Our closest neighbour, Papua New Guinea, is struggling with an HIV/AIDS epidemic that is spiralling out of control. HIV-related illnesses are now the leading cause of death in Port Moresby General Hospital and the epidemic shows no sign of letting up.
According to a UN report released to coincide with World AIDS Day last year, rates of HIV/AIDS infection in PNG have increased by 30 per cent each year since 1997. A slow initial reaction and inadequate budgetary resources from the PNG Government mean that the country now hosts 90 per cent of diagnosed HIV cases across the Pacific region.
A 22 year old HIV-infected woman in Papua New Guinea
The Australian Government is critical of Papua New Guinea’s lack of input into the crisis and late last year extended a five-year $60 million dollar program in an attempt to get the situation under control.
However, the Australian response, despite its far outweighing the PNG response in monetary terms, also has its critics.
Father Paul Duffy, who lived and worked in PNG for two decades, believes that AusAID has made little progress with the $60 million National HIV/AIDS Support Project (NHASP).
‘AusAID would be very confident that it’s doing a big thing for the country. It would say it always listens to Papua New Guineans and does what they request it to,’ says Father Paul. ‘But Papua New Guineans would say the opposite: that AusAID never listens to them, that they fail to understand the complexity of the country, they fail to understand what really needs to be funded they fund the things that they’re interested in.’
Margaret Thomas, the head of AusAID in PNG, does indeed say that they are working with the PNG Government and the National AIDS Council Secretariat to tackle the problem, but that PNG’s own limited resources makes it difficult.
‘There’s only 1.5 million kina (A$700,000) allocated in this year’s budget and human resources are also only slowly being built up in relevant departments. So you actually have a situation where I think about 96 per cent of the response to HIV/AIDS is funded by the donor community, of which Australia is the major contributor,’ she says.
Prostitution, multiple sexual partners and violence against women are all common in PNG. Barbara Smith, the project manager for NHASP, says that women’s disempowerment in Papua New Guinea is one of the big issues in facilitating the spread of HIV.
‘The status of women is fairly low in PNG, women don’t have much power, they don’t for example have power in most sexual relationships to negotiate the use of condoms,’ she says. ‘Worldwide, we’ve seen the feminisation of the [HIV] epidemic and that’s starting to happen in PNG, where 46 per cent of the infected people are now women and increasingly young women, as older men seek young female partners to try to avoid HIV.’.
In March 2004, PNG police launched a raid on a guesthouse and arrested women they suspected of prostitution. Their efforts were apparently a response to the growing AIDS problem and according to a Human Rights Watch report the women were paraded through Port Moresby and publicly shamed as spreaders of HIV. Some women later claimed that they were raped while in police custody and condoms were used as evidence that they were sex workers.
Dame Carol Kidu, PNG’s Minister for Community Health and the only woman member of parliament, says that getting the rapidly increasing infection rate under control will be anything but easy.
‘There are many obstacles, some of them culturally based, some of them based in the geography of the country, the remoteness, the low literacy levels, the lack of gender equality,’ she says. ‘No matter how well intentioned government and donor agencies might be, the challenges are enormous.’
These are the same issues that allowed the disease to spread so rapidly in Sub-Saharan Africa, meaning that PNG could well lose this fight.
Kidu says that soon everyone will be affected by the disease, whether that’s through being HIV positive or knowing someone who is.
She is frustrated with the lack of consultation between aid donors and organisations and government departments. She says that many donors work directly with communities, which creates an overlap in some areas, or a funnelling of funds into what the Department of Community Health considers to be projects of low-level priority.
‘ I’m trying to talk seriously about the dangers of establishing parallel systems that don’t integrate and strengthen government, because those parallel systems almost invariably don’t become sustainable. We know it by experience,’ she says. ‘I’m [not]objecting to foreign donors working in communities, but I am objecting to them working in communities in parallel, and not in consultation with, government.’
Margaret Thomas admits this has been an issue in the past, but says it is something that AusAID are hoping to address in future HIV/AIDS community projects, which are becoming an increasing focus in tackling the epidemic.
Ken Davis from Union Aid Abroad says that AusAID is just selective about who they consult with. ‘I think there’s a tradition, particularly under this [Australian] Government, of using the word œconsultation to mean, holding meetings to ratify decisions that are already made, or drafts that are already written,’ he says.
Davis also says there is a serious lack of accountability in the Australian aid program, which is mostly run by commercial enterprises whose primary focus is the bottom line contracted by AusAID. For example, the management company ACIL Pty Ltd received the contract to implement the National HIV/AIDS Support Project.
‘It’s a question of democratic mandates in relation to the aid program. In order for that to be fulfilled and in order to make a proper strategy, there has to be public accountable evaluation of the commercial-in-confidence programs, where most of the Australian money has been sunk,’ says Davis.
‘That level of public accountability is demanded of the non-profit organisations but is not available for AusAID as a whole, or for the really large contracts in HIV, policing, governance, security or whatever. Nor is it available for the other departments treasury, customs, police that are now such a big part of the Australian aid program.’
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