HIV COUNSELING AND TREATMENT ISSUES IN PAPUA NEW GUINEA

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HIV COUNSELING AND TREATMENT ISSUES IN PAPUA NEW
GUINEA

• Professor Glen Mola
• Head, Dept. of ObGyn, UPNG
• 19.9.2002

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The HIV situation in PNG (NCD)

• HIV epidemic began in National Capital in 1986.
• Antenatals zero HIV for the first years of
  testing (1987/88), 0.6 IN 2001, 1 for the first
  8 months of this year.
• STD clinic attendees, 10 HIV positive
• TB clinic patients 15 HIV positive
• Blood donors 0.5 HIV positive.

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Maternity care at PMGH HIV

• National capital public hospital (PMGH) cares for
  10,000 confinements pa.
• 35 women per day, 20 beds. Some deliver on the
  floor
• 5000 antenatal clients at PMGH and another 4500
  at urban clinics line ups of 100-120 women every
  morning
• Standard tests are Hb, VDRL, (HIV
  serosurveillance).

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Population of National Capital and confinements
at PMGH
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Care of HIV Ante-natal women

• From 1994 to 2001 we used to do pre-test
  counseling and linkage of the result to the
  woman HIV women had post-test counseling over
  several sessions, and referral to social workers
  and paediatricians.
• This stopped in 2001 because we were told that
  our attempts at pre-test counseling were
  inadequate we had nothing beneficial to offer
  HIV women.

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Maternity hospital conditions

• Sometimes no gloves in labour ward
• Frequently short of medical disposables,
  antiseptics disinfectants
• Financial constraints no casual workers
  (cleaners etc.) nurses and doctors have to clean
  up, - sometimes too busy - place stays soiled,
  smells. Needle sticks.
• Attempts to enlist support of female support
  persons foiled by nursing staff concerns.

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Treatment default leads to the commonest cause of
death

• T.B. commonest cause of death in adults for many
  years at PMGH,
• Patient stop their drugs when feel well.
• Disease recrudesces and they succumb
• HIV treatment even more difficult to monitor and
  ensure proper compliance, - side effects and
  other treatment issues more of a problem than
  with TB treatment

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The Public Health Conundrum

• Even at the generic price HAARVs will cost US500
  pa per person.
• PNG spends less than 30 per capita on health pa
• ?better to put money into primary prevention
  rather than AIDS treatment?
• The Ugandan experience
• Family planning could save 50 of our 1000
  maternal deaths _at_ cost 1 per Mum

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Most people want.

• Help when they are sick, have accident,
• Reproductive health care, Family planning,
  Infertility, delivery aftercare
• Immunization,
• Water supplies,
• Health education etc

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Reaction of individuals to HIV positivity AIDS

• Many want to blame someone when they find out
  they are HIV the man.
• Up to 2001 we found that 20 of antenatal HIVs
  partners were HIV -ve.
• Put themselves in Gods hands tell you that
  now everything will be alright
• Many do not seem to take any notice of the HIV
  status diagnosis just carry on with life as
  before.

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Reactions of individuals cont.

• Remain positive, - but hoping that if they live
  healthy, do what the doctor says, take herbals
  etc. that they will be alright. Clutch at straws,
  follow any traditional and seek out any promise
  of cure.
• A few become very angry and want to take the
  world with them.
• All PNGeans want to go home to die, or at least
  be taken home for burial.

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Family reactions to HIV relative

• Supportive and caring.
• Dont want to have anything to do with the HIV
  relative blamed for their behaviour. In the
  early part of the epidemic then victims are often
  obviously those with more sexual partners
• Where were you when we needed you?

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Even without ARVs there are still some benefits
in knowing HIV status

• What is going to happen to you.
• How you can help yourself use the health
  service to help yourself
• Nutrition, no poisons, exercise, support
  groups, positive thinking,
• How to avoid giving HIV to others
• Fertility planning the care of children
• Preparation for last days where, who with, put
  right with God and man, Will.

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Some areas of the Highlands of PNG have very high
incidence of STIs
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The Prevalence of STDs in PNG

• Asaro valley survey (1997) shows,
  - Trichamonas, 46,
  - Chlamydia trachomatis, 25
• The PMGH Antenatal clinic study (1995), -
  Chlamydia trachomatis, 23
• Positive Syphilis serology surveys (ANCs),
  - 4 in NCD,
  - 10-20 in the Highlands
  provinces.
• 65 of young adults in the Asaro survey had some
  kind of STD.

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Projected prevalence of HIV in young PNG adults
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Adolescents in PNG

• Could be encompassed by 12-19 year olds but
  surveys show that up to 30 of kids in grade 6
  have had sex in some areas.
• Account for 21 of our population, - compared to
  22 of the population who are women of
  reproductive age.
• But are currently almost invisible or ignored
  as far as the health care system is concerned.

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Adolescents are everywhere.

• Health workers need to think about this.
• Consider everyday scenarios, bus, market, store,
  street.
• But whom do we see at clinics and hospitals.
• We rarely see an adolescent .?
• Many different types and needs