Giving New Lease of Life to Papua New Guinea's HIV Patients
MANILA, PHILIPPINES (12 January 2003) - In mid-2002, Papua New Guinea became the fourth country in the Asian and Pacific region - after Thailand, Cambodia, and Myanmar - to be recognized as having a generalized HIV/AIDS epidemic.
The first human immunodeficiency virus (HIV) infections in Papua New Guinea were reported in 1987. Since then, HIV prevalence and acquired immune deficiency syndrome (AIDS) cases have been increasing at an alarming rate.
In the first half of 2002, the prevalence of HIV among antenatal women in Port Moresby General Hospital reached 1%. This puts the situation on a par with the statistics seen in 1992 in South Africa, a country in which about one fifth of the population is now HIV-positive.
Increasing poverty, in both urban and rural areas, has led to rising levels of crime and sex trade growth, and about one in six sex workers in Papua New Guinea is now infected with HIV.
Heterosexual transmission accounts for almost 90% of cases. Although cases are split fairly evenly between the sexes, there is a much higher prevalence among females in the 13-22 age group compared to males of the same age.
A major cofactor in the rise of HIV/AIDS is the prevalence of sexually transmitted infections (STIs), which is among the highest in the world. The World Health Organization (WHO) estimates that Papua New Guinea generates more than 1 million new cases of curable STIs each year. Yet, STI services are seeing no more than 1% of these cases.
"The rapid increase being seen in HIV/AIDS points to a southern African style socio-economic pattern in HIV transmission that poses a serious threat to the country's future," says Maryse Dugue, an ADB Project Specialist (Health).
"AIDS is now a major killer in Papua New Guinea, putting increasing strain on the country's public health system. The situation urgently requires a response that includes better access to the latest treatments and management of those treatments."
Care of people infected with HIV remains almost nonexistent in Papua New Guinea, except where health services run by churches have attempted to build programs of home-based and day care. But their capacity is limited compared to the magnitude of the problem.
WHO has recommended that Papua New Guinea be placed in the group of countries given priority for increased access to anti-retroviral (ARV) drugs through the International Treatment Access Coalition (ITAC).
Once unaffordable to developing countries, ARV drugs are now available in the region for as little as $1 per day. However, facilities are lacking to manage the impact of treatments, including toxicity, side effects, and adherence. Unsupervised treatment can cause increased resistance and bad side effects.
To pilot a model for HIV/AIDS care in the country, ADB has approved a technical assistance (TA) grant of US$450,000 that will set up two pilot AIDS clinics.
The total cost of the TA is estimated at US$655,000 equivalent, of which WHO will contribute about $72,000 and about $133,000 equivalent will come from the Government. The assistance will be carried out over 30 months to the end of 2005.
The model of care to be developed under the TA is based on private-public networks and partnerships to expand care and treatment facilities to increase the access of HIV-infected people to comprehensive care, treatment, and support.
One of the clinics will be established at the Port Moresby General Hospital, which will provide care, counseling, and support, including access to, and monitoring of ARV treatment for at least 100 patients by the end of 2004. A second pilot center will be later established in a church hospital in a high prevalence area. The Catholic HIV/AIDS Program has already expressed interest in selecting a Catholic hospital as a pilot HIV treatment center. By about October 2005, at least 3,000 patients will have been treated in the two centers.
The hospital center will work with nongovernment organizations (NGOs) and churches to identify the cases and guarantee compliance with treatment through social support to the patients and their families.
"ARVs can greatly improve the quality of life for people infected by HIV, allowing them to stay more economically and socially active," adds Dr. Dugue. "Priority will be given to reducing mother-to-child transmission."
The TA will train staff for the centers, provide equipment, and build referral systems and partnerships necessary for its functioning. Discussions will be held with several NGOs such as the Salvation Army that can conduct home visits and care, and thus provide the foundation for a center outreach network.
Those living with HIV/AIDS will be closely involved in the design and operations of the pilot centers. Experience in establishing and running these pilot centers will be used in the design and planning of more HIV clinics in the provinces.
"Papua New Guinea is hoping for future financing for AIDS programs from the Global Fund, which could help in the replication of this scheme and in ensuring its sustainability," says Robert Siy, Jr. Director of ADB's Pacific Operations Division (Area A).
"Without a radically new approach, the AIDS problem is going to become increasingly desperate in the country."
By about October 2005, the two centers will have treated about 3,000 patients. But another important outcome should be the reduced stigma and discrimination suffered by people infected by the virus.
Discrimination against those with HIV remains strong in the country, with some health workers reluctant to care for people infected and many children orphaned by AIDS rejected by their families. About 3,000 children, many of them AIDS orphans, are reported to be living on the streets of Port Moresby.
"Experience in Asia and Africa shows that, provide they have strong support from peers and families, HIV-positive people who are involved in awareness raising and care delivery can demonstrate that they can still live long, productive lives," Dr. Dugue concludes.
Read the full TA report.
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