Responding to HIV/AIDS in
Papua New Guinea
AUSTRALIA’S STRATEGY TO SUPPORT PAPUA NEW GUINEA
2006–10
APRIL 2006
www
.ausaid.gov
.au

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IMPACTS OF HIV/AIDS 2005–2025 IN PAPUA NEW GUINEA, INDONESIA AND EAST TIMOR

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Contents
SUMMARY
4
1 INTRODUCTION
6
2
GOAL, PRINCIPLES AND PRIORITIES
8
Goal

8
Principles
8
Priorities
9
3
FOCUS AREAS OF THE PNG NATIONAL STRATEGIC PLAN ON HIV/AIDS 2006–2010
10

1
Treatment, counselling, care and support
10

2
Education and prevention
12

3
Epidemiology and surveillance
14

4
Social and behaviour change research
15

5
Leadership, partnership and coordination
16

6
Family and community support
18

7
Monitoring and evaluation
19
4
DELIVERING AN EFFECTIVE RESPONSE
20

1
Make gender a crosscutting theme
20
2
Build
capacity
20

3
Act on lessons learned
21
4
Manage
risks
21

5
Adopt an integrated approach
23
IMPACTS OF HIV/AIDS 2005–2025 IN PAPUA NEW GUINEA, INDONESIA AND EAST TIMOR

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Summary
After wide consultation within the Government
In PNG, HIV is spread primarily through sexual
of Papua New Guinea and the community, the
activity. Key determinants of the epidemic include
National AIDS Council developed the document
high rates of sexually transmitted infections,
Papua New Guinea National Strategic Plan on
pervasive multiple partnering, widespread
HIV/AIDS 2006–2010. This plan sets out the basis
engagement in transactional sex and extensive
for a national coordinated multisectoral response to
sexual violence against women. Underlying social
the HIV/AIDS epidemic for the next five years. In
and institutional factors that are hampering
his endorsement of the National Strategic Plan, the
the national response to the epidemic include
Prime Minister of Papua New Guinea, Sir Michael
insufficient leadership, a lack of coordination
Somare, urged all development partners to support
and surveillance capacity, gender inequality and
the implementation of the plan.
deteriorating health services.
Australia has made an explicit commitment to the
The goal of Australia’s strategy to support PNG’s
National Strategic Plan by using it as the foundation
response to HIV/AIDS is to work with the
document for this strategy, Responding to HIV/AIDS
Government of Papua New Guinea and other
in Papua New Guinea: Australia’s strategy to support
development partners to reduce the spread of
Papua New Guinea 2006–10. It also demonstrates
HIV/AIDS in the country and to mitigate the effects
Australia’s support for the ‘Three Ones’ principle of
of the disease on Papua New Guineans living with
‘one agreed HIV/AIDS Action Framework that drives
HIV/AIDS and their families, and on PNG society
the alignment of all partners’, as articulated by the
generally. The strategy’s objectives support each of
Joint United Nations Programme on HIV/AIDS
the seven focus areas of the National Strategic Plan.
(UNAIDS).
Australia will give highest priority to enhancing
The escalating HIV/AIDS epidemic in Papua New
preventive efforts to reduce the spread of the
Guinea (PNG) has reached a critical stage. It has
epidemic. The next five years will be a crucial period
passed the threshold of 1 per cent prevalence across
for developing effective preventive interventions
the adult population and is therefore classified as
to slow the expansion of the epidemic. Australian
a generalised epidemic, making PNG the fourth
support will therefore focus on initiatives such as
country in the Asia-Pacific region to have that
improving access to treatment services for sexually
classification. The potential human, social and
transmitted infections – the presence of which
economic impacts of HIV/AIDS pose a significant
greatly increase the risk of HIV infection for people
development challenge for PNG.
exposed to the virus – and improving rates of
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RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA

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condom availability and use. These efforts will be
evidence-based to ensure they are effective, culturally
appropriate and well targeted.
A further priority will be to support PNG in
working towards achieving universal treatment
targets. Though antiretroviral therapy is a relatively
expensive intervention, it not only saves lives but has
preventive benefits.
Australian efforts will extend across PNG’s diverse
communities in order to mobilise and support them
in reducing the spread of HIV and to broaden the
reach of treatment and care. The strategy therefore
addresses underlying institutional, social and
cultural factors that are increasing the spread of
HIV/AIDS in PNG and inhibiting response efforts.
The implementation of Australia’s assistance will
therefore encompass a combination of interventions
focused on rapidly responding to critical gaps in the
present response while supporting the development
of longer term, sustainable interventions that build
the capacity of public institutions, policymakers,
service providers, the private sector, research bodies,
communities and civil society to deliver the HIV and
AIDS response.
RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA
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1 Introduction
HIV – the human immunodeficiency virus that
rising to 20.4 per cent and rural adult prevalence
weakens the immune system, ultimately leading to
rising to 8.6 per cent.
the acquired immune deficiency syndrome (AIDS)
HIV transmission in PNG is primarily driven by
– was first reported in PNG in 1987. In 2002, PNG
unsafe sexual practices. Transmission has been
became the fourth country in the Asia-Pacific region
accelerated by high rates of sexually transmitted
to be classified as having a generalised epidemic, as
infections, multiple sexual partnering, early sexual
the prevalence rate in the general adult population
debut, high levels of sexual violence and coercion,
rose above 1 per cent. Although there is a paucity
gender inequality, widespread transactional sex
of epidemiological data available on HIV/AIDS
and population mobility. This has occurred in a
in PNG, it was agreed at the National Consensus
context of deteriorating health services, low levels
Workshop at the end of 2004 that adult prevalence
of condom availability and use and high levels of
rates were between 0.9 and 2.5 per cent, with a
unemployment, particularly among young people
median of 1.7 per cent.
and women.
PNG has the poorest social indicators in the Asia-
Australia recognises the threat posed by the HIV
Pacific region. Papua New Guineans face low life
epidemic to PNG’s development and economic
expectancies, high rates of maternal and child
growth prospects. The Government of Papua New
mortality, low levels of literacy, a lack of economic
Guinea has made HIV/AIDS one of five priorities
opportunities, declining standards of service
in its Medium Term Development Strategy 2005–2010.
delivery, high rates of violence and a lack of law and
Its response to the HIV/AIDS epidemic is outlined
order. Papua New Guineans are now also facing the
in Papua New Guinea National Strategic Plan on
challenge of a generalised HIV/AIDS epidemic.
HIV/AIDS 2006–2010 and in National HIV/AIDS
A 2005 modelling study estimated that there
Strategic Framework 2004–2008. Implementation of
were 64 000 Papua New Guineans then living
the response is supported and coordinated primarily
with HIV/AIDS. If HIV/AIDS continues to spread
by the National AIDS Council and its secretariat
at the present rate and if interventions do not
(part of the Department of the Prime Minister and
expand, it is projected that there will be over half a
National Executive Council) and by the National
million (537 000) Papua New Guineans living with
Department of Health.
HIV/AIDS in 2025. In this scenario, prevalence
Supporting PNG’s HIV/AIDS response is one of the
among 15–49 year olds is projected to reach 10.9 per
four pillars of the Papua New Guinea – Australia
cent nationally by 2025, with urban adult prevalence
Development Cooperation Strategy 2006–10,
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RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA

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reflecting both countries’ recognition that
foundation document for this strategy is an explicit
combating the HIV epidemic is central to successful
commitment to supporting the Government of
development outcomes in PNG.
Papua New Guinea in its response to HIV/AIDS.
It also demonstrates Australia’s support of the
From 2000 to 2006 Australia’s support for the
‘Three Ones’ principle of ‘one agreed HIV/AIDS
PNG government and community response to
Action Framework that drives the alignment of all
the HIV epidemic was primarily through the
partners’, as articulated by the Joint United Nations
$66 million National HIV/AIDS Support Project.
Programme on HIV/AIDS (UNAIDS).
This project has made a positive contribution
to the HIV/AIDS response in terms of raising
awareness, socially marketing condoms, providing
comprehensive training for counsellors and health
workers, supporting law reform, expanding access to
voluntary counselling and testing, fostering church
leadership, supporting provincial AIDS committees
and providing grants for research and community
projects. However, the prevalence of HIV/AIDS
continued to rise over this period.
In the face of a worsening generalised epidemic,
Australia’s strategy to support PNG’s response to
HIV/AIDS aims to extend support widely across
PNG’s diverse communities in order to mobilise
and support them in reducing the spread of
HIV and to broaden the reach of treatment and
care. Australia will support PNG in addressing
underlying institutional, social and cultural factors
that are increasing the spread of HIV in PNG and
hampering response efforts.
Australia’s strategy to support PNG’s response to
HIV/AIDS outlines the goal, principles and priorities
that will guide Australia’s development of a new
program of activities to support the PNG National
Strategic Plan. Guided by the goal, principles
and priorities, Australia has developed a detailed
implementation framework. This framework defines
how Australian support will be delivered through a
consultative process involving close cooperation with
the Government of Papua New Guinea and active
engagement with other development partners.
Australia’s strategy is based on the PNG National
Strategic Plan, which offers a comprehensive
framework for responding to HIV/AIDS in PNG
over the next five years. In his endorsement of this
plan, the Prime Minister of Papua New Guinea,
Sir Michael Somare, urged all development
partners to support the implementation of the plan.
Australia’s use of the National Strategic Plan as the
RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA
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2 Goal, principles and priorities
Responding to the HIV/AIDS epidemic is one
Australia’s primary focus will be on enhancing
of four pillars that have been agreed by the
preventive efforts to reduce the spread of the
governments of Australia and Papua New Guinea
epidemic. Australia will also support PNG in
under the framework for the Papua New Guinea
working towards universal treatment targets.
– Australia Development Cooperation Strategy
2006–10.
PRINCIPLES
The document Papua New Guinea National Strategic
Plan on HIV/AIDS 2006–2010 was produced through
Australia’s engagement on HIV/AIDS in PNG
the collaborative effort of many individuals and
is based on the understanding that HIV/AIDS
organisations. It promotes an integrated response
is a development crisis that requires a range
to the HIV epidemic and is flexible enough to
of immediate, medium-term and longer term
provide policymakers, administrators, business
responses. The success of Australia’s program of
managers, donor organisations, church leaders,
support will depend on how effectively Australia
non-government organisations and other partner
engages with Papua New Guineans and their
agencies with a framework to guide their specific
institutions.
responses within their own settings.
The principles that will underpin Australia’s
Australia’s strategy to support PNG’s response to
engagement on HIV/AIDS in PNG are:
HIV/AIDS outlines how Australia will assist the
> Promote local ownership and leadership and
continued implementation of the PNG National
support local expertise and institutions in
Strategic Plan.
responding to the epidemic.
> Build capacity in PNG government agencies,
GOAL
systems and individuals to effectively implement
and monitor the PNG National Strategic Plan.
Australia will work with the Government of Papua
New Guinea and other development partners to
> Promote coordination and partnership based
reduce the spread of HIV/AIDS in PNG and to
on an understanding of each stakeholder’s
mitigate the effects of the disease on Papua New
comparative advantages.
Guineans living with HIV/AIDS and their families,
> Acknowledge the complexity and scale of the
and on PNG society generally.
epidemic and the need for responses that are
evidence-based, well-resourced, targeted and
locally adapted.
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RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA

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> Place people and human rights at the centre of
> mobilising communities on HIV prevention, to
the response and encourage the involvement and
develop informed, culturally appropriate, rights-
visibility of people living with HIV and AIDS.
based strategies to address behavioural and social
issues driving the epidemic
> Engage those communities most likely to be
affected by the epidemic in the development and
> promoting gender equality and reducing sexual
implementation of policy and programming.
violence to address the greater risk posed to
women and girls, and supporting equitable access
> Support a continuum of responses that,
to services to prevent and treat HIV/AIDS
while focusing primarily on preventing HIV
transmission, will also provide care and support
> expanding the health sector response by
for people living with HIV/AIDS and access to
improving the capacity of primary health services
quality and affordable treatment.
to prevent HIV and other sexually transmitted
infections and to support treatment, care and
> Seek to address the underlying causes of
improved access to HIV/AIDS treatment,
vulnerability, including stigma, discrimination
including antiretroviral therapy
and gender inequalities.
> mainstreaming HIV in development initiatives,
Through its engagement on HIV/AIDS in PNG,
to promote a multisectoral response to the factors
Australia will support the guiding principles of
driving the epidemic and arising out of it, and
the PNG National Strategic Plan and the UNAIDS
‘Three Ones’ principle.
> building the evidence base for action, to ensure
interventions are effective, culturally appropriate
and well targeted.
PRIORITIES
These specific areas for Australian assistance reflect
The National Strategic Plan focuses on seven areas,
the understanding that a generalised, sexually driven
which provide the broad strategic framework for an
epidemic requires fundamental social, cultural
integrated national response for the next five years:
and institutional factors in PNG to be addressed
1 Treatment, counselling, care and support
in order to effectively and sustainably reduce the
spread of HIV/AIDS and mitigate its impact. A
2 Education and prevention
series of objectives for such assistance were selected,
3 Epidemiology and surveillance
based on an assessment of Australia’s comparative
advantage and the kind of resources we can provide.
4 Social and behaviour change research
Australia’s strategy aligns those objectives with the
5 Leadership, partnership and coordination
focus areas of the PNG National Strategic Plan.
6 Family and community support
Gender inequality is a major driver of the HIV
7 Monitoring and evaluation.
epidemic in PNG. Gender-based approaches
are recognised internationally as crucial for all
Based on lessons learned from our history of
responses to HIV. The significance of gender is
cooperation on HIV/AIDS in PNG, on consultations
recognised in the National Strategic Plan and gender
with the Government of Papua New Guinea and on
issues cut across each of the plan’s seven focus
advice from a PNG-based steering committee and an
areas. Australian support of the National Strategic
international advisory reference group, Australian
Plan will highlight the significance of gender and
support needs to be directed to specifically assist in:
seek to ensure that there is a very strong focus on
> strengthening leadership and coordination
gender across all areas.
within national, provincial and local governments
and within the non-government sector,
including churches
RESPONDING TO HIV/AIDS IN PAPUA NEW GUINEA
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3 Focus areas of the PNG National Strategic
Plan on HIV/AIDS 2006–2010
1 TREATMENT, COUNSELLING, CARE AND SUPPORT
The roll-out of antiretroviral therapy is likely to be
constrained by insufficient numbers of appropriately
trained health workers. Medical supply logistics will
GOAL
require much greater integrity to supply sexually
To decrease morbidity and mortality from AIDS
transmitted infection treatment and antiretroviral
and related causes, to improve the quality of lives of
drugs and other HIV-related items. Real expenditure
people living with HIV, and to encourage access to
by government on health care fell by 13.4 per cent
voluntary counselling and testing
between 2001 and 2004.
Studies have determined that sexually transmitted
SITUATION ANALYSIS
infections are widespread among the PNG
population. Given the epidemiological synergy
The impact of the growing HIV/AIDS epidemic
between HIV and other sexually transmitted
will create a crisis for already weak health systems,
infections, expanding access to treatment for sexually
with an excessive burden falling on tertiary health
transmitted infections is particularly important at
services due to the poor state of primary health
this early stage of PNG’s generalised epidemic. The
services. The PNG National Health Plan 2001–2010
attitudes of some health workers need to be changed
has predicted that for every 5 per cent increase in
in the context of the HIV/AIDS epidemic and high
HIV prevalence in PNG, the total national spending
rates of sexually transmitted infections, so as to be
on health will need to increase by 40 per cent.
more supportive of condom distribution and sexual
Demand for health care services will increase as the
and reproductive health programs. HIV/AIDS
epidemic causes workforce attrition. Counsellors
can also exacerbate the spread of tuberculosis and
and caregivers will need greater support, as they face
compromise its control, and efforts to strengthen and
difficult and isolating conditions.
integrate tuberculosis programs are needed.
The health sector’s response to HIV/AIDS in PNG
has been hampered by inadequate planning and
coordination between national government agencies
TREATMENT, COUNSELLING, CARE AND SUPPORT
and the deteriorating state of primary health
UNDER THE NATIONAL STRATEGIC PLAN
services. Major issues include poor coordination
PNG’s Medium Term Development Strategy
between different parts of the system, poor
ranks primary and preventive health care as a top
management and supervision of staff, inadequate
expenditure priority, and emphasises the need to
financial and human resources, closure of aid posts
strengthen rural health services, particularly health
and low levels of outreach to remote areas.
centres and aid posts. ‘Effective supervision, regular
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Document Outline

• Responding to HIV/AIDS in Papua New Guinea
• Contents
• Summary
• 1 Introduction
• 2 Goal, principles and priorities
• 3 Focus areas of the PNG National Strategic Plan on HIV/AIDS 2006…2010
• 4 Delivering an effective response

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