HIV and the Highlands Highway

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.

 

A long narrow paved road on a ridge.

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.

 

Two men with their faces painted. One man's back is facing the camera, his back contains a message painted in white that says World Aids Day.

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.

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About Engage

The Australian Government’s overseas aid program is improving the lives of millions of people in developing countries. Australia is working with the governments and people of developing countries to deliver aid where it is most needed and most effective. Australian aid has helped our neighbours and countries further abroad to develop. For example, Australian aid has wiped out polio from the Pacific. Australian aid has seen more than 1.5 million children immunised against measles and polio in Papua New Guinea. We helped build the first bridge across the Mekong River in East Asia, boosting economic opportunities for millions of people living in the region. And our water supply and sanitation programs are providing clean water for nearly 500,000 people in Tanzania, South Africa, Mozambique and Zimbabwe.

5 thoughts on “HIV and the Highlands Highway

  1. I find it curious that a major part of the Australian government’s humanitarian response to a serious life-threatening epidemic such as HIV would be to fund the Catholic church’s programs. Your own scrutiny of the engagement has been less than glowing:

    “Attitudes to condom promotion differ significantly between partners. The partner with the one of the largest coverage of activities across PNG (the Catholic Diocesan HIV Program) is opposed to condom promotion, although practice varies across the dioceses.”
    - read: http://www.ode.ausaid.gov.au/current_work/documents/png-aust-hiv-engagement.pdf#page=10

    It seems that this partnership is a double-standard in the quality of medical care provision and education, as in Australia we are educated on HIV prevention with factual, scientific, secular information. We are taught that condoms not only increase our protection against HIV, but also a whole list of other serious sexually-transmitted diseases, and also unwanted pregnancies (an important part of improving gender-equity and empowerment of women). We also know that abstinence-only as a public health education message has failed to have any effect on HIV prevention (read: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005421.pub2/abstract).

    Reading the criticisms of the Catholic church over it’s history on the subject of HIV/AIDS (http://en.wikipedia.org/wiki/Catholic_Church_and_AIDS), it is surely baffling that the Australian government would consider this organisation a serious partner in the fight against HIV. Surely a better response would be to fund the PNG Ministry of Health programs, along with other secular medical organisations active in HIV prevention in the country? Do not our nearest neighbours, a former Australian territory, deserve better?

    • Thanks for your interest in Australia’s HIV program in PNG and your comments about our partnership with churches, among others, to deliver it.

      Increasingly comprehensive HIV prevention programs include not only condom promotion but services which test and treat for STI and HIV.

      Testing, in particular is seen as an important activity for HIV prevention services, identifying those who are positive and in need of antiretroviral therapy (ART) – which also prevents transmission – and those who are negative and can be helped to stay that way.

      However, finding partners who can deliver these services across PNG, in particular in the highlands provinces, is a challenge.

      Even with Australia’s efforts to support the PNG Government and its Department of Health, the churches still provides half of all outpatient health services. In many places they are the only provider of health services. It is for this reason the churches are an important partner for the PNG and Australian Governments.

      At the start of 2011, the National Catholic AIDS Office ran 102 HIV testing sites, nearly half the national total, and 13 ART sites, providing treatment to nearly two thousand people.

      In 2010, 135,234 men and women were tested for HIV, with over 50 per cent testing at one of the testing sites supported by AusAID (we don’t yet have the total figures for 2011, but there have been year-on-year increases to date).

      These results would not be possible without the support and work of our in-country partners, including the churches.

      In 2012, churches will receive around fifteen percent of the funding available for all NGO partners under the PNG Australia HIV program.

      While some faith based organisations, like the Catholic Church, face restrictions in ‘promoting’ condoms, other faith based organisations like Anglicare, have wholeheartedly endorsed condom promotion.

      In 2011, the Australian Government funded the distribution of 25 million condoms in PNG, with nearly two million distributed though Anglicare. That said, the distribution of condoms in PNG is actually led by a private sector coalition called the PNG Business Coalition on HIV/AIDS.

      It is certainly true that secular NGOs and interventions like Tingim Laip, have a very important role in HIV prevention – especially, in conducting outreach to those most at risk. These community led programs are often better suited to this sensitive task than some government health departments.

      Save the Children’s Porot Sapot project has worked with sex workers and men who are having sex with men in Port Moresby, Lae and Goroka over the last ten years. A recent study found that 74 percent of sex-workers in Moresby accessed condoms from Porot Sapot in 2010.

      The complex social environment of PNG demands flexibility and the use of a variety of approaches. One valid and worthwhile approach is to work with the National Department of Health programs on HIV – which we support – but it can not be the only approach. Our experience has been that a range of partners are required for an effective response, as it is almost impossible to find all the different capabilities required in one organisation.

      One of our major partners is a secular medical organisation (Clinton Health Access Initiative), which builds the capacity of government treatment services in affected areas. We work with over 20 civil society partners ranging from very small community organisations of people with HIV and sex workers to secular international NGOs and faith based organisations.

      For more information please visit the PNG webpages on AusAID’s website. For further information on our health activities, this page may also be of interest to you.

  2. Thank you for taking the time to respond to my comment.

    I appreciate the efforts of AusAid to tackle HIV in PNG, and understand that turning an ideal prevention and treatment strategy on paper into reality on the ground is constrained by the complexities of the various actors involved and their own limitations of scale and expertise.

    I also appreciate that some faith-based actors are willing to put aside their prejudices / moral objections to accept the science on HIV and offer comprehensive programs for prevention and treatment. I also accept that in some cases the churches have a head-start with their community networks for the spread of educational healthcare messages. I applaud those faith-based actors that are doing the right thing and providing comprehensive programs. I do however object when organisations exploit vulnerable people for the furthering of religious creed through proselytism, a principle outlined in the RC/NGO Code of Conduct (http://en.wikipedia.org/wiki/Humanitarian_principles#Proselytism). The Catholic Church’s often dangerous statements that contradict accepted scientific knowledge on HIV prevention could be viewed as exploitation, as providing false information to patients, or neglecting to provide information that could prevent harm to a patient is unethical. The provision of medical care is also not the Catholic Church’s primary mission, and therefore not their expertise or focus.

    In the short-term, perhaps 15% of the total budget to faith-based actors in 2012 is acceptable. After all the humanitarian imperative obligates the international community to provide humanitarian assistance wherever it is needed – and the need is urgent. However, in the long-term – funding church groups to deliver healthcare is undesirable (it’s not their expertise or primary focus), unsustainable (it replaces services that should be provided by the PNG government), and a double-standard of care from the Australian people. The focus of the majority of our efforts should be to help build the capacity of the PNG government and it’s department of health. Secular medical NGOs with the expertise to respond to the HIV crisis should be prioritised to build their capacity, so that in time the scale of secular NGO and PNG government HIV prevention and treatment services outnumbers the faith-based services.

    Perhaps the faith-based groups would even thank the day they can return to what they do best!

    Thanks again for your efforts, and your time. Keep up the good work.

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