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A time bomb on our doorstep

By Peter Curson - posted Tuesday, 12 September 2006


HIV-AIDS in Papua New Guinea is a time bomb waiting to explode. Just as bubonic plague rewrote the history of medieval Europe, HIV-AIDS threatens to totally reshape the Papua New Guinean nation.

HIV-AIDS came relatively late to Papua New Guinea, and the disease attracted little attention until relatively recently. The country has also yet to experience anything like the levels of infection that have characterised many other developing countries.

Despite this, evidence is emerging of a huge epidemic developing, that will ultimately threaten the social and economic viability of the nation and have important implications for Australia’s regional security. Since 1987 the number of cases of full blown AIDS has been increasing rapidly, and in the last ten years, HIV infections have probably increased by at least 30 per cent a year.

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Today, while the official number of those living with HIV is recorded as between 12,000 and 28,000, the real number may well exceed 80,000 in a total population of about six million. Within 15 years, there could easily be more than one million cases of HIV-AIDS, and such an epidemic would cause serious injury to the national economy and totally overwhelm social and health services.

Poor economic growth and worsening poverty have characterised Papua New Guinea over the last decades, and the labour force is predominantly unskilled and unemployment high. HIV-AIDS is likely to substantially reduce the number of adults in the labour force, reduce GDP, and remove what skilled labour already exists.

By 2020 the labour force could well be one-third smaller than it would be without HIV-AIDS. If all this turns out to be the case, then we are looking at a disaster that may eventually rival that experienced by many countries in Sub-Saharan Africa.

It is a chilling scenario and one that has many implications for security in the Pacific region. As is the case in parts of Africa, Papua New Guinea’s working age population is most at risk, and evidence suggests a mainly heterosexual epidemic in which casual sex with multiple partners, sexual violence and a growing commercial sex industry around urban centres and mines, figure prominently as the major routes of transmission.

In Papua New Guinea more than 50 per cent of young adult males are sexually active with multiple partners. Add this to a tradition of pre-marital sex, strong cultural taboos against talking about sex, the low status of women, high levels of unemployment and poverty, a general feeling of helplessness as well as a fatalistic belief that supernatural forces rather than human behaviour produces HIV, and you have a potent mix.

While HIV-AIDS is not restricted to the poor, those most disadvantaged usually bare the full brunt of the disease. In Papua New Guinea approximately 40 per cent of the population are living in poverty and as a consequence, many adults and children suffer varying degrees of deprivation and malnutrition, making them more at risk from infectious disease.

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Added to this, the country’s health system is in total disarray and totally unable to address a threat like HIV-AIDS. As a percentage of GNP, health expenditure remains among the lowest in the Pacific region, and with only five doctors per 100,000 population, the country has one of the lowest health worker ratios.

While 80,000 people may currently be HIV positive, less than 500 are actually receiving antiretroviral therapy and there are only a handful of sites in the nation available to deliver such therapy. Basic drugs and medical supplies are either unobtainable or in short supply, and many hospitals and aid stations are not able to function properly.

Generally, there are very high levels of infectious disease, with syphilis, chlamydia and gonorrhoea having very high prevalence rates. Life expectancy at birth remains the lowest in the Pacific, and infant and child mortality, the highest. Malaria is rampant, and the number of TB cases, many linked to HIV-AIDS, is growing out of control.

Probably about 70 per cent of the population do not have access to safe drinking water, let alone the resources to be able to access medicines, even if they were available. And it doesn’t stop there. Papua New Guinea is also confronted by problems in the areas of law and order, economic management and security. Finally, adult literacy rates at 40 per cent are the lowest in the Pacific. In short, Papua New Guinea is on the brink of a major disaster.

It is true that up to now the country’s small urban population, its scattered rural population, its poorly developed national highway system and its small commercial sex industry, have all helped to keep the lid on the epidemic. But all that is changing. Rapid urbanisation, an increasing cash economy, increasing mobility, a burgeoning sex industry, and the gradual breakdown of traditional mores, are all contributing to major changes in sexual behaviour and encouraging the spread of infections like HIV.

HIV-AIDS in Papua New Guinea is one of our region’s greatest challenges. Australia’s aid budget recognises this, but is it too little, too late? The implications for Australia’s security are clear. HIV-AIDS threatens to totally undermine the viability of our nearest neighbour. If we do not address this growing crisis on our doorstep then the resulting epidemic could be catastrophic and the implications for our regional security, wide-ranging.

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About the Author

Peter Curson is Emeritus Professor of Population and Health in the Faculty of Medicine and Health Sciences at Macquarie University.

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