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The Changing Face of the Epidemic In Table of Contents Foreword………………………………….. ........................................................ iii Acknowledgements……………………… ......................................................... vi Abbreviations……………………………… ...................................................... vii Executive Summary……………………… ....................................................... vii Introduction………………………………… ........................................................ 1 Section I: Background…………………… ......................................................... 2 1.1 Contexts of the epidemic ........................................................................ 2 1.2 Summary of the national response ......................................................... 3 1.3 Contexts of the official estimates and projections ................................... 5 1.4 Previous consensus workshops ............................................................. 5 Section II: Overview of Surveillance System and Data .................................... 6 2.1 Routine Surveillance .............................................................................. 6 2.1.1 Routine HIV case reporting of HIV/AIDS .......................................... 6 2.1.2 Distribution of HIV infection by age .................................................. 8 2.1.3 Province of Detection ....................................................................... 8 2.1.4 Mode of Transmission ...................................................................... 9 2.1.5 Routine STI case reporting. ........................................................... 10 2.1.6 HIV infection Among Blood Donors ............................................... 11 2.1.7 HIV infection among VCT clients ................................................... 11 2.2 Sentinel surveillance of HIV infection ................................................... 12 2.2.1 Antenatal Clinics (ANC) ................................................................. 12 2.2.2 STI clinics ...................................................................................... 14 2.2.3. HIV in TB Patients......................................................................... 15 2.3 Behavioural Surveillance Surveys and Other Behavioural Research ... 16 2.3.1 Behavioural Surveillance Surveys (BSS) 2006 .............................. 16 2.3.2 Behavioural surveys using RDS .................................................... 17 Sex Workers ........................................................................................ 17 Men who have sex with men ............................................................... 18 2.3.3 Consensus Workshop Behavioural Surveillance Working Group .. 18 2.4 Hospital experience with HIV and Antiretroviral Therapy (ART) ........... 19 Section III: Updated Estimation of HIV prevalence. ....................................... 20 3.1 Previous methods of estimating the HIV prevalence ............................ 20 3.1.1 Workbook ....................................................................................... 21 3.2 Process for estimating HIV infection in PNG ........................................ 21 3.3 Methodology and assumptions for 2007 estimations ............................... 21 3.3.1 Methodology .................................................................................. 21 3.1.1.1 Estimation and Projection Package (EPP) .............................. 22 3.1.1.2 Spectrum ................................................................................. 22 3.3.2 Data Used ...................................................................................... 23 3.3.3 Methods and assumptions ............................................................. 23 3.3.4 Quality of Data ............................................................................... 24 3.3.5 New estimates: the new face of the epidemic ................................ 25 3.5 Comparison between new and old estimates ....................................... 26 3.6 Update and Projection of key HIV Indicators ........................................ 28 Conclusions and Recommendations…………. .............................................. 30 References……………………………….. ........................................................ 33 Appendix 1: Participant Lists…………….. ...................................................... 36 ii Lists of Tables Table 1: New and Cumulative HIV infections detected in Papua New Guinea, 1987 - 2006 ...................................................................................................... 7 Table 2: HIV infections reported in Papua New Guinea, 1987–2006, by mode of transmission ................................................................................................. 9 Table 3: ANC Antenatal HIV Prevalence, Urban Sites 2002-2006 ................. 13 Table 4: ANC Antenatal HIV Prevalence, Rural Sites 2002-2006 ................. 14 Table 5: HIV Prevalence in STI Clinics, 2002-2006…. ………………………..15 Table 6: Organizations involvement and contribution in ART Program……...19 Table 7: Assumptions and errors in adult HIV prevalence estimates in generalized epidemics using EPP………………………………………………..23 Table 8: Estimated HIV Prevalence……………………………………………...25 Table 9: Previous and new estimates of HIV prevalence in PNG………….…27 Table 10: Update and projection of key indicators on the HIV epidemic….…29 List of Figures Figure 1: New and cumulative annually reported HIV infections in Papua New Guinea, 1987–2006…………………………………………………………………7 Figure 2: HIV infections detected in PNG by age, 1987 – 2006………………..8 Figure 3: HIV infections reported in Papua New Guinea, by province of detection 1987 – 2006………………………………………………………………9 Figure 4: HIV Testing Amongst Blood Donors, 2002-2006……………….…...11 Figure 5: HIV tests conducted amongst VCT clients 2002 – 2006…… …….12 Figure 6: TB testing by year 2002 – 2006………………………………………16 Figure 7: Quality of global sero-surveillance system quality………………………………………………………………………….........24 Figure 8: Urban, Rural and National trends in the HIV Epidemic in PNG……26 Figure 9: HIV prevalence in ANC from Port Moresby General Hospital 1992 – 2006…………………………………………………………………..……………..28 List of Charts Chart 1: Data and tools used for estimation and projection in generalized epidemics………………………………………….………………………………..22 iii Foreword It is my pleasure to introduce this milestone HIV and AIDS Estimation Report for 2007, developed by the National AIDS Council Secretariat and the National Department of Health. The compilation of this report is an important step in the provision of strategic information for the national response to the HIV epidemic. This document provides updated information on the HIV situation in the country and these data are the cornerstone for planning, resource allocation, advocacy, and HIV policy formulation, in addition to the design of prevention, behaviour change, treatment, care and support programs in Papua New Guinea. The compilation of this report satisfies one of the key objectives of the government through the National AIDS Council and the National Department of Health to provide up to date information on the HIV epidemic so that all stakeholders can access and use this information to plan and implement their response to HIV. The data used in this report were collected from STI, HIV, ANC and TB clinics, VCT sites and behavioural surveillance sites. About 4,017 people tested HIV positive in 2006; 30% more than in 2005. Sero-surveillance sites showed an increase in prevalence levels with the total number of reported HIV infections reaching 18,484 by the end of 2006. Despite the lack of comprehensive information about the age and sex of people diagnosed with HIV, as age was not recorded in one-third of the data; where age was recorded, the majority of HIV infections were in people aged between 20 and 35, with higher numbers of HIV infections found in female youth and younger women. According to the data available, the most common age at diagnosis for men is in the 25-29 and 30-34 year age groups, with 60% of all infections in males under the age of 35 and three quarters below the age of 40. More female youth and young women are diagnosed with an HIV infection at an earlier age particularly in the 20-24 and 25-29 year old groups, with 61% of infections by the age of 29, over three quarters of infections diagnosed by the age of 34, and 94% by the age of 44. The national HIV prevalence is estimated to be 1.28% among adults aged 15- 49 at the end of 2006, which means there are about 46,275 people estimated to be living with HIV. The trend of the epidemic is showing a high increase, especially in rural areas where 85% of the PNG population lives. It is projected that starting in 2007 the prevalence among the rural population will become higher than in urban areas. The new 2006 prevalence estimate, when compared to previous estimates, show that while the prevalence is lower than what has been previously estimated; the trends in the epidemic are increasing more sharply than what has been previously documented. iv Other projections in this report estimate that in 2007, 3,700 people will die of AIDS. Increased numbers of people dying of AIDS continue to impact on the vulnerability of children and youth, and it is projected that in 2007, 3730 children (0-17) will be orphaned due to AIDS. These alarming statistics are a cause of grave concern for the government and we are mobilizing all of our resources to minimize the impact of the HIV epidemic on people‟s lives in rural and urban areas.
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