Aids will destroy a nation

Despite assurances from the Papua New Guinea Government that it is doing "more than any other government" to stop the spread of HIV/AIDS, the country is now facing a health emergency. At least 120,000 Papua New Guineans are likely to have HIV/AIDS, and infections are multiplying rapidly. Infection rates are now estimated to be 2 per cent to 3 per cent of the population. If today's trends continue, 18 per cent of the population could be affected by 2010, and 25 per cent by 2020.

PNG could lose up to a third of its population to the disease.

If these projections come to pass, the resulting decline in the labour force and gross domestic product per capita would be catastrophic, not to mention the suffering of the orphans and those left to care for survivors.

The basic health situation in PNG has deteriorated in the past 30 years.

Little has been done by those responsible to arrest the obvious decline. Newspapers in PNG have begun campaigning for some government-led action.

Allocating blame for this situation is a waste of time the people of PNG don't have. The dimensions of infection and the way it is spread need to be clearly understood.

The biological, social and political drivers responsible for this rapid rise in HIV/AIDS infections have to be recognised so that practical measures can be found to halt the present trend.

HIV/AIDS in Papua New Guinea is spreading through heterosexual sex and social conventions of promiscuity. The low status of women means they have little power to negotiate sexual relations, let alone condom use. Young women, often subject to rape, are the most vulnerable group in the country.

The virus circulates between generations when old men sleep with young girls, for example; casual and commercial sex increases the danger that men will go on to infect their wives.

Sexually transmitted diseases are closely linked to the spread of HIV/AIDS and are also widespread in PNG.

Low standards of living (standards that have barely improved in the past 30 years) and a decaying health infrastructure mean malaria, tuberculosis and diarrhoeal diseases are endemic.

The HIV virus is attacking a population already weakened by waves of preventable infections. PNG's maternal mortality rate, for example, is the second highest in the world. One in 18 rural women die in pregnancy or childbirth. Of the infants who live, one in 10 will die before their fifth birthday.

Unlike the bubonic plague or cholera, HIV/AIDS has a long gestation period. An epidemic won't simply "burn out". The virus is most infectious when it is first acquired but often not diagnosed until years later. This raises the chances the virus has to spread.

Again, unlike many other diseases, HIV/AIDS avoids the very old or the very young and attacks people in their prime.

High crime levels and suspicion of police and government also aggravate the epidemic by decreasing trust, and fuelling rumours and misinformation. One of the resulting dangers is accusations of sorcery and the rise in quack remedies that become part of the problem.

The extent of the epidemic in our Pacific neighbour today is probably underestimated because the health infrastructure is decaying, particularly in rural communities. Most hospitals are poorly equipped and maintained and often run out of basic medical supplies. In many hospitals, there is not even running water to wash your hands.

Anti-retroviral therapy can be offered to only a tiny proportion of those infected. PNG medical officers point out that there is no incentive for people to seek testing if no treatment or care is available after a positive diagnosis and patients risk discrimination.

A large amount of foreign aid has been devoted to the epidemic, notably from Australia, but also from other countries and multilateral agencies. In the past six years, Australia has allocated more than $60 million specifically to fight HIV/AIDS in PNG. However, in the absence of real leadership by the PNG Government to fighting the epidemic with concrete steps, these sums are ineffectual. The potential is for another South Africa, where the government did not deal aggressively with HIV/AIDS: citizens there now spend more time attending funerals than they do getting their hair cut, shopping or having barbecues. HIV/AIDS has altered the fabric of a nation.

Australia also has a direct interest in PNG's HIV/AIDS epidemic because increasing numbers of PNG nationals are using the Queensland health system in the Torres Strait Islands and on Cape York.

No country has made serious progress in stopping or slowing the spread of HIV/AIDS without serious and resolute commitment by those in power. The HIV/AIDS epidemic is only one of the serious health challenges faced by the country, and strategies to tackle HIV have to build on basic health initiatives that today are sorely lacking.

Furthermore, why would people voluntarily come for HIV testing in a country where previously treatment was non-existent, where comprehensive care and support after a diagnosis was not in place and where discrimination and stigma were widespread? To date, there has been no specific notification process for AIDS-related deaths.

Miranda Darling Tobias is a Research Fellow at The Centre for Independent Studies, a public policy research institute. * This article is based on Miranda's paper, The HIV/AIDS Crisis in Papua New Guinea, which can be found at www.cis.org.au.