Beginning with the Lord’s Prayer, HE Ratu Epeli Nailatikau, President of Fiji began the ‘Pacific Islands Voyage’ with a celebration of the united efforts of the 22 countries comprising the Pacific Island Countries and territories (PICTS) in response to HIV and other sexually-transmitted infections (STIs). With a population of around 10 million, the region is home to one third’s of the world languages and a rich cultural diversity. PICTS has a low HIV prevalence rate of < 0.1% (with the exception of Papua New Guinea, which has prevalence of 0.9%) with three countries reporting no HIV at all.
However, STIs rates are among the highest in the world and an estimated 25% of the Pacific Islanders below the age of 25 suffer from an STI. “Gender inequality and traditional gender roles in the region adversely impact the sexual and reproductive health of women. Condom use is inconsistent and alcohol consumption and drug use are other risky behaviours increasing the individual’s risk to STIs and HIV,” the President conceded. “Also many countries have legislation that is discriminatory against sex workers, MSMs, TGs and PLHIV.”
And yet, the responses towards HIV/STI have improved tremendously over the past few years. A Rapid Diagnostics of HIV Testing Algorithm has been rolled out in countries. Specimens were previously shipped to Australia or New Zealand for testing. These rapid tests have reduced the turnaround time from > 4 weeks to less than 48 hours. This has increased the number of people tested, with some countries testing >50% of their population.
A five-country study (in Fiji, Guam, Kiribati, Samoa and Solomon Islands) revealed that more than 50% of the respondents on ARTs had stopped treatment at least once. Poverty, stigma and discrimination, little knowledge about treatment, and lack of family support are major barriers to adherence and often result in PLHIVs quitting treatment. Some are also overwhelmed with the side-effects. In many cases the simple gesture of being reminded by a family member to take the medicine was enough incentive to continue treatment.
Rebecca Kubu Navanua of the Pacific Positive Group of Women felt that PLHIV, who are trained as community and outreach workers, play an important role by way of community outreach, advocacy and governance. They facilitate education sessions in the community focusing on safe sex, the need for acceptance and love from family and friends, ensuring that people can live normal lives on treatment and can have children free of HIV. The outreach workers also give inputs in drafting HIV laws/policies; work with church leaders; and do training on human rights including right to treatment without discrimination so that people with HIV get the respect they deserve. They have meaningful involvement in governance as members of several decision-making bodies like national AIDS committees, national HIV boards and national networks.
Dr Moale Kariko, of the PNG National AIDS Council Secretariat, summed up the way forward. Since 2011, access to testing, treatment and information on HIV has improved considerably. HIV is now concentrated in certain geographical regions and in key populations such as sex workers. However risk factors exist with the potential for the virus to spread more widely. Rates of STIs are very high and gender inequality, stigma and discrimination add fuel to fire. 26% of those in need of ART are still not accessing it, loss-to-follow up is high and condom use is low. More investment is required for prevention interventions in most at risk populations.
Shobha Shukla, Citizen News Service – CNS
Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.