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Caldwell, J
AIDS in Melanesia
It's Everyone's Problem: HIV/AIDS and Development in Asia and the Pacific
AusAID, Canberra, 22 November, 2000, 24 pp

Paper prepared for Australian Agency for International Development (AusAID) Special Seminar, November 22, 2000. Reproduced with kind permission of AusAID.


"There has long been reason to expect a major heterosexual AIDS epidemic in PNG and probably in the rest of Melanesia. Socially and behaviourally Melanesia is strikingly similar to other areas of the world with serious AIDS epidemics. High levels of other sexually transmitted infections (STIs) indicate behaviour patterns that would also facilitate the transmission of HIV. STIs also act as cofactors for HIV infection. Low levels of male circumcision parallel the situation in other epidemic areas. Near parity by sex in cases reported so far in PNG is evidence that primary infection is largely heterosexual. Such an epidemic, by affecting males and females equally and by infecting children around the time of birth through vertical transmission from seropositive mothers, impacts on the whole society.
The late start of a major epidemic in PNG can probably be attributed to the relatively small aggregation of people in urban centres (even Port Moresby has fewer than one-quarter of a million people), a highway system that does not network across the whole country, the limited size of the commercial sex sector, and possibly the absence of chancroid to act as a cofactor. The situation is now changing. HIV infection, mostly concentrated in Port Moresby and mostly measured there, has been rising by about 60 per cent per annum over the last four to five years. This rise appears to be genuine and, if sustained, would infect 10 per cent of PNG’s adult population in little more than a dozen years. Such exponential rises have been witnessed in some countries of sub-Saharan Africa. The aim should be to take early action so that such a situation does not develop. Essential elements in such action would include the following. (1) The development of a much more comprehensive surveillance system for both HIV/AIDS and STIs supported by a populationbased
sample survey program. (2) An educational and informational program with highprofile government leadership. (3) An efficient condom distribution program that reaches such high-risk groups as commercial sex workers and adolescents and provides commercial sex workers with sufficient support to ensure use. (4) A major compaign against STIs which would probably have to include both mass medication over short periods and routine clinic treatment. (5) Care and support workers including where possible persons with HIV/AIDS. (6) The encouragement of large companies, especially foreign ones, to provide employees and their families, or whole communities, with comprehensive health services, including comprehensive HIV/AIDS and STI services. (7) A strengthening of the public health system to meet these challenges. (8) Sufficient external technical assistance to make these aims possible. The Solomon Islands and Vanuatu have so far been protected by their small populations and small urban areas (their capitals have populations of 50 and 20 thousand respectively). The greatest threat to them is likely to come from a major epidemic in Port Moresby or in PNG as a whole."

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  • Moodie, Rob & Edith Fry, HIV/AIDS - A Global Overview With Emphasis on Asia and the Pacific, It's Everyone's Problem: HIV/AIDS and Development in Asia and the Pacific, AusAID, Melbourne, 2000, 24 pp. [ PDF File | Details... ]