View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Saskatchewan's Research Archive POLICY AND PRAXIS: AN ANTHROPOLOGICAL ANALYSIS OF HIV AND AIDS IN PAPUA NEW GUINEA A Thesis Submitted to the College of Graduate and Postdoctoral Studies In Partial Fulfillment of the Requirements For the Master of Arts In the Department of Archaeology and Anthropology University of Saskatchewan Saskatoon, Saskatchewan, Canada By David Bennett © Copyright D.M.J. Bennett, April, 2019. All rights reserved. PERMISSION TO USE In presenting this thesis in partial fulfillment of the requirements for a Postgraduate degree from the University of Saskatchewan, I agree that the Libraries of this University may make it freely available for inspection. I further agree that permission for copying of this thesis/dissertation in any manner, in whole or in part, for scholarly purposes may be granted by the professor or professors who supervised my thesis work or, in their absence, by the Head of the Department or the Dean of the College in which my thesis work was done. It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and to the University of Saskatchewan in any scholarly use which may be made of any material in my thesis. Requests for permission to copy or to make other uses of materials in this thesis in whole or part should be addressed to: Head of the Department of Archaeology and Anthropology University of Saskatchewan 55 Campus Drive Saskatoon, Saskatchewan, S7N 5B1 Canada Or Dean College of Graduate and Postdoctoral Studies University of Saskatchewan 116 Thorvaldson Building 110 Science Place Saskatoon, Saskatchewan, S7N 5A2 Canada !i ABSTRACT The South Pacific nation of Papua New Guinea (PNG) is in the midst of a generalized HIV epidemic with an adult prevalence rate higher than one percent. This thesis focuses on on HIV and AIDS policy in PNG from an anthropological perspective. The research conducted in this thesis considers HIV and AIDS in PNG through two distinct yet interrelated techniques. First, I conduct a detailed review and analysis of the ethnographic and non-ethnographic literature under a thematic framework. Second, I utilize a discursive methodology as part of a critical-interpretive framework to review and analyze selected policies from both governmental and non-governmental sources at the national, bilateral, and multilateral level. This grounded methodology allows for the analysis of discourse through a critical process of memoing and inductive analysis of the policy artefacts. I seek to determine the constituent discourses and themes found in PNG’s HIV and AIDS policy documents. Three primary themes emerged from the analysis. Firstly, there is a clear recognition that HIV and AIDS causes adverse effects across PNG’s society. These adverse effects are often segmented across various sectors of society, as represented by economic effects and development indicators. Direct human costs are often noted as being secondary to these economic and developmental impacts. Secondly, there is a diffusion of responsibility in responses to the epidemic. Subordinate to the primary tropes, but fitting within this dyadic conceptualization, are factors such as stigma, discrimination and gender. Finally, the use of technocratic rhetoric —a combination of medico-scientific terminology and development jargon – obscures the cultural dynamics of HIV-related stigma and discrimination. The examination of policy and literature !ii also indicates the presence of an implementation gap (differences between policies that exist on paper), and how they were actually conceived and implemented (or not) in affected communities. This body of research adds to the existing corpus of knowledge on the topic of HIV and AIDS in PNG, along with the critical anthropological analysis of text. While this thesis stands solidly on its own, it also sets the perfect stage for more traditional and long-term anthropological fieldwork !iii ACKNOWLEDGMENTS This work was partially supported by the University of Saskatchewan Graduate Scholarship, (2011-2013), University of Saskatchewan Graduate Teaching Fellowships (2013-2016), as well as several teaching, service, and research assistantships. I am eternally grateful to my supervisor, Professor Pamela J. Downe for her encouragement and support throughout this project. I am also grateful to my Thesis Advisory Committee members Dr. James Waldram (FRSC) and Dr. Karen Lawson for their insight and expertise. I also wish to thank the faculty, staff, and my colleagues in the Department of Archaeology and Anthropology at the University of Saskatchewan and in the Department of Anthropology at the University of Regina. I offer a special acknowledgement to my teaching counterpart, Candice Koblun, thank you for everything. !iv DEDICATION To my father. !v TABLE OF CONTENTS PERMISSION TO USE………………………………………………………….