Implementing Pacific strategy on HIV/AIDS

Dennie Iniakwala and Robyn Drysdale
HIV/AIDS IS A GROWING THREAT IN OUR REGION. IN AUGUST 2004, PACIFIC LEADERS adopted the Pacific Regional Strategy on HIV/AIDS 2004-2008 at their annual Pacific Islands Forum meeting. The Secretariat of the Pacific Community (SPC) accepted the responsibility of developing, managing and monitoring the strategy's implementation plan, in coordination with regional agencies and development partners. Amid significant threats to the sustainability of the health, economic and social development goals of Pacific communities, SPC faces a challenging task.

Rates of infection

Information on how many people are living with HIV/AIDS in our region is not clear, partly because of inadequate surveillance. But most importantly because we fail to acknowledge its existence.

The last national epidemiological survey in Papua New Guinea, in November 2004, confirmed the existence of a generalised epidemic-over one percent of the population infected, with more than 10,000 reported cases.

However, the number of people actually estimated to be infected is around 50,000. In other parts of the region, the prevalence is still low but appears to be rising in places. To December 2004, New Caledonia has reported 272 cases, French Polynesia 243, Guam 168 and Fiji 182. If infections in Fiji continue at the current rate, the projected number within five years will be over 1000.

Despite the region's current relatively low-level epidemic prevalence, the reality is that the Pacific presents all the signs of vulnerability: high rates of sexually transmissible infections (STIs), a mobile population, poor economic growth and access to employment, increasing substance abuse, commercial sex, violence against women and limited knowledge of or access to information on reproductive health and HIV/STI prevention. Access to and awareness of the importance of HIV testing is also low.

What is needed is a specific focus on what will have the strongest impact and give the best value for money in the areas of prevention and behaviour change.


What can be done to help?

SPC needs assessments undertaken in 2004 found that the majority of HIV/AIDS and STI education and prevention activities within the region were focused on generic and non-targeted “awareness-raising” messages.

Patchy political commitment and leadership weakened the capacity for an effective response and little was being done to fight the stigmatisation of people living with HIV/AIDS.

The region also had restricted capacity for biosocial research and surveillance, as well as limited advancement of care and treatment of and support for HIV-positive people.

One of the four components of the Regional HIV/AIDS Strategy implementation plan promotes the development of targeted and well-researched behaviour-change communication: working intensively with vulnerable and higher-risk groups such as seafarers and their spouses, “transactional” sexual encounters, men who have sex with men, and indigenous sexual minorities such as fa'afafines.

In line with this, much greater and more targeted distribution and social marketing of condoms is required, as well as STI treatment, prevention of mother-to-child transmission, and scaling-up of access, awareness and acceptance of testing for HIV.

Testing needs to be complemented with behavioural surveys to better identify who is at risk now and will be in the future. Increased efforts must be made to destroy the stigmas surrounding HIV/AIDS and cultural taboos concerning sexuality, and to address specific difficulties in maintaining access to treatment, care and support, and the lack of educated staff.


Leadership and funding

The implementation plan also focuses on the strengthening of leadership and governance. Leaders need to be committed to heading the fight against HIV/AIDS to generate resources but also to help counter stigma and discrimination and to mobilise communities, government and non-government agencies, and workplaces.

The third and fourth components of the plan are linked to harmonising the implementation of the strategy and juggling sources of funding and technical assistance.

Estimated funding gaps have been identified - most particularly in the area of access to quality services, which has an estimated 78 percent gap for the required budget.


Action now

Political commitment and leadership, combined with adequate resource allocation, are urgently required if the transmission of HIV and the impact of AIDS are to be minimised in the Pacific. It is now critical that national and regional partners support the Pacific Regional Strategy on HIV/AIDS with actions.


Dr Dennie Iniakwala is HIV/AIDS Adviser at SPC and Robyn Drysdale is SPC's Behaviour Change Communication Specialist. Visit SPC's HIV/AIDS Section website for news on the implementation of the HIV/AIDS strategy and activities, including the latest statistics for each country in the region: http://www.spc.int/aids/