June 01, 2006
Papua New Guinea: No Escaping the Virus
BY Sheri Fink
Villagers on the island of Kiriwina, part of the Trobriand Islands (and known by tourists as the "Islands of Love,") take shelter from the rain.
On the 25th anniversary of the AIDS epidemic, HIV threatens even the world's most isolated populations.
Papua New Guineans take pride in their country's tourism motto: "Land of the unexpected." Visitors to the South Pacific nation have been known to come across rare wildlife, mud-covered men, and once, in the 1980s, a mountain tribe that had almost no previous contact with foreigners. But perhaps the most unexpected thing about Papua New Guinea is that it has become the epicenter of AIDS in the Pacific, and only the fourth country in the region to experience an epidemic that has crossed from high risk groups into the general population.
For the first two decades of the epidemic, Papua New Guinea's government did little to prepare for HIV. The nation's geographic isolation and poor transportation infrastructure had protected the people and their age-old traditions from this modern scourge. (The country is larger than California, but if you laid all of its paved roads end to end, they wouldn't even reach from San Diego to San Francisco.)
HIV entered the country through trade and tourism. "Fergus," who co-founded Papua New Guinea's only organization for people living with HIV and AIDS, has a typical story. He came from a coastal village to the capital, Port Moresby, to study. When he couldn't pay for college, and couldn't find a job, he ended up on the street. "When somebody picked me up for the first time, he gave me 20 kina (US$7 dollars). I said, 'Wow, this is good! Rather than suffering and going through the hardship, why don't I sell myself for money?' So I went out with Australians who flew in for tourism. I spent all my life with the white guys."
While it's easy to see how HIV reached the capital, and spread through poverty and the sex trade, it's harder to understand why HIV is now beginning to devastate secluded rural areas.
With those white guys came HIV and AIDS. About one in every six sex workers in Port Moresby has already contracted HIV. While it's easy to see how HIV reached the capital, and spread through poverty and the sex trade, it's harder to understand why HIV is now beginning to devastate secluded rural areas, home to more than 80 percent of the population. Dr. Paul Harino, who works at a hospital in the Eastern Highlands, about an hour's flight from Port Moresby, says more and more patients with AIDS are coming to see him. "HIV has now gone right down to the villages, even some so remote that the only means of transport is an airstrip with a small plane into town. They come here with fully blown AIDS."
A recent study funded by the Australian Agency for International Development (AusAID) -- Papua New Guinea's former colonial ruler and by far the greatest monetary donor to the fight against HIV here -- projects that more than half a million people in this country of just over five million could become infected with HIV in the next 20 years. Dame Carol Kidu, Papua New Guinea's Minister of Community Development, explains why. "Since people are mobile, if an individual becomes positive in an urban area and goes back to a community that has no knowledge of this, there's the potential it can almost wipe out the reproductive age group in communities." These communities don't associate sex with illness, because attitudes toward sex evolved long before sexually transmitted diseases were a threat. "There's great variety in Papua New Guinea in cultural practices to do with sexuality and fertility," Kidu says, "so that is a risk."
Joyce Motobila is the only AIDS awareness worker in the Trobriands. She has made it her personal mission to educate as many islanders as possible about the disease.
She worries about places like the Trobriand Islands. Nicknamed the "Islands of Love," the coral archipelago is about 300 miles from the capital. Joyce Motobila, the only AIDS educator on the islands, says that sex there is free. "If I want to go and have sex with anyone from any village, it's my choice. No one will say no. It's the attitude of everyone and we're trying to help people to see that it's dangerous."
Motobila says that some of the sex rituals observed during certain indigenous holidays, such as the yam harvest festival, also put people at high risk. On the night of the festival, even those who are married are allowed to have sex with other people. Despite the AIDS threat, tribal chiefs and political leaders have insisted on keeping the tradition, and in recent years have promoted it as a tourist attraction. Outsiders have poured into the Trobriands to take part in the festival, and the level of sexually transmitted infections has soared.
