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PASA 35 2010.Indd No. 35 January 2010 ISSN 1018-2152 PASAPaci! c AIDS Alert Bulletin Contents: Policing women’s bodies in PNG ...................................................... 2 Stigma, discrimination and regionalism key challenges Paci! c must address gender inequality to ! ght HIV ................. 3 for Paci! c AIDS work, says AIDS Alliance ......................................16 Tackling the Paci! c’s high rates of chlamydia ..............................5 Introducing Homo-Sphère – New Caledonia’s Implementing HIV continuum of care in PICTs ............................ 5 ! rst gay NGO ...........................................................................................17 Integrated antenatal HIV and STI counselling ............................. 7 No time to waste in implementing second Regional ‘Score’: Vanuatu and Solomon Islands launch their ! rst Strategy on HIV and other STIs .........................................................19 Paci! c condom social marketing programme ..............................8 ICAAP 2009 through the eyes of the Papua New Guinea Love Patrol is on again! .........................................................................11 Sexual Health Society .........................................................................20 Komuniti Tok Piksa: Voicing community stories on HIV The Safe Festival Campaign – an essential ingredient and AIDS in PNG ....................................................................................12 of the Paci! c Youth Festival ...............................................................23 Stepping Stones evaluation: Re" ecting on successes and World AIDS Day – Human rights in the Paci! c ............................26 challenges and the way ahead .........................................................13 Bored? Confused? Not any more! ...................................................27 Mainstream media and behaviour change: Is it HIV? A handbook for health care providers .........................28 Two sides of the communications coin .........................................15 Gender and HIV Policing women’s bodies in PNG ecently, certain health-care R settings in Papua New Guinea Power di! erentials between health-care workers have taken a new policy approach to HIV testing based on an ‘opt out’ and female patients make it di" cult for women to approach, rather than the historical make choices to ‘opt out’ in the clinical encounter. ‘opt in’ approach. ! e ‘opt out’ approach is especially advocated in health-care settings such as antenatal clinics (ANCs), and is designed to increase HIV testing rates. ! e assumption is that increased opt- out testing will reduce mother-to- child transmission (MTCT) and increase the number of women on ‘! ere has been a long history of out’ program initiated in 2004 felt that antiretroviral therapy (ART). women who test HIV-positive in the they could not refuse the test o# ered antenatal setting who do not return by the health-care worker. Power Angela Kelly has a dual appointment for treatment or delivery, both in di# erentials between health-care with the PNG Institute of Medical PNG and the developing world as workers and female patients make it Research and the International a whole. While the numbers are di$ cult for women to make choices to HIV Research Group, at the School improving as health-care providers ‘opt out’ in the clinical encounter. of Public Health and Community adapt to the complex needs of women Medicine at the University of New testing positive in this context, much ‘Until we can increase the number South Wales. She is working on more still needs to be done. As some of women who return a" er their a number of projects, including have argued, great caution needs to diagnosis for safe delivery and for one funded by AusAID: ‘Women be taken when only seeing success ongoing follow-up, and improve and men’s experiences of PMTCT of the PMTCT program in terms of the social and health outcomes [prevention of MTCT] in Papua New the number of women testing and on for women and their children and Guinea: A gendered socio-cultural treatment. families who have already tested analysis of barriers and facilitators for positive with an opt-in, then it is program engagement 2009–2011’. ‘International research tells us that neither ethical nor in the interests women who test positive in an ANC of maternal and child health to shi" For Angela, this policy shi" to ‘opt are less likely to disclose their HIV direction in HIV testing to opt-out,’ out’ in the PNG context has occurred status to their partners than women argues Angela. without an evidence base of what the tested in other sites. We also know issues are for women undertaking that women with HIV experience ‘It is not in the interest of women HIV testing in ANCs and entering a higher rates of intimate-partner to advocate for scaling up e# orts continuum of HIV care. ‘We actually violence than women who do not to test pregnant women for HIV if know very little about PNG’s HIV- have HIV.’ the unintended consequences of a positive antenatal mothers and why positive result put the women at more so many are declining to accept Research in South Africa indicates risk of violence, abandonment and treatment, return for delivery or that irrespective of their test results possible death. ANC testing makes accept the care and support o# ered a" er undergoing provider-initiated HIV testing and disclosure a gender post-delivery. And we certainly do counselling and testing in the issue rather than a couple one. ! e not know the clinical and social antenatal setting, women said that lives of women and children will not impact of the change to opt-in HIV they felt pressured by the health- be genuinely advanced until men testing for pregnant women. ! is is care worker to undergo the test. In are included in all ANC settings and a large gap in our knowledge of the Botswana more than two-thirds of made to feel equally responsible for epidemic in PNG. women testing for HIV under the ‘opt HIV in their relationships. 2 PASA n° 35 – January 2010 Gender and HIV ‘We must also think about the 40% of services. We need to also think about For more information, please contact pregnant women in PNG who never what role increasing community Angela Kelly, Research Fellow, attend an ANC or have a supervised awareness about HIV testing in International HIV Research Group delivery. Antenatal HIV testing does ANCs plays in women’s decision to (IHRG), School of Public Health and not and will never reach those women avoid or delay entry into health care Community Medicine, University of who do not access antenatal care when pregnant.’ New South Wales, Sydney, ph: +61 (2) 9385 1396; email: [email protected] Paci! c must address gender inequality to ! ght HIV Tione Chinula (SPC) s indigenous peoples around A the world contemplate how to strengthen e# orts to tackle HIV in their communities, an HIV advocate in the Paci% c believes that more emphasis should be put on addressing the gender dimension of the disease. SPC Prevention O$ cer Jovesa Saladoka says that if e# orts to curb the spread of HIV in the Paci% c are to succeed, strategies on HIV must include gender equality. Jovesa made the comments in relation to the 2009 theme of the International Day of the World’s Indigenous Peoples (9 August): ‘Indigenous Peoples and HIV/ AIDS’. ! e day aims to strengthen international cooperation for % nding solutions to the problems faced by indigenous peoples in areas including ‘Most women who get the disease are infected by culture, education, health, human their husbands or long-term partners’ rights, the environment, and social and economic development. ! e failure to address the gender dimension in the Paci% c early on in the epidemic has contributed, to a certain extent, to the spread of the disease, Jovesa says. PASA n° 35 – January 2010 3 Gender and HIV human rights puts them at risk of ‘Unless the underlying attitudes and inequalities contracting HIV. Entire societies are su# ering the consequences. that allow gender-based violence to occur are Unless the underlying attitudes and understood and addressed, controlling HIV inequalities that allow gender-based infection will remain a major challenge.’ violence to occur are understood and addressed, controlling HIV infection will remain a major challenge.’ Additional factors in the Paci% c that contribute to the spread of the epidemic include high rates ‘New cases being recorded in the condom may go some way towards of sexually transmitted infections Paci% c are showing a higher level of empowering women to make (STIs), which increase the likelihood risk and vulnerability for women,’ decisions about their sexual health, of contracting HIV; low condom use; he says. ‘Most women who get the public’s attitudes with regard to lack of rights for certain vulnerable the disease are infected by their acceptability of this condom, which is groups in some countries, including husbands or long-term partners. So relatively new, are yet to be seen. men who have sex with men, and an issue that particularly needs to be SPC’s Human Development Adviser sex workers; lack of active reinforced among men is responsible (Gender Equality) Treva Braun says engagement by leaders; and behaviour. Men can explore how they gender-based violence is another limited access to education, which can create a culturally friendly, level manifestation of gender inequality subsequently limits access to playing % eld where everyone a# ected that needs particular attention in information on HIV prevention
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