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Weikum D, Kelly-Hanku A, Neo-Boli R, Aeno H, Badman SG, Vallely LM, Willie B, Kupul M, Hou P, Amos A, Narokobi R, Pekon S, Coy K, Wapling J, Gare J, Kaldor JM, Vallely AJ, Hakim AJ. Sexual and reproductive health needs and practices of female sex workers in Papua New Guinea: findings from a biobehavioral survey Kauntim mi tu (‘Count me too’). Arch Public Health 2022; 80:202. [PMID: 36064615 PMCID: PMC9442976 DOI: 10.1186/s13690-022-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Little research has explored the sexual and reproductive health (SRH) experience of female sex workers (FSW), including girls aged < 18 years who are commercially sexually exploited (CSE), in Papua New Guinea (PNG). This paper describes the SRH history of FSW and CSE girls and factors associated with their use of moderately or highly effective contraceptive methods in three settings in PNG. Methods From 2016 to 2017, respondent-driven sampling (RDS) surveys were conducted among FSW and CSE girls in Port Moresby, Lae, and Mt. Hagen. FSW and CSE girls who were born female, aged ≥12 years, sold or exchanged vaginal sex in the past 6 months, spoke English or Tok Pisin, and had a valid RDS study coupon were eligible to participate. Interviews were conducted face-to-face and participants were offered rapid routine HIV and syphilis testing. Survey logistic regression procedures were used to identify factors associated with the use of moderately or highly effective contraceptive methods. Weighted data analysis was conducted. Results A total of 2901 FSW and CSE girls (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled. The proportion using moderately or highly effective contraceptive methods was 37.7% in Port Moresby, 30.9% in Lae, and 26.5% in Mt. Hagen. After adjusting for covariates, factors significantly associated with the use of moderately or highly effective contraceptive methods in Port Moresby were being age 20–24, being married, being divorced or separated, having one or more dependent children, being away from home for more than 1 month in the last 6 months, and having tested HIV negative. No factors were significantly associated in Lae or Mt. Hagen. ANC attendance amongst FSW and CSE girls who gave birth in last 3 years was highest in Port Moresby at 91.2%. HIV testing was inconsistently and inadequately offered at ANC across the three cities. Conclusions Kauntim mi tu provides much-needed insight into the SRH experiences of FSW and CSE girls in PNG, where their use of moderately or highly effective contraceptive methods is low. We hope to shed light on the complicated reality they face due to illegality of sex work and multitude of complex healthcare experiences.
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Hakim AJ, Iwamoto C, Badman SG, Willie B, Pekon S, Aeno H, Neo-Boli R, Ase S, Weikum D, Vallely AJ, Kelly-Hanku A. High Prevalence of Chlamydia and Gonorrhea and the Need for Sexually Transmitted Infection Testing Among Men Who Have Sex With Men and Transgender Women in Papua New Guinea. Sex Transm Dis 2021; 48:109-117. [PMID: 32976356 PMCID: PMC8667082 DOI: 10.1097/olq.0000000000001300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Papua New Guinea has among the highest prevalence of sexually transmitted infections in the world but no estimates of Chlamydia trachomatis, Neisseria gonorrhoeae, or hepatitis B virus (HBV) are available among men who have sex with men (MSM) or transgender women (TGW). METHODS We conducted respondent-driven sampling surveys among MSM and TGW in Port Moresby, Lae, and Mt Hagen (2016-2017) to characterize the prevalence of these infections. Eligibility criteria were as follows: aged ≥12 years, born male, could speak English or Tok Pisin, and had oral or anal sex with another person born male in the past 6 months. Participants were surveyed face-to-face and offered testing for anorectal and genital chlamydia and gonorrhea, syphilis, HIV, and HBV. All results are respondent-driven sampling weighted. RESULTS We enrolled 400 participants in Port Moresby, 352 in Lae, and 111 in Mt Hagen. Chlamydia prevalence rates in the 3 cities regardless of anatomical site were 19.9%, 19.2%, and 24.3%, respectively. Gonorrhea prevalence rates regardless of anatomical site were 10.3%, 9.4%, and 9.6%, respectively. Hepatitis B virus prevalence rates were 11.7%, 13.8%, and 13.6%, respectively. In multivariable analysis, syphilis was associated with having either chlamydia or gonorrhea in Port Moresby (adjusted odds ratio, 4.0; 95% confidence interval, 2.0-7.9) and Lae (adjusted odds ratio, 2.4; 95% confidence interval, 1.2-5.0). CONCLUSIONS There is a large unmet need among MSM and TGW in Papua New Guinea for chlamydia and gonorrhea detection and treatment. The high prevalence of HBV reinforces the importance of ensuring introduction and scale-up of HBV treatment and immunization. Urgent efforts are needed to introduce laboratory-based diagnosis for chlamydia and gonorrhea to ensure these populations have access to much needed treatment services.
