Health
HIV/AIDS, A Worry Still In 2004
Australia, France, UN give funds to fight epidemic
Papua New Guinea excluded, HIV/AIDS is still classified as a low level epidemic in the Pacific.
But indications are that this will not remain so for long given that HIV/AIDS is a sexually transmitted infection (STI) and other STIs are prevalent in the islands. The prediction came from Dr Michael O'Leary, a regional epidemiologist, working at the United States Center for Disease Control and Prevention based in Palau.
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"If STIs are common, this suggests a greater risk for the spread of HIV because the activities or behaviours which spread STIs are the same as those which spread HIV," said O'Leary. "As well, the presence of STI facilitates HIV transmission. So to access vulnerability, we need only ask ourselves, are STIs common?"
That the rate of STIs in the region is alarming is shown in a report done in 1999 to 2001 on ante-natal women who are infected. O'Leary said in one Pacific islands nation he would not name, almost 30 percent suffered from chlamydia, whilst another island nation had over 26 percent of women who had trichomonas, two common STIs.
These rates are disturbing given that in a country like Kuala Lumpur, less than five percent of women had chlamydia during the same period. The way forward, O'Leary believes, is the implementation of a combination of factors that would include political support and leadership, setting clear and achievable strategies and activities, care and support for people living with HIV/AIDS, financial support and sustained effort.
Impractical and mostly counter-productive are measures like mandatory testing, release of names and isolation of patients. These suggestions have been taken on board by several regional HIV/AIDS/STI initiatives with at least three funding sources.
The goal of the AusAID-funded programme is to reduce the vulnerability and impact of HIV/AIDS in Pacific Islands countries and territories. It runs for five years commencing late 2003 with a regional and national component that includes help in the re-development and implementation of a new regional HIV/AIDS strategy.
On the national front, areas of assistance will include strengthening responses by providing management, technical and financial support to government and civil society organisations.
The French government is also pitching in money to complement the AusAID and United Nations Global Fund projects.
Under the global fund initiative, two years of funding of US$7.51million has been approved which will be directed towards HIV/AIDS, tuberculosis and malaria.
Among other regional initiatives on HIV/AIDS unveiled at the recent Pacific Community conference in Fiji are:
* Strengthening STI/HIV surveillance including expanding laboratory facilities, making national labs like Fiji's Mataika Laboratory become regional labs.
* UNAIDS office is back in the Pacific after a three-year absence when it opened in PNG in mid-2003. The Fiji office looking after Fiji and the nine countries of Kiribati, Tonga, Solomon Islands, Vanuatu, Federated States of Micronesia, Marshall Island, Palau, Nauru and Tuvalu, opened on September, 2003.
* The third office will open in Samoa.
The situation in the islands
AIDS is now the major cause of death in Port Moresby's general hospital‹Papua New Guinea's largest‹and if world trends are anything to go by, the numbers will continue to climb not decline.
Under the World Health Organisation's (WHO) classifications, HIV/AIDS in Papua New Guinea has reached "generalised epidemic," and after Thailand, Cambodia and Myanmar, it is the fourth largest country with HIV/AIDS in the Asia/Pacific region. By March 2003, total reported cases of HIV/AIDS in Papua New Guinea were 7036. But WHO estimates the total HIV infection is much higher, something in the vicinity of 15,000 to 20,000, and given the national government's lethargic reaction to the epidemic, medical experts say the crisis will only get worse.
"Lack of political will is leading to lots of denial and many still do today," Dr Ninkama Moiya, director of PNG's National AIDS Council Secretariat said. "There has been some response from the national government, but support in terms of funding is sadly lacking."
In a paper presented at the recent Pacfic Conference in Suva, Moiya said poor government support was shown when the National AIDS Council Act was rejected by parliament in 1994. The act which paved the formation of the council he now heads was not passed until three years later, in 1997. Since the country reported its first case of HIV in 1987, PNG has seen a gradual but steady increase in infection and by 1995, the rise in numbers has been "exponential."
Males and females are affected equally, and as in other countries, the young populace, those between 15 to 35 years are bearing the brunt of the epidemic. Some 100 people are said to be infected each month with transmission being predominantly in the heterosexual mode, Moiya said.
"HIV is now reported from all provinces in PNG since March, 2003. Just some three years ago, some of these provinces were untouched by the epidemic.
"AIDS related death is the leading cause of death in the medical wards of Port Moresby General Hospital, the biggest hospital in the country.
"An increasing number of people now admit of knowing someone they've been close to who has died or is infected and affected by HIV/AIDS."
Advocating top level political leadership and commitment to drive the fight against HIV/AIDS is the AIDS Council's number one challenge for the future. Provincial responses ought to be tailored, prioritised and strengthened for provincial needs, said Moiya.
"We would need national government commitment to support funding the national response. Development of relevant sectoral policies and mainstreaming HIV/AIDS also need to be addressed."
FIJI
HIV/AIDS in Fiji is more than just a health concern, it has been upgraded to a national security issue following presentations made to the country's national security council by the Health Ministry.
The elevation to national security status stems from the security council's concern for the threat HIV/AIDS poses to the young and vibrant sector of the population.
Of the 129 confirmed cases of people living with HIV/AIDS in Fiji, a frightening 52 percent are in the age group of 20 to 29. Following close behind at 26 percent are those in the 30 to 39 age bracket. Some 11 percent are those between 40 to 49. But what is more disturbing is the number of youngsters, infants included, who are HIV positive.
Figures released to the November Pacific Community conference show that seven percent of those living with HIV/AIDS in Fiji are between 0 to 9 years old. They got infected through their mothers, and under the Ministry of Health policy, these ones are treated by antiretroviral drugs. The only other group that gets the drugs free from the Fiji Government are medical workers who accidentally prick themselves with needles while treating HIV patients.
Others have to meet the cost of the drugs or simply go without it, something that is bound to change now that Fiji has successfully applied for funds from the UN-administered Global Fund on HIV/AIDS. There are more males than females suffering from the disease in Fiji. The main mode of transmission being heterosexual sex, some 84 percent got infected this way.
Health ministry predictions say the number of HIV infections should continue to rise reaching some 6500 cases by 2015. As the way forward, Dr Timaima Tuiketei, assistant director of preventative health care in Fiji's ministry of health, highlighted an eight-pronged multi-sectoral response that includes:
* preventing people from being infected with HIV/AIDS.
* focussing on countering the spread of the disease amongst young people.
* concentrating on people living with HIV/AIDS.
* voluntary counselling & HIV testing.
Unlike PNG, Tuiketei said her ministry's work against HIV/AIDS is enhanced with enormous display of government commitment led by the Prime Minister himself as well as the country's First Lady and the powerful indigenous leaders body, the Fiji Council of Chiefs.
KIRIBATI
With 42 confirmed HIV/AIDS cases in Kiribati, the north Pacific atoll nation is‹in comparison with Papua New Guinea's 7036 cases and Fiji's 129‹still in the infancy stage of the epidemic.
This may be so, but taken in proportion with the country's population, the figure is quite alarming. Most of those infected are men, some 74 percent. Most are seamen working on overseas-based commercial freighters and fishing boats.
The second highest risk group are the wives of seamen. About five are now HIV positive. Equally disturbing is the high number of little girls infected through mother to child transmission. The Kiribati Health Authority's HIV/AIDS Taskforce work was boosted with the formation of a parliamentary committee on HIV/AIDS late in 2003.
Headed by the country's health minister, the committee was formed in line with a resolution of the summit of heads of government who are members of the Pacific Islands Forum in Auckland last August. Now with the political commitment demonstrated publicly, the hope would be to see this translated into financial commitment.
