This report provides an update on the HIV-AIDS (Human Immuno Deficiency Virus/ Acquired Immune Deficiency Syndrome) situation in Papua New Guinea and the national response to the epidemic.
2. The Current Situation with HIV-AIDS:
2.1: Epidemiological Review
The HIV-AIDS epidemic in Papua New Guinea has continued to escalate dramatically, entering a new and more critical phase in 1999. By December 3 1st 1999 the cumulative number of reported HIV positive cases had reached a total of 2,342 individuals.
Equal numbers of males and females were affected, recording 5 1 % among men and 45% among women, with sex not reported in 4% of cases. 89% of infections were acquired through unprotected sexual intercourse and 9% acquired the infection from their mothers as babies.
Over the past 18 months several provinces have demonstrated a sharp increase in the number of HIV cases detected. Among the most significant were Sitnbu, Western, Enga, and Manus Provinces where the prevalence rate per 1 00,000 population has risen sharply.
Despite the increasing trend, testing is still limited in certain provinces. In Gulf, Bougainville and Sandaun, testing is almost completely confmed to the screening of blood for transfusion.
In certain sections of our community we are beginning to see close to one in every five individuals being affected. The epidemic is being spread predominantly through unprotected sexual intercourse. The number of children being infected through mother to child transmission is increasing sharply.2.2: Risk Situation:
Papua New Guinea's vulnerability to the HIV-AIDS epidemic is directly related to the various social, economic and cultural dynan-fics that define the country's development context. Factors such as the poor health status of the population, lack of infrastructure and basic services, limited education and employment opportunities, mobility and urbanisation, and gender disparities all contribute to conditions in which HIV/AIDS flourishes. In addition, all these issues impact on the country's capacity to respond effectively to the epidemic.
HIV-AIDS is affecting the young sexually active and econon-dcally productive members of the community. A major indirect cost of the HIVIAIDS epidemic is the loss of skilled labour and productivity, and the impact on the rural sector is potentially devastating.
Given our sociocultural and geopolitical diversity, innovation is needed in Papua New Guinea for an effective national response to HIV-AIDS, All sectors of society will need to give their support to HIVIAIDS prevention and care initiatives. What is done today will only have an impact 10 or more years down the line. Only through a collective effort can the fight against HIV-AIDS be a success.
3. The Council's Vision and Mission.
The Council has adopted the following vision and mission:
Vision: "To contribute towards a healthy, independent, secure and prosperous Papua New Guinea"
Mission: "As the main advocate for national action on HIV-AIDS, the National AIDS Council will lead, strengthen and support an expanded response aimed at preventing the further transmission of HIV, providing leadership and guidance through a multi-sectoral response, reducing the vulnerability of individuals and communities to HIV-AIDS, and minimising the impact of the epidemic in Papua New Guinea"
4. The Secretariat:
The Council is pleased to report that the Secretariat is now in place and has been working in the past year to build consensus with the provinces and come up with appropriate structures to implement the National Medium Term Plan The Secretariat is now well established with the appointment of ten staff and the setting up of the offices on the 3' floor of Aopi House. Approval has been given by the Department of Personnel Management for the Council Secretariat to move into the Garden City Complex on Boroko once the Ombudsman Conunission is re-located.
The Secretariat staff composition is well balanced in line with the skills required to monitor and co- ordinate the implementation of the Medium Term Plan and the NAC Act5. Collaboration with Other Agencies:
PNG is fortunate to have had the support of the international agencies in the battle against AIDS. The Government of Australia is committed to supporting us as we initiate and implement activities to address HIV/AIDS in the country. We continue to work very closely with other agencies like the European Union (EU), United National's Development Fund (UNDP) , Save the Children Fund (UNICEF), the United National Population Fund (UNFPA), and the World Health Organisation (WHO). The World Health Organisation has provided technical support and training since the beginning of the epidemic in this country, and has given commitment to continue to provide support as and when requested.
We are indeed grateful for the support provided by all these agencies and look forward to creating partnerships with new agencies both locally and internationally. The Australian Government, through AusAID, has provided support over the past four years through the Sexual Health and HIVIAIDS Prevention and Care Project, and has indicated substantial support to us in the implementation of the National Medium Term Plan in the next five years. The European Union will conduct a feasibility study to assist us in areas of particular concern to the Council. All our UN partner agencies and UNAIDS have indicated ongoing support to the National response. Talks are already underway with the World Bank to facilitate a national HIV and Development Study.6. Major NAC Secretariat Activities for 1999
During 1999 the Secretariat has worked hard to translate the National AIDS Council Act and the National Medium Term Plan in order to develop and implement specific interventions in all sectors of our society.
