When a Papua New Guinean MP recently said that his country was "starting to look like a very sick society," he wasn't talking about the escalating HIV crisis. He was referring to the disturbing increase in rape and sexual violence blighting the Pacific nation.
But of course these two issues are entwined. Australia's northern neighbor is fast becoming the new frontline in the global HIV/AIDS epidemic, with worrying similarities to sub-Saharan Africa a decade ago. At least 60,000 Papua New Guineans (around 1 percent of the population) are currently infected, and some pundits believe PNG could end up another South Africa, where almost 27 percent of the population are living with HIV.
"PNG has everything that's wrong — lots of migration within the country, family disruption within towns and villages, a lot of sexually transmitted infections, and a sexual culture that makes HIV spread very rapidly," says Dr. Peter Piot, head of UNAIDS, the United Nations program on HIV/AIDS.
Long before this epidemic began, Papua New Guinea was a nation beset by problems. It is a "fragile state," to use the Australian government's term, marked by social upheaval and a widespread breakdown of law and order. It is a country torn between the weight of its traditions and the rapid changes brought by globalization and development.
Unfortunately, this turmoil has helped create ideal conditions for the spread of the virus. The growth of industries such as mining and logging has led to a highly mobile population, as people travel the country to find work in towns or mine sites. As the constraints of traditional village life break down, people are more likely to have many sexual partners from different regions. Combine this with unsafe sex practices and a lack of education about HIV, and the danger of the situation is brought into sharp focus.
The problem is also exacerbated by the low social status of women. "Within marriage, women have very little say over their own sexual activities," says Dr. Martha Macintyre, a senior lecturer in medical anthropology at Melbourne University. "Sexual access is considered a right that men acquire over women in the context of marriage." This has obvious impacts on the HIV crisis — extra-marital sex is extremely common in PNG, but with men holding all the power in sexual relationships, it is difficult for women to negotiate safe-sex practices.
The power imbalance between men and women has its most extreme expression in PNG's high incidence of sexual violence. Stories of brutal sexual assaults abound in the nation's news media — in the space of a few days recently, there were reports of an alleged rape of a 7-year-old by a police officer, a pack rape of a 14-year-old school girl by 20 men, a rape of a mother by her 20-year-old son, and the molestation of a 2-year-old. Dr. Macintyre believes that the joint problems of rape and female powerlessness have been exacerbated by modern industry.
"The kind of development that is being encouraged internationally — logging, mining, et cetera — these are completely male-dominated," she says. This leads to enclaves of all-male workers with plenty of cash, increasing the power disparity as well as encouraging prostitution. "These places have become breeding grounds," says Macintyre.
While the predictions are dire, Papua New Guinea has one crucial thing in its favor — forewarning. In contrast to Africa, there is a chance that the catastrophe can be averted before it becomes inevitable.
The looming crisis has sparked an impressive international response. With the help of donors such as Australia, the World Health Organization and the Global Fund to fight AIDS, Tuberculosis and Malaria are bringing antiretroviral drugs to the country, as well as designing ways to overcome ignorance about the disease.
But there is some doubt that PNG's hospitals can cope with the huge numbers of victims likely to be stricken. Professor John McBride, of the Cairns Base Hospital, spent three months in Port Moresby General Hospital in 2004 as part of a WHO pilot program to introduce antiretroviral drugs into the country.
"The health system is enormously under-resourced, it's very hard to get anything done," he says.
There are just five doctors to every 100,000 people in PNG — the worst ratio in the Pacific. And while Dr. McBride found the medical staff in Port Moresby professional and well trained, the lack of essential resources meant morale was low.
For many Papua New Guineans, the antiretroviral drugs that began flowing into the country in 2004 came too late. AIDS has been the leading cause of death in Port Moresby General Hospital since 2001 and, given the notorious difficulties of managing HIV treatments, this is unlikely to change.
But medicine is just one aspect of the fight against HIV/AIDS. Preventative measures, such as education and encouraging condom-use, are just as crucial. And in a diverse country of largely inaccessible terrain, where more than 700 languages are spoken, the logistics are proving difficult.
According to Lockley, there is some evidence that strategies are working and the culture is changing. "I think there is evidence that things are improving — in terms of getting people to talk about [HIV/AIDS], to use condoms, using peer pressure to encourage people not go out and rape. At a local level people are doing great work. But of course, it's a national problem."