Global AIDS - Papua New Guinea

Fighting against HIV Epidemic - Courier-Post - Port Moresby - 19 October, 2004

Focus - Tuesday 19th October, 2004 - By Maureen Gerawa

DESPITE all the criticisms levelled against the National AIDS Council (NAC), particularly with its blunt advertisements on HIV campaigns, it has no doubt started the debate on the HIV issue.

Young children, including those at primary schools who have never discussed sex with their parents, were being confronted with the issue. A six-year-old boy and his seven-year-old brother, for instance, getting on a PMV bus after school suddenly realised the radio is playing the advertisement by former NAC director Dr Clement Malau, quickly blocked their ears.

One says, “em samting no gut’’ (it is no good). This is exactly what they were told at home whenever Dr Malau came on television or radio with his blunt HIV message during the initial years of NAC. Even if the boys may not have understood the entire message, they have understood from the reactions from their parents that AIDS is something terrible.

A year from now, Papua New Guinea should know whether the Australian Government will continue to fund the HIV/AIDS support project through NAC.

Talks are now on between AusAID and various stakeholders, including the Government and faith-based organisations on how this assistance will be continued after next year.

One of the options will be for AusAID to channel its funds directly to the different sectors.

The HIV/AIDS support project, which cost Australia $A60 million, came into being four years ago when AusAID was asked to fund the Government’s medium-term plan through the National AIDS Council Secretariat in 1998.

The NAC Act was passed a year before that by the Parliament and the secretariat set up in 1998, replacing the National AIDS Surveillance Committee which was formed under the Health Department to advise the Government on the HIV epidemic.

The medium-term plan provided a general guideline on what the council should do to respond to the HIV/AIDS epidemic.

There were two principles under which the project was implemented — firstly, the council was expected to translate the plan into activities and programs, and secondly, to establish the National AIDS Council as a co-ordinating mechanism to co-ordinate provincial AIDS committees.

So what has the council done? National AIDS Council director Dr Ninkama said the secretariat had set up the provincial AIDS committees as mandated.

However, a number of them were not operating due to various factors, including the instability of provincial governments due to politics and other issues.

In these provinces, the council had helped support local groups directly instead of going through the PACs to implement its programs. So much has been done there is no space to mention all of it but the programs and activities under the HIV/ AIDS support project were divided into seven components.

These were information, education and communication (IEC); community, care and support (CCS); legal and ethical; provincial programs; sectoral response; peer education; medical laboratory, monitoring and evaluation.

In IEC, the activities included media campaigns, specific anti-stigma campaigns, condom promotion, ABC (Abstain, Be faithful and Condom) messages and training of drama groups to carry the message.

The sector response included a toolkit which was a set of guidelines developed in collaboration with different organisations to guide the production of workplace policies.

The toolkit is now being tested. The HIV prevention programs being carried out in a number of organisations such as the Correctional Institutional Service, mining sector, logging, police and PNG Defence Force have also been developed under this component.

The sectoral response programs encompassed treatment, counselling care and support; education and prevention; epidemiology and surveillance; social and behavioural change research; leadership partnership and co-ordination; family and community support and monitoring and evaluation.

Recently, government departments have begun meeting with the National AIDS Council to develop a document to guide the response to the HIV/AIDS in the government sector.

The council had tried for a long time for such a document to be formulated so each government department would take ownership of the HIV problem — and finally it is coming.

The main thrust of the provincial responses focused on encouraging provinces to develop innovative approaches for HIV prevention to suit the local scenario. It asked provincial governments to take ownership of the provincial programs to respond to local needs and to ensure the programs were sustained.

Most of the provincial administrations have yet to embrace this vision, depending on NAC to continue to fund the PAC activities.

The high-risk strategy, introduced recently at the National Capital District Provincial AIDS Council, is one of the initiatives to involve local communities and civil-service organisations.

This will eventually be introduced in other provinces as well and complements the peer education program.

Under the legal and ethical component, the major project accomplished is the HIV/AIDS Management Act which has been passed. It is awaiting to be enacted and implemented.

Testing and statistics being collated by the council comes under the medical laboratory, monitoring and evaluation component. Dr Moiya said the council was carrying out this work although it would be normally done by the Health Department. It is hoped the department will eventually take it up.

There was also training conducted for hundreds of HIV counsellors and care providers for people living with HIV/AIDS — and HIV/voluntary counselling and testing sites across the country.

“We are mandated to guide, monitor and facilitate. It is not about doing things but we’re doing it because no one is doing it. We have tried to sensitise others to do it,’’ he said.

The council has initially recruited nine national staff to work with the council which meant only one staff member was assigned to each component of the project. The figure was eventually increased to 15 but this was obviously not enough, resulting in staff often being overwhelmed with work.

AusAID consultants in each component had recruited about 10 others under the support project who will go when the project ends. The awareness, care and counselling component of the project was implemented in collaboration with community-based organisations, faith-based organisations and non-government organisations.

