‘I’m not afraid – I have protection!’ reads the caption on this AIDS awareness poster at the entrance to the AIDS ward of Mount Hagen General Hospital in PNG. PHOTO: AAP Image/AFP/Torsten Blackwood. Used with permission.

With Australia’s nearest neighbour, Papua New Guinea, facing the possibility of a catastrophic HIV epidemic, Australian AIDS activists are working with local positive people to ensure their voices are heard.

The head of the United Nations’ AIDS agency, Dr Peter Piot, has said he is alarmed by the apparently uncontrolled spread of HIV in Papua New Guinea.

Speaking at the Asia-Pacific Leadership Forum on HIV/AIDS and Development in Port Moresby in February, Dr Piot described PNG as “a new frontline of the AIDS epidemic,” and said he was shocked at the rapid growth in the number of people infected in the country, especially women.

Against this background, Australia’s National Association of People Living with HIV/AIDS (NAPWA) has been working with the country’s HIV-positive community since 2002.

A key milestone for the PNG positive community came in November 2003 with the formation of the country’s first representative organisation for people living with HIV/AIDS, Igat Hope (the name means ‘there is hope’ in Tok Pisin).

The organisation’s founding followed the 2003 NAPWA conference in Cairns, which was attended by a large delegation of people from PNG, and since then, NAPWA has been actively involved with Igat Hope, providing peer support, mentoring and guidance to assist the fledgling organisation.

Currently operating in Port Moresby but with plans to expand to other cities and eventually become a truly national organisation, Igat Hope’s objective is to give positive people a unified voice — to lobby government, provide information, promote access to treatment and care, and fight stigma.

The group has been granted funding from the United Nations Development Program and is working with NAPWA to develop a constitution, develop advocacy skills and organisational capacity.

With funding from the Australian government’s overseas aid program AusAID, NAPWA representatives have visited PNG twice in recent months, once in August last year and again in January.

PNG may be geographically close to Australia, but the country’s experience of HIV/AIDS is shaping up to be worlds apart. While the most recent UNAIDS figures, for the end of 2003, put the number of people living with the virus at around 16,000, there is evidence that the number is much higher — as many as 100,000 of PNG’s 5.4 million people could be infected, and the epidemic is said to be spreading rapidly, fuelled by extreme poverty, violence against women, and internal migration.

It sounds very much like a recipe for disaster, and indeed it is — for some years, warnings of the possibility of an Africa-style epidemic in PNG have drawn only a lukewarm response from the country’s government. Now there are fears that with the HIV epidemic becoming generalised within country, there is little that can be done to avert a catastrophe.

The enormity of the threat to PNG was emphasised by Dr Piot. “It’s about the survival of the nation,” he told the Leadership Forum.

At a function to officially launch Igat Hope, Dr Piot said the establishment of a national PLWHA organisation was a “defining moment for the response to AIDS in Papua New Guinea.”

NAPWA’s International Portfolio Convenor, John Rock, agrees that the formation of a national advocacy organisation is a key milestone. While local organisations and drop-in centres are best placed to deliver services on the ground, he said: “Igat Hope is the only body which is really going represent PLWHA voices at a higher-order level.”

“I would hope that they would have a greater voice in policy, with the National AIDS Council, that they should be involved with the Global Fund.”

The challenges facing Igat Hope are considerable, Rock acknowledged. “Not only do you have a lot of ethnic diversity, but you also have geographic isolation,” he said. Internal communications within PNG are very poor: Port Moresby — the capital and largest city — is unconnected by road to other major cities, making transport slow and expensive.

While government and non-government organisations in PNG are committed to responding to the growing AIDS problem, the challenge, said Rock, is “to decide what is the best way to use that funding given that the infrastructure to deliver things like treatment and services is not well-established.”

For individual positive people, the immediate urgency for most people is simply getting food and shelter, said Rock. “Most positive people don’t have a job, they have no prospects of a job and they have little or no income,” he said.

In a country with chronic underemployment, no welfare system and where general health is very poor to begin with, the added stigma of being HIV positive creates a substantial burden. HIV testing levels are very low — tests are not easily available — which means that most positive people become aware of their HIV status only when they or their spouse become too sick to work.

“The difficulty is that PNG is a very complex and very specific society with many social and economic problems,” said Rock. “The willingness of external agencies is there to assist, and I daresay there is a recognition in the government of the seriousness of the problem. What everybody’s struggling with is what is the best way forward to try to achieve something in a timeframe which is effective before the problem gets much much worse.”