MILLIONS TO DIE OF AIDS IN PNG
Now or never if Pacific wants to win against HIV
Samisoni Pareti
Diplomatic speech says to avert a humanitarian crisis, Pacific governments need to pour money into HIV/AIDS now. Undiplomatic speech should say Pacific leaders need to get off their butts and grab HIV/AIDS by the horn or history will judge them as leaders that led their people into total annihilation.
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Port Moresby Hospital... up to 18% of PNG’s population could be infected in three years’ time and increasing further to an alarming 25% in 2020. |
Some if not all of them may not be around to see such a tragic end and made to answer for such negligence.
The talk should be that leaders of the Pacific are only paying lip service, applying cosmetic measures like annual HIV budgets and establishments of AIDS Council strategies which are like a droplet of water in the wide and deep Pacific Ocean.
As shown in a recent report of the Australian Centre for Independent Studies, Papua New Guinea is proof of the common Pacific region’s lethargic treatment of the imminent HIV crisis.
PNG crisis
With HIV prevalence estimated between 1.8% to even 3% of the population, leaders of PNG, according to the report, still have their heads buried in the sand.
“Nowhere in the world has a country made serious headway in stopping or slowing the spread of HIV/AIDS without a serious and resolute commitment by those in power,” said CIS research fellow, Miranda Darling Tobias, in her report titled ‘The HIV/AIDS Crisis in Papua New Guinea’ released on February 8.
“There have been too many tragic precedents for Papua New Guinea to ignore their own HIV/AIDS epidemic.
“The world wants to help but outside efforts alone cannot be effective without leadership from Papua New Guinea itself.”
In the report’s executive summary, Tobias observed that under present rising infection trends, up to 18% of PNG’s population could be infected in three years’ time and increasing further to an alarming 25% in 2020.
“Papua New Guinea could lose a million people to the disease. The decline in the labour force and in gross domestic product per capita would be catastrophic.”
“The extent of the epidemic is probably underestimated because the health infrastructure is crumbling, particularly in rural communities.
“Most hospitals are poorly equipped and maintained and often run out of basic medical supplies.
“Antri-retroviral therapy can only be offered to a small proportion of those infected.”
The Tobias Report quoted World Health Organisation figures which showed a 2% infection rate in ante-natal clinics and an 18% rate in patients at Port Moresby General Hospital.
In fact the National Catholic AIDS Office believes that 50% of all patients in medical and tuberculosis wards in Port Moresby are admitted due to AIDS.
Mt Hagen General Hospital had at one time reported that 2 to 3 out of every 10 admissions had HIV/AIDS.
At Kundiawa Hospital, the report said AIDS cases were about 3% but doctors suspected the infection rate was much more. In Daru and Lae cities, infection rates had been estimated at between 19% to 20%.
Said the Tobias Report: “Estimates of increases in infections are frightening. In 1995, only around 300 people had been diagnosed with HIV/AIDS.
“HIV/AIDS increases rapidly because people are most infectious when recently infected.
“WHO estimated that new infections were rising at 20% a year and the figure was increasing. AusAID has estimated annual increases of 15% to 30% in numbers infected every year.
“These rates mean that AIDS could kill over one third of the adult population in Papua New Guinea within 20 years.”
Fiji is ‘PNG a decade ago’
The worry for health workers in the Pacific is that the lessons of PNG seemed to have been lost on its closest neighbours to the east, Fiji, especially.
Head of the UNAIDS Pacific office based in Suva, Stuart Watson, said HIV infection statistics are showing that Fiji is currently where PNG was a decade ago.
Last month, Fiji’s ministry of health disclosed that 36 new cases of HIV infections were confirmed in 2006—a 30% increase over 2005 and when compared to figures of 1996, this was a 90% jump.
Given that infection rates grow numerically, figures in 2016 would be frightening, said Watson
“In 1989, Fiji had eight HIV cases and if you start there and look at each year until now, you will see a fairly rapidly escalating graph.
“That tells us that we’re heading in the same direction as PNG.”
Both PNG and Fiji know that human nature can be a problem when it comes to fighting the spread of HIV. It’s like disaster management, no one wants to contribute money into it until a disaster has struck and lives lost.
“And again the experience around the world and at personal as well as national levels show that people don’t take it seriously until they are directly affected.
“So it’s not until you know someone living with HIV or you’ve seen a relative or friend die, or you see it in the health system when you go to hospitals and see people wasting and experiencing infections relating to HIV, then you start to take it more seriously.
“But otherwise, it’s somebody else’s problems. It’s a problem that belongs to those bad people, those sex workers.”
Watson is too diplomatic to tell Pacific leaders that they are doing too little in fighting the epidemic. All he would say is that the region needs to do more.
“We know from the experiences of Thailand, Brazil and Uganda that strong committed leadership, unafraid to talk about issues, about condoms, the difficult issues that we tend to bury our heads in the sand for has had a dramatic impact on the rate of new infections.
“For example in Uganda, where there was a change in the political scene and they stopped actively promoting condom, the senior leadership stopped talking about HIV, protection and all the issues surrounding HIV, the rates began to shoot back up again.
“That’s why I said that we know what works. We do know that strong, committed leadership, putting resources in it and being consistent about it, works.”
Another issue that is hardly debated in the region but one that could impinge on the fight to arrest the rise in HIV infections is the issue of resource allocation.
