of goods is small – all you can buy is betel nuts, cigarettes and beer. The floor of the market is carpeted with betel nut husks compressed into the mud. Tingim Laip do outreach in the late morning. By the afternoon people may have been drinking and fights can break out. At the back of this busy market, behind the beer stall, the Tingim Laip people pointed out a shed where casual sex can be arranged. Once the team provides free boxes of condoms to stall holders and does a condom demonstration to a small crowd, it’s time for us to hit the Highway again.