In pursuit of export-driven growth, the government of Papua New Guinea (PNG) established discrete rural enclaves, which generated local jobs and a cash economy, in contrast to their surroundings where people relied on subsistence farming. However, these enclaves also inadvertently fostered the exchange of goods and cash for sex among the mostly impoverished surrounding populations. High-risk sex behavior associated with increasing poverty and lack of information was transforming the communities around the enclaves into HIV/AIDS hotspots.
To help prevent the escalation of what was then categorized by the World Health Organization as a generalized epidemic, the Asian Development Bank (ADB) approved a grant of $25 million for the HIV/AIDS Prevention and Control in Rural Development Enclaves project in April 2006. The project sought to control by 2015 and stabilize by 2020 the spread of HIV infection. Its intended outcomes were: (i) strengthened PNG government in responding to the HIV epidemic, and (ii) community behavior change away from high numbers of concurrent partners and toward increased use of condoms. Reflecting a multi-pronged approach, the project had 4 planned outputs: (i) public–private partnerships (PPPs) in rural development enclaves, (ii) community behavior change and condom social marketing, (iii) strengthened and expanded HIV surveillance system, and (iv) project management support.
By completion, the project was able to substantially deliver its output targets and thus achieve its intended outcomes. Under output 1, 6 memorandums of agreement were signed by the National Department of Health (NDOH), provincial governments, and enclave operators, triggering the formation of project PPPs. Surpassing its target of 81 facilities, 154 buildings in 78 healthcare sites were renovated, particularly to provide a dedicated space for HIV testing and care. It increased the use of Voluntary Counseling and Testing services by rural populations by 10% annually and enabled a 65% increase in the number of people tested at enclave health facilities from 2005 to 2010. By end−2010, a total of 56,056 HIV tests had been recorded.
Under output 2, the project helped create a shift in behavior in communities surrounding the enclaves. Exposure to the project’s mass media campaigns, which reached 70%−74% of the enclave population, had some influence on decisions to use condoms with casual partners. A qualitative assessment of the Marital Relationship Training showed improved perception of HIV risk and communication between couples, but not condom acceptability and use. While below the target, the distribution of branded and non−branded condoms reached a total of 4.2 million; an extensive distribution network, with more than 1,200 outlets had been also been established across the country.
Under output 3, a viable HIV surveillance system, including an HIV sero-surveillance unit within the NDOH and a behavioral surveillance unit at the National Research Institute, supported by an increased number of reporting sites were established. Improvements in data collection and consistency of reporting enabled the PNG HIV prevalence rate update in 2009. The behavioral surveillance component provided useful information for HIV programming, especially in relation to populations most at risk.
The project, executed by the NDOH, was rated successful by ADB’s Pacific Department.