He said a few weeks ago, the Government begun working to develop a document to guide the response to HIV/AIDS in the government sector.

“We are now having discussions with AusAID, other donor agencies, non-government organisations and others on what kind of format we should come up with,’’ said Dr Moiya.

One of the success stories of NAC has been its relationship with development partners.

While AusAID had been the major sponsor of NAC’s programs and activities, other donor agencies have also joined the fight against HIV/AIDS, developing programs to tackle areas left off by the council.

The United Nations Development Program (UNDP) is working with the leaders of the various sectors by running two workshops so far this year.

The European Union is funding the peer educators program, mostly with young people. The United Nations Children’s Fund (UNICEF) has collaborated with NAC on the introduction of the mother-to-child-transmission treatment being implemented by the Obstetrics and Gynaecology division of the Port Moresby General Hospital.

The World Health Organisation is also providing technical support in the antiretroviral (ARV) program, funded by the Asian Development Bank. The program is being piloted at PMGH with plans to extend it to other regions.

“We’ve achieved a lot of things. We’ve managed to set up the secretariat and the provincial AIDS councils even though some of the provincial AIDS committees are not working (as we would like them to),” said Dr Moiya.

“But we have generally set down the foundation work for future response, set up some policies and guidelines under which the response can be developed further.’’

“And we’ve sensitised leaders of different sectors to take ownership of the problem and respond appropriately in their own settings.’’

After five years of the program, would Dr Moiya say the council had used the $A60 million as it should?

“No. In any funding, there is always some wastage, some misappropriation. We had our share of the problems but we try to be accountable,’’ he said.

Dr Moiya said apart from funding programs and activities at the national level and paying salaries, money was also sent out to the provinces for provincial activities and salaries of the provincial staff. Usually, the PAC staff send applications for their programs which are screened before funds are approved. If the proposals are done unsatisfactorily, the PAC staff are asked to re-do them.

The grants sent based on these proposals were to fund local and CBO and NGO activities in the local settings.

“Some (provinces) are struggling, while others are not,’’ he said. “We would like the provincial administrations to take ownership of the programs. They need to fund these programs and pay the salaries of the PAC staff because the project (HIV/AIDS support project) will not be here forever. Somehow the Government needs to take over.’’

Despite all the efforts made so far by the council in trying to address the HIV issue, the reported HIV cases are continuing to increase.

Between the first case reported in 1987 and 1995, the figures had increased steadily. However, the figures had doubled after that which put PNG as the fourth country in 2002 as having a generalised epidemic. The most affected population are between 15 to 45 years old.

The cumulative figures had gone beyond 8000 by December 2003, with the highest prevalence rates being recorded among sex workers and mothers at the antenatal clinic.

This year, the figure is estimated to be more than 9000. The reported HIV cases were found only in certain provinces at the beginning but HIV cases are now being reported in almost every province in the country.

One of the most effective means of dealing with the HIV/ AIDS issue is being able to work with people living with HIV/ AIDS — which the council had done.

A number of these people have helped formed Igat Hope, a network of PLHWAs in Port Moresby, with the aim to extend the network to other provinces.

“Getting the message (across to people) is not a problem but it is changing attitudes and behaviour that is an issue. People know AIDS has no cure, but still continue to have sex without condoms. This is typical of human beings,’’ Dr Moiya said.

Dr Moiya also revealed the National Government had given about K706,000 in the past two years to the council which could not sustain the operations of the council, even for a year.

“It could perhaps pay for the service of a car and fuel and be used up,’’ Dr Moiya said. “Thanks to the project (HIV/ AIDS) we are able to do a lot of work,’’ he said.

Dr Moiya said the council had reviewed its structure, including job descriptions with the intention of increasing its staff ceiling. But if the project ceases, the council will have to reduce its activities to concentrate on monitoring and co-ordinating the activities of the different sectors and provinces.

What is the way forward?

“The Government needs to take ownership of the problem. There must be a strong political will and leadership — and PNG has to make HIV a visible problem, make the epidemic a visible problem,’’ Dr Moiya said.

“We need to strengthen the council secretariat and the provincial AIDS committees —and work towards eliminating stigma and discrimination and implement the HIV/AIDS Management Act.’’

Other issues that need to be tackled include negotiating future funding from development partners; mainstream activities to different sectors; develop workplace policies; develop monitoring and evaluation indicators of the national strategy plan; and address legal and ethical issues in regards to HIV in workplaces such as insurance.

“We (often) feel overwhelmed but I think we’ve done a lot that we can proud of,’’ he said.

“After all, what is said and done at the individual level is a private matter. In other words, we can say and do all we want but if people at the individual level can’t respond positively to prevent HIV, all we’ve done will go for nothing.’

“I hope people will continue to take heed. If not the epidemic will continue to grow.’’