The crises facing the HIV treatment and care responses in Papua New Guinea are grave. Findings presented at the recent HIV Summit in Port Moresby in August and in turn at the ASHM HIV&AIDS Conference in Perth this September present a worrying picture. PNG has one of the highest levels of ART drug resistance in the world. Additionally, maternal child transmission remains persistently high and key populations can find it difficult to access services even where they exist due to high levels of stigma and fears of discrimination.
ASHM has been supporting the national response to HIV in PNG for many years. At the Conference in Perth during a session focused on a Call to Action for HIV Treatment and Care in PNG, ASHM’s senior international clinical advisor Dr Arun Menon warned that access to treatment and rising drug resistance are key issues that require urgent action from the international community:
Photo: Dr Arun Menon, ASHM International Clinical Advisor
“High levels of 1st line treatment drug resistance, in which individuals do not respond to treatment, and persistent transmission from mother to child during pregnancy are compounded by a serious lack of medications for both HIV and other sexually transmissible infections.”
(PNG has the fourth highest pre-treatment drug resistance among those first starting HIV treatment in the world at an alarming 17.8%)
Research presented in Perth showed that people with HIV in PNG face interrupted treatment due to frequent shortages of medication; “Interrupted resistance is a serious problem and can lead to acquired drug resistance – after which previously successful treatment regimens no longer function. 42% of patients in PNG re-commencing ART after interruptions do not respond to treatment due to acquired drug resistance”.
He reiterated that urgent action on a number of fronts is required to respond more assertively to the challenges of HIV in PNG, and Australian authorities must also recognise that this is also a major issue for the region in terms of health security. “The rise in drug resistance is a serious threat to global health if not urgently addressed, resulting in unnecessary deaths, an increase in hard-to-treat infections, and ultimately increased health-care costs.”
ASHM’s focus on PNG has been on health care worker capacity building. This work has been consolidated over the last 2 years through the Sexual and Reproductive Health Integration Project (SRHIP), funded by the Department for Foreign Affairs and Trade (DFAT). Through the training of ART prescribers, ASHM is expanding access to care for many who would otherwise have been unable to connect with a qualified provider and, through mentoring and specialist training in managing complex cases for HIV, ASHM is ensuring the workforce remains robust, resilient and up to date in their practices. Our partners include the Burnet Institute who are helping to improve health systems and governance in-country, while the Catholic Church Health Services are working to facilitate the integration of their clinics into the network of local and provincial services. Igat Hope, the community led organization for PWHIV in PNG, is working to standardize counselling for those affected, while the National AIDS Council, together with the National Department of Health, collaborate on national strategy.
While those efforts combined are seeing tangible results challenges remain as outlined by ASHM Advisor and lead from the PNG Sexual Health Society Dr John Millan (pictured below) including:
- ARVs stock-outs resulting in people having to come back to collect treatment potentially every week because stocks are too low
- Low retention rates with too many lost to follow-up
- High turnover of human resources (and indeed low or infrequent pay) with several clinics having no doctors, counsellors or social workers
- ART drug resistance
- High vertical transmission rates
- High HIV/TB co-infection rates
- Stigma/discrimination against PLHIV
- Laws that discriminate against key populations
- Gender-based violence
- Reduced donor interest or support
Photo: Dr Janet Gare from the PNG Institute of Medical Research spoke at the forum in Perth to highlight the significant obstacles affected populations face to accessing treatment services not least discriminatory practices and stigmatising attitudes from health care providers.
The PNG Prime Minister officially launching the National HIV & STI Strategy observed by Eamonn Murphy head of the UNAIDS/Regional Support Team for Asia and the PCIFIC, Parliament House, Port Moresby September 2019)
With these challenges in mind, ASHM and our partners have come together to produce a collective and urgent Call to Action, outlining our critical concerns and heavily informed by our PNG based colleagues’ advice, observations and recommendations with the aim of reaching donors and draw their attention to a series of priority actions, which, if implemented, could have a significant impact on the quality of life for our nearest neighbours.
We sincerely hope that the Call to Action is heeded, and that ASHM can continue to work with our partners in PNG
PNG call to action statement