………………..i ABSTRACT………………………………………………………………………………………ii ACKNOWLEDGEMENTS………………………………………………………………………iv DEDICATON………………………………………………………………………..…………….v TABLE OF CONTENTS………………………………………………………………..…..……vi LIST OF TABLES……………………………………………………………………………..…ix LIST OF FIGURES……………………………………………………………………………….x LIST OF ABBREVIATIONS AND ACRONYMS…………………..……………………..……xi 1. INTRODUCTION AND BACKGROUND………….………..………….…………………..1 1.1 Introduction……………………………………………………………………………1 1.2 Background Information and Country Context…………………………………….…4 1.3 An Exigent Epidemic……………………………………………………………..….12 2. METHODOLOGY, METHODS AND DATA SAMPLING…………………………..…….17 2.1 Introduction…………………………………………………………………………..17 2.2 Analytic Methods…………………………………………………………………….23 2.3 Data Collection and Sampling……………………………………………………….26 2.3.1 Papua New Guinea National AIDS Council Secretariat……..…………….28 2.3.2 Joint United Nations Programme on HIV/AIDS………………………..…29 2.3.3 Australian Agency for International Development……..………………….30 2.4 Theoretical Background and Implications………………………………………..….31 !vi 2.5 Summary……………………………………………………………………………..35 3. REPRESENTATIONS OF HIV AND AIDS IN ETHNOGRAPHIC LITERATURE: AN ANALYTICAL OVERVIEW………………………………………………..…………..…..36 3.1 Introduction…………………………………………………………………………..36 3.2 Ethnographic Explorations.…………………………………..………………………37 3.3 Summary…………………………………………………………………………..…65 4. REPRESENTATIONS OF HIV AND AIDS IN NON-ETHNOGRAPHIC LITERATURE: AN ANALYTICAL OVERVIEW…………………………………..………….……………68 4.1 Introduction………………………………………………………………………..…68 4.2 The Church: Roles and Responses of Religious Bodies……………..………………68 4.3 On Gender……………………………………………………………………………74 4.4 Rituals and Realities: Men who have Sex with Men………………..……………….79 4.5 Healthcare (or Lack Thereof)………………………………………………….……..82 4.6 Epidemiological Experiences………………………………………………….……..87 4.7 Sex and Schools: The Educational System…………………………………………..92 4.8 On Screen and In Print: Media and HIV in PNG…………………………….………95 4.9 The View and Response from Australia……………………………………….….….98 4.10 Mind the Gap: Remedies and Research…………….…………………………..…101 5. DATA ANALYSIS AND DISCUSSION..………………………………………………….102 5.1 Introduction…………………………………………………………………………102 5.2 Background Information on the Role and History of Papua New Guinea’s National AIDS Council Secretariat………………………………………………………..….103 !vii 5.3 Background Information on the Role and History of Other Governmental and Non- Governmental Organizations………………………………………………………….. 105 5.4 The Structure of the Policy Document.……………………..………………………108 5.5 Analysis of Policy…………………………………………………..………………111 5.6 Discussion and Summary..………………………………………………………….136 6. CONCLUSIONS AND FUTURE DIRECTIONS…………………………………………140 6.1 Conclusions…………………………………………………………………………140 6.2 Future Direction ……………………………………………………………………145 WORKS CITED……………………………………………………………….……………….148 !viii LIST OF TABLES TABLE 1.1: Human Development Ranks, Values, and GNIs of Selected Countries……………..9 TABLE 4.1: Maternal and Infant Mortality Rates and Life Expectancies……………………….86 TABLE 4.2: Selected Health Comparators Between Countries…………..……………………..88 !ix LIST OF FIGURES FIGURE 1.1: Political Map Of Papua New Guinea………………………………………………5 FIGURE 4.1: ABC Approach as represented in Educational Curriculum……………………….94 !x LIST OF ABBREVIATIONS AND ACRONYMS AIDS: Acquired Immunodeficiency Syndrome ARV/ART: Antiretrovirals/Antiretroviral Treatment AusAID: Australian Agency for International Development HIV: Human Immunodeficiency Virus M&E: Monitoring and Evaluation MDGs: Millennium Development Goals NACS: National AIDS Council Secretariat NDoE: National Department of Education NDoH: National Department of Health NHPS: National HIV Prevention Strategy NGPP: National Gender Plan and Policy NSP: National Strategic Plan PACS: Provincial AIDS Council Secretariat PICTs: Pacific Island Countries and Territories PNG: Papua New Guinea STI: Sexually Transmitted Infection TB: Tuberculosis UNAIDS: Joint United Nations Programme on HIV and AIDS UNDP: United Nations Development Programme UNGASS: United Nations General Assembly Special Session on HIV and AIDS VCT: Voluntary Counselling and Testing !xi CHAPTER ONE INTRODUCTION AND BACKGROUND 1.1 Introduction The HIV and AIDS1 activist, public health scholar, and practitioner of medicine, Shereen Usdin, introduces her book by stating that, “the HIV/AIDS pandemic had indelibly altered the landscape of life in the 21st century. A pandemic of superlatives, it is described as the greatest humanitarian