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Affiliation(s)
| | - Chelsea Iwamoto
- US Centers for Disease Control and Prevention
- Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Barne Willie
- Papua New Guinea Institute of Medical Research, Goroka
| | - Simon Pekon
- Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea
| | - Herick Aeno
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Sophie Ase
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Andrew J. Vallely
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Papua New Guinea Institute of Medical Research, Goroka
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Papua New Guinea Institute of Medical Research, Goroka
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Kelly-Hanku A, Worth H, Redman-MacLaren M, Nosi S, Boli-Neo R, Ase S, Hou P, Aeno H, Kupul M, Amos A, Badman SG, Vallely AJ, Hakim AJ. PERPETRATION OF VIOLENCE BY FEMALE SEX WORKERS IN PAPUA NEW GUINEA: 'WE WILL CRUSH THEIR BONES'. Br J Criminol 2020; 61:104-122. [PMID: 35923353 PMCID: PMC9345598 DOI: 10.1093/bjc/azaa058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is a small but important body of literature on female sex workers' (FSWs) violence towards others, but little of that focused on low- and middle-income countries. Drawn from a larger biobehavioural study of FSWs in three cities in Papua New Guinea, we analyse the interviews from 19 FSWs who reported having perpetrated physical violence towards four major groups: (1) ex-husbands; (2) clients; (3) other sex workers and (4) other people (mainly women). Our study demonstrates that FSWs' use of violence arises from a complex set of social, material and gendered circumstances and cannot be addressed in isolation from other aspects of their lives.
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Affiliation(s)
- Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - H Worth
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia
| | - M Redman-MacLaren
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - S Nosi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - R Boli-Neo
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - S Ase
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - P Hou
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - H Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - M Kupul
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - A Amos
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - S G Badman
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - A J Vallely
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
| | - A J Hakim
- The Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, Australia
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Kelly-Hanku A, Redman-MacLaren M, Boli-Neo R, Nosi S, Ase S, Aeno H, Nembari J, Amos A, Gabuzzi J, Kupul M, Williie B, Narokobi R, Hou P, Pekon S, Kaldor JM, Badman SG, Vallely AJ, Hakim AJ. Confidential, accessible point-of-care sexual health services to support the participation of key populations in biobehavioural surveys: Lessons for Papua New Guinea and other settings where reach of key populations is limited. PLoS One 2020; 15:e0233026. [PMID: 32413084 PMCID: PMC7228081 DOI: 10.1371/journal.pone.0233026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
To achieve the UNAIDS 90-90-90 targets at a national level, many countries must accelerate service coverage among key populations. To do this, key population programs have adopted methods similar to those used in respondent-driven sampling (RDS) to expand reach. A deeper understanding of factors from RDS surveys that enhance health service engagement can improve key population programs. To understand the in-depth lives of key populations, acceptance of expanded point-of-care biological testing and determine drivers of participation in RDS surveys, we conducted semi-structured interviews with 111 key population participants (12-65 years) were purposefully selected from six biobehavioral surveys (BBS) in three cities in Papua New Guinea. Key populations were female sex workers, men who have sex with men, and transgender women. Four reasons motivated individuals to participate in the BBS: peer referrals; private, confidential, and stigma-free study facilities; "one-stop shop" services that provided multiple tests and with same-day results, sexually transmitted infection treatment, and referrals; and the desire to know ones' health status. Biobehavioral surveys, and programs offering key population services can incorporate the approach we used to facilitate key population engagement in the HIV cascade.