Money spent on HIV today is an investment, yet there is a thought that an equal amount of resources ought to be directed at not only communicable diseases like HIV but on non-communicable diseases (NCDs) as well.
In other words, spend money on HIV but not at the expense of work on NCDs like diabetics, coronary diseases, obesity and high blood pressure.
‘Difference in the numbers’
The point was well put by Dr Viliami Puloka, formerly of Tonga’s ministry of health but now a health adviser at the Secretariat of the Pacific Community.
“We are told almost daily about the risk of HIV/AIDS and “people living with AIDS,” said Dr Puloka on a paper he presented recently.
“That is appropriate but the truth is that the risk of contracting HIV in Tonga is very small, while the risk of dying from diabetes and cardio-vascular disease is among the highest in the world.
“As far as we know, there is only one individual or perhaps a handful living with AIDS in Tonga but there may be 9000 people living with diabetes.
“These are people who suffer from a preventable disease, who often have to medicate for the remainder of their life, and who die prematurely losing many years of their prime.
“The big difference is in the numbers. There are almost 10,000 times as many people living with diabetes in Tonga as there are living with HIV/AIDS.
“Prevention of diabetes and other conditions related to lifestyle deserves as much attention and public resources as people with HIV.”
As Dr Puloka argued, the “difference is in the numbers.” Of the 16 leading risk factors that caused deaths in the western Pacific region in 2000 for example, high blood pressure ranked the highest at more than 1500.
Tobacco and cholestorol ranked second and third respectively, whilst deaths related to unsafe sex came 16th at no more than 100 deaths.
Out of the 11 leading causes of death in the Pacific, eight of these, according to the SPC health expert, are “preventable risk factors,” namely:
• high blood pressure.
• smoking.
• high cholesterol.
• little fruit and vegetable intake.
• alcohol.
• overweight and obesity.
• physical activity.
Attack today’s problems first
Dr Puloka said he’s not advocating the diversion of resources from HIV work to those in the area of combatting NCDs in the Pacific.
On the contrary, all he’s asking for is a fair distribution of those scarce resources.
“It must be clear that we have the double burden of diseases. We still have the infectious disease to deal with, communicable diseases but overall that is going down.
“NCDs, diabetics, heart disease, high blood pressure and all that are really a big burden in the Pacific at the moment.
“It’s going up. In some places though, both of them exist side by side. So we still have to look at the communicable diseases, but at the same time we would like to address NCDs and unfortunately or fortunately at the moment, a lot of donor agencies are putting in a lot of funds on communicable diseases.
“I think what we are asking for now is to bring in more resources to address the real issues in most of the Pacific islands.
“Except for PNG, HIV is really not the big issue in the Pacific. It really isn’t. Even this pandemic flu, influenza, bird flu and all those stuff will be a big disaster but it’s something in the future and it may or may not happen in the Pacific.
“While it is very well and very good and we are happy that we got resources for those issues, we would like to see more resources and support to deal with the current problem.
“The current problem has somewhat become neglected. Definitely we need to put in more resources into NCDs because that’s the big issue at the moment.
“I must say though that it is a very good sign, a very positive development that has been happening, especially from NZAID, I think AusAID as well, in that they are beginning to put in more resources on NCDs which is a very good development in the Pacific.
“I think they have recognised that people in the Pacific are dropping like flies due to diabetics, heart disease and so on, and I think a lot more people are beginning to express that and make it very clear that’s where the problem is and that’s where we need to channel more of our resources.”
‘Not an either or situation’
For UNAIDS, the issue should be a non-issue. Watson said for the UN programme that coordinates all UN agencies’ work on HIV and AIDS, it is “not an either or situation.”
“We certainly recognise that NCDs are of critical importance to all countries in the Pacific, but that does not mean we should be shortsighted.
“We need to deal with HIV NOW when we have the chance to make significant gains in prevention efforts rather than waiting for disaster to arrive,” said Watson.
“It is likely that the number of identified HIV cases in the Pacific represents only a small percentage of the actual cases and by not improving our efforts around prevention, awareness and treatment we allow the virus to spread. It would be irresponsible to put the ambulance at the bottom of the cliff when we can actually do something now.
“UNAIDS asserts that the cost of acting now will be much, much smaller than waiting until the problem is big—that means that by NOT investing now, we really will be taking away resources from other important issues later like NCDs, other health issues, national development, etc.
“But this shortsightedness is indeed what drives planners and policymakers and politicians—they need to be seen to be putting the resources into what is in the forefront of the peoples’ minds (like NCDs). A good leader recognises the long-term, not just the immediate.”
‘It’s the same person’
On this, Dr Puloka had the parting word: “I don’t think we should ignore HIV.
“I think what needs to happen is that there has to be a balance and we give resources to where they are needed. There needs to be another look, a relook, at what’s the current situation. True when HIV first came, we thought everybody in the Pacific is going to be wiped out by HIV. We thought it was going to catch the Pacific like wildfire, but it has not.
“I think it’s only PNG, but for the rest of the Pacific it hasn’t. So it is not right to think that we should take all the resources from HIV and concentrate on NCDs. What I’m saying is give the resources to where the problem is, you know a more appropriate allocation of resources, that’s all it is.
“It is not to compete with HIV because after all, it’s the same person, same family that can have high blood pressure, heart disease and HIV/AIDS. So we are dealing with the same person. So the assistance still goes to the same person but the issues involved need to be addressed appropriately. |