Key activities during 1999 include the participation of a large delegation of Papua New Guincans to the first Regional Conference on HIV-AIDS. The Secretariat staff, together with the Sexual Health Project, facilitated at the National Women's Triennial Convention in Alotau, personalising the HIV epidemic for the women.
The Secretariat organised and conducted four regional and one National workshops. The workshops began the process of establishing structures and multisectoral planning for the implementation of the Medium Term Plan. In line with this the Council has passed a policy document which will set up the basis for the provincial structures.
In line with this policy and the consensus reached in the National Workshops conducted in 1999, the Secretariat has set out the following criteria for provincial support to be provided:
1. A multisectoral membership of the Provincial AIDS Conmiittee (PAC) at the provincial level
11. Endorsement of political leaders at the provincial level by the Provincial Executive Council (PEC)
111. A transparent accounting mechanism, and
IV. Completion of a 5 year provincial implementation plan.
The Secretariat Advisers have organised the establishment of four of the planned five technical advisory committees and the committees met during 1999 to begin reviewing policy and program papers on HIV-AIDS.
The World AIDS Day is a very important focus of the year's activities for the HIV-AIDS program. The 1999 World AIDS Day program received strong political support at both the National and Provincial levels.7. Plan for 2000
The Council and its Secretariat has started off in the right direction and has initiated the initial process of implementation of the Medium Term Plan. All sectors have been encouraged to take part. The challenges ahead of us are to ensure that the Secretariat is well supported to sustain a comprehensive response to the threat of AIDS to the country. Budget support in 1999 was K5OO,000. The Secretariat had requested at least KI.3 million core budget conunitment to facilitate, develop and maintain the multi-sectoral response in the 2000 budget but had received K500.000, as was in 1999. We are optimistic that in the budget review process or the 2001 budget, the threat of AIDS to our development is fully acknowledged so additional resources are provided as required by the Secretariat.
The focus for the year 2000 will be on assisting the provinces to fulfil the criteria agreed upon for support. . In addition, the Secretariat is seeking support from all our partner agencies to facilitate a Comprehensive National Study on HIV and Development. The study will be in line with the Papua New Guinea Human Development Report and will have three main objectives:
1. advocating a multi-sectoral response for the epiden-iic in the country by allowing individual sectors to properly visualise the impact of the epidemic in their individual sectors
11. making available a comprehensive reference on HIVIAIDS in Papua New Guinea to students, researchers, planners and development workers; and
111. to serve as a guide for the development of specific interventions to address HIV and development interventions in line with the National Medium Term Plan.
All relevant sectors of Government and the private sector will be requested to take part in the study.
The issue of AIDS will require Leaders at all levels to be open minded and not to be judgmental nor moralistic in making decisions that will ensure a responsible but effective response to HIV-AIDS in the country. Honourable members, with your leadership, support and collaboration, we can make a difference to Papua New Guinea's development by stopping the explosive spread of HIV-AIDS in our country.
Predictions are that HIV/AIDS will be the leading cause of death in the National Capital District within twelve months according to a recent review of figures reported to the National AIDS Council Secretariat by the Port Moresby General Hospital.
Preliminary reports have established that AIDS has become the leading cause of death in the Port Moresby General Hospital medical wards.
Diagnosis for the first three months reported 185 new HIV cases with 41 new AIDS cases and 4 AIDS deaths reported around the country.
This brings the total cumulative HIV cases detected to 1741 in l999 from 1556 in 1998 since HIV was first reported in 1987. The number of AIDS cases reported has reached 618 while the number of deaths has reached 145 persons.
The main cause of the spread of HIV/AIDS in Papua New Guinea is unprotected sexual intercourse. The second most common way of transmission is from mother to child during pregnancy and labour.
Of the total HIV/AIDS cases identified; forty six percent (46%) were female while fifty percent (50%) were male. Four percent (4%) of the cases were unknown. Women at a younger age group are the most vulnerable group. The average age for women was 26 years while it was 32 years for men.
There has also been an increase in the number of children under two (2) years who have been diagnosed with HIV at the Port Moresby paediatric clinic where a total of 72 children have been diagnosed since 1995. This year 18 children have been treated of which, two have died so far.
Today, I want to warn and inform all of us that HIV/AIDS has now sprung up in all areas of our country and the figures I have quoted are only for people diagnosed and reported to the health department.