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Affiliation(s)
- Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michelle Redman-MacLaren
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ruthy Boli-Neo
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Somu Nosi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Sophie Ase
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Joshua Nembari
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Angelyn Amos
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Josephine Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Martha Kupul
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Barne Williie
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rebecca Narokobi
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Parker Hou
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Simon Pekon
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - John M. Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Steve G. Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J. Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Avi J. Hakim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Kelly-Hanku A, Weikum D, Badman SG, Willie B, Boli-Neo R, Kupul M, Hou P, Gabuzzi J, Ase S, Amos A, Narokobi R, Aeno H, Pekon S, Coy K, Wapling J, Gare J, Dala N, Kaldor JM, Vallely AJ, Hakim AJ, on behalf of the Kauntim mi tu Study Team. Factors associated with HIV and syphilis infection among female sex workers in three cities in Papua New Guinea: findings from Kauntim mi tu, a biobehavioral survey. Sex Health 2020; 17:311-320. [DOI: 10.1071/sh19218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
Abstract
Background
In this paper, factors associated with HIV and syphilis infection in three cities in Papua New Guinea are explored. Methods: Respondent-driven sampling surveys among FSW in Port Moresby, Lae, and Mt. Hagen (2016–17) were conducted. FSW who were aged ≥12 years, who were born female, who spoke English or Tok Pisin and who had sold or exchanged vaginal sex in the past 6 months were eligible to participate. Participants were interviewed face-to-face and offered rapid HIV and syphilis testing. Survey logistic procedures were used to identify factors associated with HIV and syphilis infection, including modern contraception use, physical violence and having a casual male partner. Weighted data analysis was conducted. Results: Overall, 2901 FSW (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled in the study. HIV prevalence was 15.2% in Port Moresby, 11.9% in Lae and 19.6% in Mt. Hagen. Factors associated with HIV varied by city; for example, use of modern contraception in Port Moresby, experiences of physical violence in Lae and ever having tested for HIV in Mt. Hagen. No one variable was associated with HIV in all cities. Prevalence of syphilis infection was 7.1%, 7.0%, and 3.0% in Port Moresby, Lae, and Mt. Hagen, respectively. Factors associated with syphilis infection also varied by city and were only significant in Lae. Conclusion: The different factors associated with HIV and syphilis infection in each city highlight the complex HIV and syphilis epidemics among FSW and the importance of conducting surveys in multiple locations and developing local interventions.
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Kelly-Hanku A, Newland J, Aggleton P, Ase S, Aeno H, Fiya V, Vallely LM, Toliman PJ, Mola GD, Kaldor JM, Vallely AJ. HPV vaccination in Papua New Guinea to prevent cervical cancer in women: Gender, sexual morality, outsiders and the de-feminization of the HPV vaccine. Papillomavirus Res 2019; 8:100171. [PMID: 31212024 PMCID: PMC6595234 DOI: 10.1016/j.pvr.2019.100171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/25/2023]
Abstract
Papua New Guinea has among the highest estimated burden of cervical cancer globally, but currently lacks national cervical screening or human papillomavirus (HPV) vaccination programmes. The Papua New Guinean government is committed to introducing the HPV vaccine for primary prevention, but locally-relevant research evidence is not available to guide implementation. Experience from earlier Papua New Guinean health programmes suggests that appropriate engagement with local health cosmologies and cultures for health/wellbeing, illness/disease, and recognition of the role of ‘outsiders’ in preventing, promoting or contributing to sickness, are essential to the successful introduction of biomedical interventions in this setting. We describe findings from a multi-site qualitative study undertaken in three provinces in Papua New Guinea (2012-14). Twenty-one gender specific focus group discussions and 82 semi-structured interviews, with a total of 208 participants, were conducted. There was strong community support for the introduction of the HPV vaccine for cervical cancer prevention in Papua New Guinea. Significantly, and despite being officially discussed in the context of a planned future intervention focusing on vaccinating young girls to prevent cervical cancer, the intervention was de-feminised, where both girls and boys were supported to be vaccinated in any HPV programme in Papua New Guinea. First study of HPV vaccine acceptability in Papua New Guinea and the Pacific. Evidence of strong support for the vaccination of both girls and boys against HPV in Papua New Guinea. Local beliefs and concerns about HPV immunisation may impact acceptability in Papua New Guinea. Suspicion of Western medicine and health care workers reported in rural areas.
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Affiliation(s)
- Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia.
