Academic journal article Journal of Health Population and Nutrition

AIDS in Papua New Guinea: Situation in the Pacific

Academic journal article Journal of Health Population and Nutrition

AIDS in Papua New Guinea: Situation in the Pacific

Article excerpt

INTRODUCTION

This report on the possibility of an epidemic of acquired immunodeficiency syndrome (AIDS) focuses on Papua New Guinea (PNG) as seen within its Melanesian and, more broadly, Pacific Island context. PNG with 5.3 million people constitutes 80% of the population of Melanesia and 60% of that of the Pacific, i.e. Oceania without Australia and New Zealand. For almost as long as human immunodeficiency virus (HIV)/AIDS has been identified, it has been realized that PNG, the largest nation of Melanesia, was in danger of a serious epidemic of AIDS. One reason is that the mode of transmission of HIV is (apart from ensuing vertical transmission from mother to child) almost entirely heterosexual. Evidence for the mode of transmission is derived both from information collected from seropositive persons and from a sex ratio (male: female) of infected persons close to 1.

Heterosexual epidemics place almost the whole community in danger, and not a segment of a community, as occurs when the predominant mode of transmission is homosexuality or intravenous drug injection. Homosexual transmission is entirely among males, and everywhere intravenous drug users have a male majority. Thus, the heterosexual epidemic in sub-Saharan Africa exhibits a sex ratio of 0.81 (earlier reported as about 1.0) and that in Papua New Guinea a ratio around 1.0. This is comparable with other countries with largely heterosexual epidemics: Thailand with a ratio of 1.4, India 1.7, the Caribbean 1.7, and Cambodia 2.0. The sex ratio in PNG contrasts with areas where other modes of transmission are important: Europe 2.9, Latin America 3.0, North America 3.9, East Asia 7.0, and Australasia 12.6 (1).

Parity between men and women in infection does not mean equally high-risk sexual activities, because transmission from males to females during sexual intercourse is about three times more likely than from females to males. Sub-Saharan African data are often cited in this paper, because we have more information on the epidemic there than on other heterosexual epidemics.

The other reason for fearing an epidemic of AIDS is that sexual intercourse outside marriage is treated fairly tolerantly in Melanesia, as it is elsewhere in the Pacific, in sub-Saharan Africa, parts of Southeast Asia, and in many developed countries. Treating premarital and extramarital sexual relations of females as a heinous sin has meant an unenviable position for women in much of the Middle East and North Africa, but it has provided a defence against AIDS: 50% of countries of the Middle East and North Africa record adult seroprevalence levels below 0.04% (1). Melanesia is more sexually permissive (2). Such permissiveness can make HIV infection more likely and has long explained the high prevalence of sexually transmitted infections (STIs), now a serious matter in that these may act as cofactors for AIDS. In the first few decades of the twentieth century, the islands of the Melanesian archipelago were noted for high levels of STIs, and PNG still has among the highest levels in the Western Pacific (3). Levels of STIs are also high in Vanuatu (4) and doubtless too in the Solomons.

AIDS was first identified in 1981, although transmission of HIV on a considerable scale must have been occurring for some years previously. Within a few years, the epidemic of AIDS spread throughout most of the world. It began relatively slowly in some places only to spread rapidly in later years. Until the early 1990s, the level of HIV/AIDS in Southern Africa was well behind that in East Africa, but it is now the highest in the world (5). Anderson's models of heterosexual epidemics predicted that some of the later, more slowlymoving epidemics would eventually surpass the earlier, faster-moving ones in proportion of population infected (6,7). There is some evidence of this pattern in Nigeria where levels of HIV infection in adults were well below 1% until the mid-1990s, but now exceed 5%. …

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