At one of the Trobriand Islands' few tourist lodges, employee Lydia David worries that if these customs aren't modified, HIV will decimate her community. "When everybody is infected with this, it's goodbye to our beautiful culture, it's goodbye to our family ties, it's goodbye to something that's so beautiful on this island."
Safe sex concepts collide as much with local traditions here as they do with the import of Western religion. Most people in Papua New Guinea are practicing Roman Catholics. Many say they don't want to use condoms to protect themselves against HIV because some pastors here preach against it. "We don't want to use the condom," says Larry Koavea, a pastor from an illegal squatter settlement in Port Moresby. "It brings disease into our community," he insists. The settlement reportedly has one of the highest rates of HIV in the country.
"When everybody is infected with this, it's goodbye to our beautiful culture, it's goodbye to our family ties, it's goodbye to something that's so beautiful on this island."
Other Western influences have also promoted the spread of HIV. On a recent Friday evening on the main island of Papua, a disco in the small mountain town of Goroka opened its doors for ladies' night. A line of young girls in scant clothing filed across the concrete dance floor as townspeople and villagers began arriving for the night's festivities. Urban and rural communities come together here, linked by the country's only major highway. A group of young men out driving that night say that nightclubbing, drinking and sex go together here. "We purposely get drunk to dance," says one. Another adds of his peers: "When they get drunk they go for it, having sex with anybody."
Many people here know little about AIDS other than that it's a "killer disease," and few have access to highly effective anti-retroviral drugs -- even when it could help prevent a mother from passing the virus on to her child.
Villagers from the Eastern Highlands village of Sugiato hold up AIDS awareness posters.
The country's cultural diversity and poor communications have hobbled even recent efforts to mount awareness campaigns. Papua New Guinea has well over 800 known languages, and many people literally don't understand AIDS awareness messages put out in the country's three official languages -- English, Pidgin and Motu. A third of adults can't read in any language, and few have radios or television. What's more, many people have no concept of viruses. In many cultures here, illness and death were historically blamed on sorcery.
Experts agree that if Papua New Guinea can be saved from the dire predictions of a widespread AIDS epidemic, it will come through the patient awareness efforts of young people native to their communities, like Joyce Motobila. The 26-year-old has taken it upon herself to spread the gospel of HIV prevention in the Trobriand Islands. She trudges along paths paved with seashells, wearing a backpack full of AIDS awareness pamphlets that she translates and explains in the local Kiriwina language. She works without pay and has even gone barefoot when her flip-flops wore out. Friends send her condoms and prevention materials by boat or a twice-weekly "puddle jumper" propeller plane -- the only two ways to reach the islands.
Motobila walks among tightly packed thatched huts, past women walking topless, and marches up to a group of teenage boys who tower over her slender, five-foot frame. She starts talking to them about condoms.
They respond with interest and laughter. Sex in the Trobriands -- long romanticized by the writings of anthropologists like Bronislaw Malinowski -- has more in common with sex in the U.S. Young people experiment with multiple partners before they marry, and sex carries with it a paradoxical shame. "It's free for them to have sex, but it's not free for them to talk about it...in public," says Motobila.
Motobila admits that changing sexual behavior is difficult, but she has reason for hope. On the Trobriands, only two people have died of AIDS so far. "People are slowly by slowly trying to change their behavior," she says. "Even midnight, boys try to come to wake me up to ask for condoms. And I was like, 'Thank God,' at least boys are taking the responsibility of looking for safety in the middle of the night."
The paramount chief of the Trobriands, who exerts a powerful influence over the population of the entire island chain, has also come on board. "People should be faithful to one partner so they can minimize the chance of spreading disease," he says through a translator. He's even practicing what he preaches. Previous chiefs have married more than a dozen wives. He has just one.
Sheri Fink is the author of the award-winning book War Hospital. She reports frequently on global health issues for Public Radio International's The World and for other broadcast, print and Web media.
PHOTOS: Sheri Fink
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The Age of AIDS
For a global picture of where we stand 25 years after AIDS was officially identified, visit the FRONTLINE Web site for an investigation into the science, politics, and human cost of this fateful disease, including what lessons of the past have been learned, and what can be done to stop AIDS in the future.