Papua New Guinea's sex disease time bomb ticks away

Aids is the single most common cause of death at Port Moresby General Hospital. Picture / Steven Nowakowski

You wouldn't want to be in ward 4B at Port Moresby General Hospital. Two exhausted-looking nurses are caring for 64 emaciated patients, their limbs like sticks.

The air is stifling but the ceiling fans aren't running because the hospital, the country's largest, can't afford the power.

Patients' relatives are snoozing full-length under the battered beds; they are expected to help feed and care for their kin, and they perch anywhere there is space.

In this ward, there are 14 people dying of Aids. It's unlikely any of them have told their caregivers, such is the stigma. A doctor tells the Herald, his voice low, that this room is labelled just as a tuberculosis ward, and indeed 20 per cent of the Aids patients that come here have TB as well.

Tonight, as most nights, several patients will take their last, shuddering breaths. Since mid-2001, Aids has been the single most common cause of death at this hospital.

But relatives may discover the truth only when the body is released for burial. "There are a lot of [unclaimed] bodies in the morgue," 24-year-old nurse Janet Tunu tells the Herald as she rushes between beds.

HIV, which destroys the immune system, is spread largely by heterosexual sex in Papua New Guinea, a poverty-stricken country still playing catch-up with the rest of the world. Its reach is hastened by cultural norms that mean no one talks about sex, although people have sex young, and men are often big drinkers with multiple sex partners (including several wives and sex workers).

There are distressing rates of rape, incest and child prostitution: health workers and teachers tell of parents so desperate to raise money for school fees that they send their daughters to work the streets. The country's poverty is compounded by rugged terrain but few roads and a largely rural population.

The result: Papua New Guinea, whose population of 5,900,000 people is one of the biggest in the Pacific, is also top of the table for HIV/Aids.

About 100,000 of the country's men, women and children are estimated to be infected; 12,341 new HIV infections were reported last year and more than 3000 deaths. The actual figure will be far higher.

The worst-case scenario is that more than half a million people will be HIV positive by 2015 - with the impact on the country's development devastating. Who will be the teachers, the political leaders, the farmers? Who will care for the orphaned children?

"In terms of Aids, Papua New Guinea is an African scenario," says Laurie Markes, New Zealand's High Commissioner to the country.

In some African states, the HIV rate is as high as 40 per cent. To prevent Papua New Guinea following that track, New Zealand's international development arm, NZAID, is increasing spending on development. The agency will this year spend $14 million on development work in Papua New Guinea; health projects will swallow more than half of that. By 2007/2008, the budget will rise to $20.6 million.

New Zealand's main focus is a joint project with other donors, which include Australia, the Asia Development Bank and the UN Population Fund, which funnels money into the national health department to reform systems. New Zealand's contribution this year is $3.2 million.

Papua New Guinea's particular disease is the gap between health policy and delivery and a shortage of people who know how to bridge it. For example, warehousing and distribution is so haphazard that basic supplies often run out; babies are sometimes delivered by nurses with plastic bags over their hands.

Aid also has to be about building people. A week in the country showed that the people are warm, resourceful and resilient. But on the ground, there are limited resources and technical know-how; nurses and doctors have to deal with decaying or broken buildings and equipment, and have suffered from years of poor human resources planning and a lack of supervision, co-ordination and leadership.

"The idea," says Tessa Te Mata, one of the two NZAID managers based in Papua New Guinea, "is to create self-sustaining systems that are not dependent on key people, so they will endure". And HIV/Aids is "mainstreamed" - part of every programme, whether specifically health-focused or not.

Non-governmental organisations can also tap into New Zealand aid money, applying through the Health Ministry. Save the Children New Zealand is getting $1.5m this year to fund a 10-year-old programme which trains village volunteers in remote East Sepik in primary health care, allowing them to dispense contraceptives and assist in childbirth.

Two principles underpin NZAID's work with the Papua New Guinea Government - partnership and participation, says Wellington-based PNG programme manager Andrea Fairbairn. "Generally a partner Government will come to us with a proposition. We are really careful - we talk about supporting things. It's our role to build capability, not take things over."

Gone is the "old model" of advisers who come in and do the job without leaving skills behind, she says. "If we see certain issues we'll raise them, but we are very constructive and focus on building the relationships," she says. "When you have that ... you can talk about everything from human rights to quarterly reporting."

And about corruption. "It's a fact of life in the business that we are in," says Catrina McDiarmid, NZAID's communications manager. The best way to deal with it, she says, is to admit it exists "and find ways of working which ensure our aid dollars are spent in an accountable and transparent way".

Another important tool, says McDiarmid, echoing Fairbairn, are "relationships which are open, transparent and based on trust".

Besides the Government and international donors, there is another powerful player in the country's development - the church. Aid workers say, without irony, that the Catholic church is the biggest non-governmental organisation in the country. However, on the issue of HIV, church and state are at loggerheads.