Oxfam Australia is using its experience gained in South Africa to help respond to the looming HIV/AIDS epidemic in Papua New Guinea, as Pacific Program Coordinator Anne Lockley reports.

Papua New Guinea (PNG) is on the brink of an Africa-level HIV/AIDS epidemic. The World Health Organisation has predicted that one in every five PNG men, women and children will be infected with HIV within the next decade unless radical action is taken.

The impoverished Pacific nation of PNG is little equipped to deal with this - its general health system is weak, and HIV response has been slow. Testing and treatment programs are scarce and fear of the disease, fuelled by misconceptions and rumours, is high.

PNG's AIDS epidemic is said to resemble South Africa's situation 10 years ago. As such, Oxfam Australia is using the experience gained from its established HIV/AIDS program in South Africa to help it respond to the PNG situation.

This has involved developing a partnership between one of Oxfam Australia's partner organisations in South Africa, the Comprehensive Health Care Trust (CHOICE), and a small community-based organisation in PNG, Hope for Living.

Hope for Living was started by Maura Elaripe Mea, one of Papua New Guinea's most prominent HIV activists, to provide HIV information, support and services to people in the Gorobe settlement and the wider Moresby South electorate where she lives.

Maura was diagnosed HIV positive at an antenatal clinic in 1997. Family, friends,doctors and nurses gave her little hope. There was discrimination and blame. But with the support and encouragement of hospital social workers, pastoral counsellors and home-based carers, her life started to change.

She recovered from common illnesses and started to see that there were ways to work through her own problems and to help other HIV positive people, and their families and communities, to do the same. That's when she started Hope for Living in Port Moresby.

Most of Port Moresby's population live in settlements. These people have left their home villages, often for fear of sorcery or payback violence, or because they have been displaced from their land by natural resource developments, population pressure or tribal fighting. Settlement areas are often extremely poor - unemployment is high and there are few services.

In the Gorobe settlement, people take their water from broken pipes, often at night when the pressure is higher. Settlement populations are at greatest risk of HIV because of the lack of employment opportunities, information, education and resources, and high population mobility. Violence, including sexual violence and rape, is common and women have little control over their own lives.

Maura estimates that in Gorobe, a quarter of the population may already be HIV positive - a much higher rate than for the rest of the country.

Since 2002, Hope for Living has been working to try to break down the stigma against people living with HIV//AIDS and encourage behaviour change to prevent further HIV transmission. Oxfam started supporting Hope for Living in 2004 with a Positive Living program which focused on self-help for HIV positive people, including nutrition and hygiene, prevention and treatment of opportunistic infections, and discussion of personal and social issues.

"This was the first time most of the participants had received any of this information or had been able to openly discuss what they were experiencing as a result of their diagnosis," Maura says.

Following this program, Maura saw a need to develop a home-based care program to meet the growing need for care in the settlement.

Formalised home-based care is new in PNG and had not yet reached Moresby's settlement populations. Papua New Guinea's strong "wantok" system - or network of extended family support - has traditionally provided care to sick family members, but the fear of HIV transmission and stigma attached to the disease has meant that these networks often don't provide care for people with HIV and AIDS.

A meeting between Oxfam Australia's Pacific and South Africa program representatives at an international AIDS conference in Thailand, last year, resulted in a link being forged between Hope for Living and CHOICE.

In South Africa, home-based care programs are well established and are recognised as a priority in the HIV response - both for the care they provide and for the more appropriate and effective prevention strategies that are conducted as part of the home care visits.

CHOICE provides HIV/AIDS services to the people of the Greater Tzaneen Municipal area in South Africa's Limpompo province. These services include training, care and support, information and health services. CHOICE is an accredited training provider in South Africa and takes volunteer carers through a comprehensive 59-day training program.

Like in the Port Moresby settlement areas, the area served by CHOICE is characterised by high levels of poverty and unemployment, carers often don't have high levels of education and literacy and support resources are few.

Oxfam Australia viewed this program as an opportunity to see if lessons learned and experience gained in South Africa could be applied to Papua New Guinea particularly, placing home based care at the forefront of the HIV response and integrating prevention strategies with care programs.

Hope for Living brought together a team of 20 volunteer carers, many of whom are motivated by having someone close to them become sick with AIDS, or were already visiting sick community members in their homes.

After Hope for Living had run a series of preparatory training sessions - including HIV basic facts, first aid, and counselling - two trainers from CHOICE, Jamela Tiva and Antoinette Schutte, travelled to Port Moresby earlier this year to help develop the carers' home-based care and HIV prevention skills.

"These two weeks provided an opportunity to talk about how to plan for the increasing needs and to hear of some potential pitfalls in running these kinds of programs in the longer term," Maura says."The home-based care team is now taking half the burden which I was carrying trying to care for and attend to the needs of the sick people.

"The carers are conducting health talks in the settlements on a range of issues such as hygiene and sanitation, not just HIV. They are trying to make the settlements a healthy and disease-free environment for us to live in."

Sharing knowledge between Oxfam's Papua New Guinea and South Africa program partners has been a positive and mutually beneficial experience. It shows that there is potential to draw on the work of an established program and share lessons learned and experiences gained, to help a new program and perhaps influence larger scale initiatives.

Oxfam Australia hopes that these exchanges continue, especially as the HIV/AIDS epidemic progresses in PNG and the importance of new ways to tackle the problem become even more apparent.

For more details on our work in Papua New Guinea visit www.oxfam.org.au/world/pacific/png