Tuesday, December 23, 2008

HIV Prevention Challenges in Papua New Guinea

PAPUA NEW GUINEA: Epidemic grows as funding falls

Via PlusNews

How do you roll out an effective HIV prevention programme in Papua New Guinea (PNG) where 800 languages are spoken, cultures and sexual mores differ wildly, and much of the country is inaccessible?
Read the whole article here.

IRMA pulled out some highlights from the article, of interest to rectal microbicide advocates, below:

- There are a number of high-risk sexual practices that are common across PNG, according to a National AIDS Council report. These include: "early sexual debut; multiple premarital and extramarital sex partners; unprotected anal and vaginal sex between men and women and unprotected anal sex between men; inconsistent condom use during the exchange or sale of sex by female and male youth, men and women; sexual violence including gang rape; and in some areas the use of penile inserts or products which dry the vagina".

"The ABC model doesn't work, it's outdated. A human being needs sex; you can be faithful, but what about your partner? And condoms are just talk in rural areas, where most of the people live; they are not available," Agnes Mek of the Rebiamul voluntary counselling and testing centre in Mount Hagen, Western Highlands, told IRIN/PlusNews.

Labels can be an uneasy fit in PNG. Indentifying commercial sex workers (CSW), a target of standard AIDS responses, presents a dilemma. "CSW are just as likely to be clerks, betel-nut sellers, collectors of firewood, struggling single mothers, girls doing Grade 8, or women trying to marry the expatriate boyfriends they meet in night-clubs," Lawrence Hammar wrote in the Papua New Guinea Medical Journal.

Sexual identity is another vague area. In a culture where initiation rituals can involve male sodomy and oral sex, same-sex activity by young men is not uncommon, and few languages have distinct terms for heterosexual, bisexual or homosexual, designing AIDS responses that target gay men, a high risk group for HIV, presents a major challenge.

- What makes all the permutations of sexual contact in PNG high risk is that condoms are not widely and consistently used. The UN system's Badcock argues that if it were merely a question of supply, then condom marketing could adopt the model used by Coca-Cola, and PNG's very own SP Breweries, who have succeeded in getting their beverages into the villages.

But condoms carry a host of associations with promiscuity - a marketing disaster. Rwabuhemba points out that condoms have received less than wholehearted support from churches and some traditional leaders also take a dim view of the intervention of latex in the sex act. Meanwhile, women typically have little power to negotiate condom use with their partners.

- Social scientists argue that to make headway against the epidemic, PNG's response must go beyond behaviour change messages drafted in Port Moresby or donor capitals, and start understanding and engaging with local communities.

Read the whole thing here.

1 comment:

Doreen said...

Malaria is pervasive in PNG, and I assume there must be some organization in place to address that problem. Has anyone tried linking several prevention messages (mosquito nets and condoms)? Maybe a medical model can subvert cultural associations of condoms and promiscuity. Once a rectal microbicide exists, the Coca-Cola model would be great.

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