However, there are lots more people still out there who have not been tested and can be able to pass on the HIY virus. These figures do not really reflect the real status of HIV/AIDS in this country and are subject to change once updates are received from the provinces. Also some Provinces are only doing limited test ing, like, North Solomons therefore, the realistic figures would be much higher.
There is a need to improve recording and reporting on every HIV/AIDS case from hospitals in the provinces so that accurate breakdown can be provided to the general public. At this time this is not possible, due to lack of information on individual patients from the reporting centres.
The National AIDS Council Secretariat is also working towards setting up a comprehensive surveillance system; building on the systems that are already in place.
In response to this challenging situation, the government endorsed the national strategy for HIV/AIDS control in the country, through the medium term plan. Since then, the National AIDS Council has established its Secretariat which is taking the implementation of the medium term plan head on.
As an initial step, the National AIDS Council Secretariat has now planned for a national and four regional workshops in June and July for the different sectors to identify and agree on how they can respond to the HIV/AIDS epidemic in their own sectors.
The national workshop will look at developing networks with all the different sectors in the country in order to facilitate a comprehensive response to HIV/AIDS epidemic in the country. All the different sectors will be invited to take part, and I encourage all the sectors to fully participate at this workshop.
The four regional workshops will attempt to bring together all the different players at the Provincial level to review the provincial structures for a more effective and efficient multisectoral response at the provincial and local level.
The regional workshops will also aim at analysing the risk of HIV infection at all levels, looking at the individual, the family and the community at large. Based on these risks, Provinces will then develop appropriate work plans which will recommend effective interventions, targeted at the.identified risk groups.
As you can see, I, as national Health Minister wish to assure. the public that we are now well underway to implementing the medium term plan to contain the HIV-AIDS epidemic in our country.
Meanwhile the National AIDS Council and the Secretariat is asking the people of Papua New Guinea who are involved in risky sexual behaviours to be cautious as the HIV virus is being predominantly spread by sexual contact in the country at all levels.
At this point of time the best and proven methods of protecting oneself is by being faithful to one sexual partner, on the part of married couples, delay-having sex on the part of the young people and using a condom, on the part of everyone who finds himself or herself in such a high risk situation.
As responsible parents we are all urged to talk to and educate our children about the dangers of catching HIV. The impact HIV will have on our society, is enormous and can be most devastating as has been the experience in many parts of the world. PNG is beginning to see this trend now.
I also request the churches, non-govemment organisations, community based groups and our schools to encourage peer education on HIV-AIDS because peers nortnally feel more free to discuss this subject more openly.
The National AIDS Council also urges the public to note that there are many healthy individuals in our society with the virus who should be treated as normal human beings.
These individuals are healthy and have a significant role to play in the development of the country and everyone should be treated with dignity irrespective of whether one carries the HIV virus or not. After all, the virus cannot be spread by ordinary day to day contact.
Stigmatisation of individuals with HIV or any other infection is unnecessary and is discouraged by the council.
To maintain focus and clarity throughout this entire process, the National AIDS Council in its first meeting for 1999 on the 7th May 1999 adopted the vision and the mission statement of the council.
The vision statement as adopted is "to contribute towards a healthy, independent, secure and prosperous Papua New Guinea" while the mission statement is; "as the main advocator for national action on HIV/AIDS, the National AIDS Council will lead, strengthen and support and expand responses aimed at preventing the further transmission of HIV, provide leadership and guidance through a multisectoral response to reduce the vulnerability of individuals and communities to HIV/AIDS, minimising the impact of the epidemic in Papua New Guinea".
As National Health Minister, I call upon every Papua New Guinean, and every person living in our country for whatever reason, be it for a short term or for a long term, to be aware of these alarming statistics which demand only one response from all of us, and that is to put all our efforts together where ever we are and whatever we are doing to combat this virus and its ill effects. We must all act now, if we are to save our nation from the devastation effect of HIV-AIDS. I know, as Papua New Guineans we do not want to see our nation go down this sad path.
I am more confident, now that the National AIDS Council and the Secretariat are beginning to roll into action our medium term plan. On this note I wish to acknowledge the support given by the people and government of Australia, all the agencies that make up UNAIDS and the European Union and thank thern for their support in this task. I no doubt believe that you will continue to support and assist us in our efforts to contain the HIVIAIDS epidemic in our country.
Given this high level of partnership with our International development partners and our own National commitment I can assure us all that we will win this battle.