| | - Jamee Newland
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Australia; Sociology Department, Australian National University, Australia
| | - Sophie Ase
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Voletta Fiya
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Lisa M Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Pamela J Toliman
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Glen Dl Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Papua New Guinea
| | - John M Kaldor
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
| | - Andrew J Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Papua New Guinea; Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Australia
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Hakim AJ, Badman SG, Weikum D, Amos A, Willie B, Narokobi R, Gabuzzi J, Pekon S, Kupul M, Hou P, Aeno H, Neo Boli R, Nembari J, Ase S, Kaldor JM, Vallely AJ, Kelly-Hanku A. Considerable distance to reach 90-90-90 targets among female sex workers, men who have sex with men and transgender women in Port Moresby, Papua New Guinea: findings from a cross-sectional respondent-driven sampling survey. Sex Transm Infect 2019; 96:143-150. [PMID: 31182653 DOI: 10.1136/sextrans-2019-053961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To characterise the Joint United Nations Programme on HIV/AIDS 90-90-90 cascade among female sex workers (FSW) and men who have sex with men (MSM)/transgender women (TGW) in Port Moresby, Papua New Guinea (PNG). METHODS We conducted respondent-driven sampling surveys among FSW and MSM/TGW in Port Moresby, PNG from June to October 2016. All participants spoke English or Tok Pisin and were aged >12 years. FSW had to be born female and sell/exchange sex with a male in the past 6 months. MSM/TGW had to be born male and have oral/anal sex with another male-born person in the past 6 months. Participants were interviewed and offered rapid HIV diagnostic and viral load testing. HIV viral suppression (VS) was defined as <1000 copies/mL. RESULTS We recruited 674 FSW and 400 MSM/TGW; HIV prevalence was 15.2% (95% CI 11.7 to 18.8) and 8.5% (95% CI 5.0 to 11.9), respectively. Among FSW living with HIV, 39.0% (95% CI 26.6 to 51.4) self-reported having been diagnosed; of them 79.6% (95% CI 62.7 to 96.5) self-reported being on antiretroviral therapy (ART), and 54.1% (95% CI 31.8 to 76.4) achieved VS. Among MSM/TGW living with HIV, 24.4% (95% CI 4.7 to 44.1) self-reported having been diagnosed; of them 43.9% (95% CI 33.6 to 54.8) self-reported being on ART, and 86.1% (95% CI 71.1 to 93.9) achieved VS. CONCLUSIONS ART use among those aware of their HIV status is encouraging. However, the generally low awareness of infection status among FSW and MSM/TGW with HIV and the low VS among FSW on ART indicate an urgent need for innovative strategies to increase testing uptake and ART adherence among these populations. Monitoring drug resistance may be warranted.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven G Badman
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia
| | - Damian Weikum
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angelyne Amos
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Barne Willie
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rebecca Narokobi
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Josephine Gabuzzi
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Simon Pekon
- Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea
| | - Martha Kupul
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Parker Hou
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Herick Aeno
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ruthy Neo Boli
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Joshua Nembari
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Sophie Ase
- Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - John M Kaldor
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia.,Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia.,Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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Hakim AJ, Coy K, Badman SG, Willie B, Narokobi R, Gabuzzi J, Pekon S, Kupul M, Hou P, Aeno H, Boli RN, Nembari J, Ase S, Amos A, Dala N, Weikum D, Callens S, Kaldor JM, Vallely AJ, Kelly-Hanku A. One size does not fit all: HIV prevalence and correlates of risk for men who have sex with men, transgender women in multiple cities in Papua New Guinea. BMC Public Health 2019; 19:623. [PMID: 31117978 PMCID: PMC6532262 DOI: 10.1186/s12889-019-6942-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Biobehavioral data about men who have sex with men (MSM) and transgender women (TGW) in Papua New Guinea (PNG) are limited to those who sell sex. Information about those MSM and TGW who do not sell sex is necessary to guide HIV prevention and treatment efforts. Methods We conducted respondent-driven sampling (RDS) surveys among MSM and TGW in Port Moresby, Lae, and Mt. Hagen, PNG from in 2016 and 2017. Eligibility criteria was: aged > 12 years, born male, could speak English or Tok Pisin and had oral or anal sex with another person born male in the past 6 months. Participants were interviewed face-to-face and offered rapid HIV testing. Weighted data analysis was conducted using RDS-Analyst (v. 0.62). Results We enrolled 400 participants in Port Moresby, 352 in Lae, and 111 in Mt. Hagen. In the last six months, 73.2% of MSM/TGW in Port Moresby, 77.9% in Lae, and 75.9% in Mt. Hagen, had a concurrent sexual partnership. Upwards of 70% of MSM/TGW in all three cities had sex with a woman in the same period. Less than half of MSM/TGW had ever tested for HIV. HIV prevalence among MSM/TGW was 8.5% in Port Moresby and 6.9% in Lae. Among participants in Mt. Hagen it was 1.3%. HIV was associated with not having sex with a woman in the last six months and sexually transmitted disease symptoms in the last 12 months in Port Moresby and Lae. In Port Moresby, it was also associated with an uncut foreskin, and in Lae with earning income in the formal sector and being unable to rely on other MSM or TGW to accompany them to healthcare services. Conclusions The large proportion of MSM and TGW with concurrent sexual partnerships, combined with the low testing coverage, indicates strong potential for the spread of HIV. The different correlates of HIV in Port Moresby and Lae highlight the importance of conducting surveys in multiple locations and using data to develop locally appropriate interventions even within a country. Electronic supplementary material The online version of this article (10.1186/s12889-019-6942-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Avi J Hakim
- US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, 1600 Clifton Rd, NE, Atlanta, GA, 30329, USA.
