Admission at the general hospital in Port Moresby provide a snapshot of a fast-growing, but otherwise barely visible, HIV/AIDS epidemic in Papua New Guinea (PNG). The Accident and Emergency department receives about two patients with HIV/AIDS a day, about half of them women. AIDS-related illness is now the leading cause of death in the wards.

Although HIV infection rates nationwide are believed to be still relatively low (estimated at 0.34% of adults aged 15-49 in Port Moresby, 0.15% in the rest of the country in 1999), there are fears that PNG could soon be facing an HIV/AIDS epidemic as grave as those in parts of southern Africa.

UN and local experts have estimated that there were 15,000 people living with HIV/AIDS in PNG in 1999. HIV/AIDS is clearly well established in the general population – in some highland areas, prevalence rates of 58% have been recorded among both men and women. Heterosexual sex is the most commonly reported route of transmission.

Around two thirds of married men have sex outside their (often polygamous) marriages. In 1999 sentinel surveillance, 17% of sex workers in Port Moresby were found to be HIV infected. Only 15% of sex workers in Port Moresby and Lae reported consistently using condoms in 1998. Condom use and HIV/AIDS knowledge are both low throughout the population. Deep-rooted traditions of tattoos and body scarring add to the risks of non-sexual transmission.

Visiting a man with HIV/AIDS, Port Moresby

Incidence of gang rape (known as "line-up") of women and even young children is high (in Port Moresby in 1997, 480 rapes were reported for every 100,000 women. Far more cases probably went unreported.) Besides the physical and emotional trauma of rape, the chances of HIV transmission are high for both the perpetrators and the victims, particularly when they are children.

Transmission from mother to child is emerging as the second most common route. Rates of HIV infection among pregnant women in Port Moresby doubled twice between 1998 and 2000. The numbers of children affected by HIV/AIDS are steadily increasing, in a culture where the fertility rate in PNG is around 4.8 children per woman (Demographic and Health Survey, 1996).

Discrimination of persons infected and affected may be severe. People with HIV/AIDS and their families are commonly rejected and stigmatized when their status is known, and there are even reports of people with AIDS being summarily killed in outlying communities. ("PNG AIDS Council Calls for Responsible Action Towards HIV/AIDS Patients", PACNews, 12/11/99.)

Unemployment in PNG is high, while national finances are at their lowest level in years. Poverty, poor health and sexually transmitted infections are rife. Infrastructure is basic and limited, and few people have access to basic services outside of the main population centres.

Like many developing countries, PNG is experiencing rapid development and cultural change, including large-scale population mobility. PNG is a rugged country with many remote and inaccessible areas in islands, mountains and forests. Over 700 distinct languages have been identified in a multi-ethnic population of less than five million. Many rural women and elders speak neither the official language, English, or Tok Pisin, the lingua franca. Mounting any effective HIV/AIDS communication campaign, especially one targetting women vulnerable to infection from their partners, involves enormous challenges.