PORT MORESBY- Papua New Guinea has the highest HIV prevalence in the Pacific region, estimated at 0.8% in 2012. The nation is grappling with an HIV epidemic that is concentrated in marginalized and criminalized key populations including female sex workers and men who have sex with men (MSM).

Stigma associated with HIV and advice from influential churches for people to rely on prayer rather than antiretroviral treatment (ART) to heal themselves further complicate the situation.

Understanding the epidemic

To reach out to key populations, efforts commenced in 2012 to define and identify at-risk groups. The data collected indicate that of 2315 attendees, 12% were female sex workers and nearly 3% were MSM. The actual figures may be higher given individuals’ reluctance to discuss their sexual behaviour candidly. The rest of the attendees were classified as either high-risk women or high-risk men.

The prevalence of STI syndromes was 68% among female sex workers, 33% among MSM, almost 63% among high-risk women and 37% among high-risk men. Given the high risk of acquiring STIs, which are often a gateway to HIV infection, presumptive treatment for gonorrhoea and Chlamydia was recommended for clinic attendees classified as female sex workers or MSM.

Using wantok values to empower key populations

For people diagnosed with HIV, beginning antiretroviral treatment and adhering to the regimen is critical. But in Papua New Guinea, socio-cultural values come into play.

“In Papua New Guinea, the community system is based on the traditional ‘wantok’ welfare and care system,” explained Dr Anup Gurung, Medical Officer, HIV Care and Treatment at the WHO Representative Office in Papua New Guinea. “If one of your ‘wantoks’ or close friends is sick or in need, you must care for him or her. This value system is being incorporated into the response to HIV, allowing communities to be more supportive of those most in need of treatment and care services and in a more effective way. This is especially true if outreach workers and counsellors are from key populations, or are themselves people living with HIV. The advice they can provide to their peers, their own community members, is taken much more seriously and is acted upon.”

A four-year study conducted at an STI/HIV clinic in the capital Port Moresby from 2007 to 2010 clearly demonstrated the ‘wantok effect.’

Of the 184 HIV positive clinic attendees, 122 initiated ART. More than half of these individuals were in declining health when they began medication, and one-fourth of them had a CD4 count of less than 120. Among those who initiated on ART, the average CD4 count increased by nearly 40 within the first six months of treatment. Between the first and last visit to the clinic during the study period, adherence to the ART regimen increased to 75% from nearly 59% for the group as a whole. The life expectancy of these individuals on treatment also increased substantially.

“These outcomes prove beyond a doubt that proper case management, especially that which includes people living with HIV staff and peers from key population communities, does increase adherence to treatment and survival over time,” concluded Dr Gurung. “Community involvement clearly reduces the loss to follow-up, increases adherence to ART, provides crucial social support and reduces mortality. The social and community support values that already exist in PNG can further empower the key populations themselves in responding to the epidemic.”