| | - Kelsey Coy
- US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, 1600 Clifton Rd, NE, Atlanta, GA, 30329, USA
| | - Steven G Badman
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Barne Willie
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Rebecca Narokobi
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Josephine Gabuzzi
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Simon Pekon
- Papua New Guinea National Department of Health, AOPI Centre, Waigani Drive, P O Box 807, Waigani, Port Moresby, National Capital District, 131, Papua New Guinea
| | - Martha Kupul
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Parker Hou
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Herick Aeno
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Ruthy Neo Boli
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Joshua Nembari
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Sophie Ase
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Angelyne Amos
- Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Nick Dala
- Papua New Guinea National Department of Health, AOPI Centre, Waigani Drive, P O Box 807, Waigani, Port Moresby, National Capital District, 131, Papua New Guinea
| | - Damian Weikum
- US Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, 1600 Clifton Rd, NE, Atlanta, GA, 30329, USA
| | - Steven Callens
- University of Ghent, Sint-Pietersnieuwstraat 25, 9000, Ghent, East Flanders, Belgium
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St, Kensington, NSW, 2052, Australia.,Papua New Guinea Institute of Medical Research, Homat Street, Goroka, Eastern Highlands Province, 441, Papua New Guinea
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Kelly-Hanku A, Ase S, Fiya V, Toliman P, Aeno H, Mola GM, Kaldor JM, Vallely LM, Vallely AJ. Ambiguous bodies, uncertain diseases: knowledge of cervical cancer in Papua New Guinea. Ethn Health 2018; 23:659-681. [PMID: 28158947 DOI: 10.1080/13557858.2017.1283393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Within their local realities, people experience and interpret disease in diverse ways that do not necessarily correlate or converge with Western biomedical interventions. In the high cervical cancer burden setting of Papua New Guinea, understanding how people experience and interpret cervical cancer is necessary for effective intervention. Drawing on work by Street on the production of unstable biomedical knowledge, we explored how ambiguity and uncertainty, coupled with cultural taboos and linguistic limitations, affect what and how people 'know' about women's reproductive organs and their associated disease. DESIGN A qualitative research approach was used to explore and understand how people in PNG articulate matters of health and disease as they relate to cervical cancer and HPV infection. Specifically, how unstable biomedical knowledge is produced and sustained. We employed a mixed-methods approach in collecting data from 208 (147 women) participants between 2011 and 2012 across 3 provinces in PNG. RESULTS We found that knowledge and awareness about cervical cancer were poor. Five thematic areas emerged in our analysis, which included the gendered knowledge of women's reproductive health, the burden of cervical cancer in the community and the role (or limitation) of language. We further identified four ways in which ambiguity and uncertainty operate on both sociocultural and biological levels, and in the intersection between to produce unstable biomedical knowledge. These included poor knowledge of where the cervix is located and the uncertainty or unreliability of (lay) diagnoses of disease. CONCLUSION Local understandings of cervical cancer reflected the limitations of Tok Pisin as a lingua franca as well as the wider uncertain biomedical environment where diagnoses are assembled and shared. There is a clear need to improve understanding of the female reproductive organs in order that people, women in particular, can be better informed about cervical cancer and ultimately better receptive to intervention strategies.
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Affiliation(s)
- A Kelly-Hanku
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
| | - S Ase
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - V Fiya
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - P Toliman
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - H Aeno
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - G M Mola
- c School of Medical Sciences , University of Papua New Guinea , Goroka , Papua New Guinea
| | | | | | - A J Vallely
- a Sexual and Reproductive Health , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby , UNSW , Sydney , Australia
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Kelly-Hanku A, Aeno H, Wilson L, Eves R, Mek A, Nake Trumb R, Whittaker M, Fitzgerald L, Kaldor JM, Vallely A. Transgressive women don't deserve protection: young men's narratives of sexual violence against women in rural Papua New Guinea. Cult Health Sex 2016; 18:1207-1220. [PMID: 27250111 DOI: 10.1080/13691058.2016.1182216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual violence against women and girls is commonplace in Papua New Guinea (PNG). While the experiences of women are rightly given central place in institutional responses to sexual violence, the men who perpetrate violence are often overlooked, an oversight that undermines the effectiveness of prevention efforts. This paper draws on interviews conducted with young men as part of a qualitative longitudinal study of masculinity and male sexuality in a rural highland area of PNG. It explores one aspect of male sexuality: men's narratives of sexual violence. Most striking from the data is that the collective enactment of sexual violence against women and girls is reported as an everyday and accepted practice amongst young men. However, not all women and girls were described as equally at risk, with those who transgress gender roles and roles inscribed and reinforced by patriarchal structures, at greater risk. To address this situation, efforts to reduce sexual violence against women and girls require an increased focus on male-centred intervention to critically engage with the forms of patriarchal authority that give license to sexual violence. Understanding the perceptions and experiences of men as perpetrators of sexual violence is a critical first step in the process of changing normative perceptions of gender, a task crucial to reducing sexual violence in countries such as PNG.
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Affiliation(s)
- A Kelly-Hanku
- a Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
- b Kirby Institute, UNSW Australia , Sydney , Australia
| | - H Aeno
- a Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - L Wilson
- c School of Political Science and International Studies , University of Queensland , St Lucia , Australia
| | - R Eves
- d State, Society and Governance in Melanesia Program , Australian National University , Canberra , Australia
| | - A Mek
- a Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - R Nake Trumb
- a Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - M Whittaker
- e School of Public Health , University of Queensland , Herston , Australia
| | - L Fitzgerald
- e School of Public Health , University of Queensland , Herston , Australia
| | - J M Kaldor
- a Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea
| | - A Vallely
- b Kirby Institute, UNSW Australia , Sydney , Australia
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11
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Tynan A, Vallely A, Kelly A, Kupul M, Naketrumb R, Aeno H, Siba P, Kaldor JM, Hill PS. Building social currency with foreskin cuts: a coping mechanism of Papua New Guinea health workers and the implications for new programmes. Health Policy Plan 2013; 29:902-11. [PMID: 24105013 DOI: 10.1093/heapol/czt072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent research as part of a multi-disciplinary investigation on the acceptability and impact of male circumcision for HIV prevention in Papua New Guinea (PNG) has shown that health workers (HWs) undertake unauthorized forms of penile cutting practices in public health facilities or in community settings, at times within a traditional context. Participation in these activities shares common features with coping mechanisms, strategies used by HWs to alleviate the burden of unsatisfactory living and working conditions. Coping mechanisms, however, are typically described as motivated by economic advantage, but in PNG evidence exists that the behaviours of HWs are also influenced by opportunities for social capital. METHODS Twenty-five in-depth interviews (IDIs) were completed with a variety of HWs from 2009 until 2011 and were triangulated with findings from 45 focus group discussions and 82 IDIs completed with community members as part of a wider qualitative study. Thematic analysis examined HW participation in unauthorized penile cutting services. RESULTS The emergence of unauthorized practices as a coping mechanism in PNG is compelled by mutual obligations and social capital arising from community recognition and satisfaction of moral, professional and cultural obligations. Using the example of unauthorized penile cutting practices amongst HWs in PNG, the research shows that although economic gains are not explicitly derived, evidence exists that they meet other community and socio cultural responsibilities forming a social currency within local traditional economies. CONCLUSIONS Coping mechanisms create an opportunity to extend the boundaries of a health system at the discretion of the HW. Fragile health systems create opportunities for coping mechanisms to become institutionalized, pre-empting appropriate policy development or regulation in the introduction of new programmes. In order to ensure the success of new programmes, the existence of such practices and their potential implications must be addressed within programme design, and in implementation and regulation.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Angela Kelly
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Martha Kupul
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Herick Aeno
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter Siba
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - John M Kaldor
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, The University of Queensland, Herston Road, Herston, Queensland 4006, Australia, Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka Eastern Highlands Province 441, Papua New Guinea, Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, New South Wales 2034, Australia and International HIV Research Group, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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Tynan A, Hill PS, Kelly A, Kupul M, Aeno H, Naketrumb R, Siba P, Kaldor J, Vallely A. Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:749. [PMID: 23941536 PMCID: PMC3751450 DOI: 10.1186/1471-2458-13-749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described. METHODS A multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software. RESULTS A number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success. CONCLUSIONS Difficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico-legal requirements, compared to existing socio-cultural interests. Community participatory approaches offer important opportunities to explore and design culturally safe, specific and accessible programs.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland Herston Road, Herston, 4006 Queensland, Australia
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Martha Kupul
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Herick Aeno
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Naketrumb
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
| | - Andrew Vallely
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research (PNG IMR), Eastern Highlands Province 441, P.O. Box 60, Goroka, Papua New Guinea
- Public Health Interventions Research Group, The Kirby Institute, University of New South Wales, 45 Beach Street Coogee, 2034 New South Wales, Australia
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Tynan A, Vallely A, Kelly A, Kupul M, Neo J, Naketrumb R, Aeno H, Law G, Milan J, Siba P, Kaldor J, Hill PS. Sociocultural and individual determinants for motivation of sexual and reproductive health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy. Hum Resour Health 2013; 11:7. [PMID: 23418879 PMCID: PMC3602021 DOI: 10.1186/1478-4491-11-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/28/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND The motivation of health workers (HWs) to deliver services in developing countries has been described as a critical factor in the success of health systems in implementing programmes. How the sociocultural context of Papua New Guinea (PNG) affects the values, motivation and actions of HWs involved in sexual and reproductive health services is important for policy development and programme planning. With interest in male circumcision (MC) as an HIV prevention option in PNG, this study explored the perceptions and motivations of HWs involved in sexual and reproductive health services in PNG, examining their implications for the possible future roll out of a national MC programme. METHODS A multi-method qualitative study was conducted with HWs across a range of health care professions working in sexual health facilities. A total of 29 in-depth interviews and one focus group discussion were completed. Qualitative thematic analysis of the transcripts and field notes was undertaken using a social constructivist approach and complemented by documentary organizational, programme and policy analysis. RESULTS AND DISCUSSIONS Introduction of new health programmes, such as a MC programme for HIV prevention, are likely to impact upon one or more of the many motivational determinants. Social-cultural and individual factors influencing HW motivation to be involved in sexual and reproductive health services in PNG included community expectation and concern, sense of accomplishment and religious conviction. Strong links to community responsibility outweighed organizational ties. Faced with an often dysfunctional work environment, HWs perceived themselves as responsible to compensate for the failed health system. The impact of community influence and expectation needs to be considered when introducing a MC programme, particularly to communities in PNG where penile foreskin cutting is a common and accepted practice. CONCLUSIONS The potential contribution to the success of a MC programme that HWs may have means that taking into account the differing needs of communities as well as the motivational influences on HWs that exist within the sociocultural environment is important. These findings will assist not only in programme planning for MC, but also in the expansion of other existing sexual and reproductive health services.
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Affiliation(s)
- Anna Tynan
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
| | - Andrew Vallely
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Angela Kelly
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, High Street, Kensington, 2052, Australia
| | - Martha Kupul
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - James Neo
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Richard Naketrumb
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Herick Aeno
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - John Milan
- Sexual Health and Disease Control Branch, National Department of Health, P.O. Box 807, Waigani, National Capital District, 131, Papua New Guinea
| | - Peter Siba
- Sexual & Reproductive Health Unit, Papua New Guinea Institute of Medical Research, P.O. Box 60, Goroka, Eastern Highlands Province, 441, Papua New Guinea
| | - John Kaldor
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2034, Australia
| | - Peter S Hill
- Australian Centre for International & Tropical Health, School of Population Health, University of Queensland, Herston Road, Herston, Queensland, 4006, Australia
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Vallely A, Fitzgerald L, Fiya V, Aeno H, Kelly A, Sauk J, Kupul M, Neo J, Millan J, Siba P, Kaldor JM. Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting. BMC Res Notes 2012; 5:613. [PMID: 23116431 PMCID: PMC3599571 DOI: 10.1186/1756-0500-5-613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 10/18/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting. METHODS A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants. RESULTS A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly. CONCLUSIONS Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.
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Affiliation(s)
- Andrew Vallely
- The Kirby Institute, The University of New South Wales, Sydney, NSW, 2052, Australia.
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Kelly A, Kupul M, Nake Trumb R, Aeno H, Neo J, Fitzgerald L, Hill PS, Kaldor JM, Siba P, Vallely A. More than just a cut: a qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea. BMC Int Health Hum Rights 2012; 12:10. [PMID: 22818494 PMCID: PMC3520875 DOI: 10.1186/1472-698x-12-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 06/27/2012] [Indexed: 11/10/2022]
Abstract
Background Male circumcision (MC) has been shown to reduce vaginal transmission of HIV to men. While community acceptability is important in a countries preparedness to introduce MC, it is equally important to map contemporary MC and other penile cutting practices, and the socio-cultural dimensions underpinning these practices. Methods A total of 482 men and women (n = 276 and n = 210, respectively) participated in 82 semi-structured and 45 focus group discussions from four different provinces of Papua New Guinea (PNG), each representing one of the four socially and geographically diverse regions of the country. Results Of the men interviewed 131 self-reported that they had undergone a penile alteration with some reporting multiple types. Practices were diverse and could be grouped into five broad categories: traditional (customary) penile cutting; contemporary penile cutting; medical circumcision; penile inserts; and penile bloodletting practices in which sharp objects are used to incise the glans and or inserted and withdrawn from the male urethra or in order to induce bleeding. Socio-cultural traditions, enhanced sexual pleasure and improved genital hygiene were key motivators for all forms of penile practices. Conclusions The findings from this study highlight the complex and diverse nature of penile practices in PNG and their association with notions of masculinity, sexuality and contagion. Contemporary penile practices are critical to a community’s acceptance of MC and of a country’s ability to successfully implement MC in the context of a rich and dynamic culture of penile practices. If a MC program were to be successfully rolled out in PNG to prevent HIV it would need to work within and build upon these diverse cultural meanings and motivators for penile practices already commonly performed in PNG by men.
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Affiliation(s)
- Angela Kelly
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
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Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, Siba P, Kaldor JM, Vallely A. "Now we are in a different time; various bad diseases have come." Understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12:67. [PMID: 22264256 PMCID: PMC3298502 DOI: 10.1186/1471-2458-12-67] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/22/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear. METHODS A multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men. RESULTS The majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs. CONCLUSION This is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG.
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Affiliation(s)
- Angela Kelly
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
- International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Martha Kupul
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Lisa Fitzgerald
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Herick Aeno
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - James Neo
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Richard Naketrumb
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - Peter Siba
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
| | - John M Kaldor
- Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia
| | - Andrew Vallely
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka EHP 441, Papua New Guinea
- Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia
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Vallely A, MacLaren DJ, Kaleva W, Millan J, Tommbe R, Marape W, Manineng C, Buchanan H, Amos A, Frank R, Kelly A, Kupul M, Aeno H, Trowalle E, John LN, Redman-Maclaren ML, Ryan C, Browne K, Tynan A, Hill PS, Gray RT, Murray J, Wilson DP, Law G, Siba P, McBride WJH, Farley T, Kaldor JM. Male circumcision for HIV prevention in Papua New Guinea: a summary of research evidence and recommendations for public health following a national policy forum. P N G Med J 2011; 54:91-108. [PMID: 24494506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In 2005, a clinical trial in South Africa found that circumcision of young men could reduce their risk of acquiring HIV (human immunodeficiency virus) infection by over 60%. In the following year, two more trials in Africa confirmed this finding, leading the World Health Organization to recommend male circumcision as a public health strategy for HIV prevention in high-incidence countries. In order to inform public health policy in Papua New Guinea (PNG), two major research projects were initiated with the goals of investigating the status of penile cutting practices and assessing understandings, acceptability, feasibility and cost-effectiveness of male circumcision for HIV prevention. In addition, behavioural surveillance surveys systematically asked questions on penile cutting practices and an ethnographic literature review informed historical perspectives of penile cutting in PNG. Key findings from these research activities were presented at a National Policy Forum on Male Circumcision for HIV Prevention held in Port Moresby in November 2011. The Forum made three key recommendations: (1) the formation of a joint National Department of HealthlNational AIDS Council Secretariat Policy Committee on male circumcision; (2) the establishment of an integrated harm reduction program; and (3) that future policy on wide-scale roll-out of male circumcision for HIV prevention in PNG be informed by a combination of data from (a) male circumcision intervention pilot programs and (b) research on the potential protective effect of other forms of penile cutting.
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Affiliation(s)
- A Vallely
- Kirby Institute, University of New South Wales, Sydney, Australia.
| | - D J MacLaren
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Coo University, Cairns, Queensland, Australia
| | - W Kaleva
- Papua New Guinea National AIDS Council Secretariat, Port Moresby
| | - J Millan
- Papua New Guinea Sexual Health Society, Waigani, National Capital District 131, Papua New Guinea
| | - R Tommbe
- Pacific Adventist University, Boroko, Papua New Guinea
| | - W Marape
- Divine Word University, Madang, Papua New Guinea
| | - C Manineng
- Divine Word University, Madang, Papua New Guinea
| | - H Buchanan
- National Research Institute, Port Moresby, Papua New Guinea
| | - A Amos
- National Research Institute, Port Moresby, Papua New Guinea
| | - R Frank
- National Research Institute, Port Moresby, Papua New Guinea
| | - A Kelly
- Papua New Guinea Institute of Medical Research, Goroka, James Cook University, Cairns, Australia
| | - M Kupul
- Papua New Guinea Institute of Medical Research, Goroka, James Cook University, Cairns, Australia
| | - H Aeno
- Papua New Guinea Institute of Medical Research, Goroka, James Cook University, Cairns, Australia
| | - E Trowalle
- East Sepik Provincial AIDS Committee, Wewak, Papua New Guinea
| | - L N John
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Coo University, Cairns, Queensland, Australia
| | - M L Redman-Maclaren
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Coo University, Cairns, Queensland, Australia
| | - C Ryan
- Papua New Guinea Institute of Medical Research, Goroka, James Cook University, Cairns, Australia
| | - K Browne
- National Department of Health and Asian Development Bank HIV Prevention Project, Waigani, Papua New Guinea
| | - A Tynan
- School of Population Health, University of Queensland, Herston, Australia
| | - P S Hill
- School of Population Health, University of Queensland, Herston, Australia
| | - R T Gray
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - J Murray
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - D P Wilson
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - G Law
- Disease Control Branch, National Department of Health, Waigani, Papua New Guinea
| | - P Siba
- Papua New Guinea Institute of Medical Research, Goroka, James Cook University, Cairns, Australia
| | - W J H McBride
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Coo University, Cairns, Queensland, Australia
| | - T Farley
- Sigma 3 Services, Nyon, Switzerland
| | - J M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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