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Papua New Guinea lacks data characterising the sexual health needs of younger key populations (KP): female sex workers (FSW) and commercially and sexually exploited girls (CSE), men who have sex with men (MSM), and transgender women (TGW). Biobehavioural surveys among KP were conducted in three cities. We conducted unweighted and weighted analysis for sample and population proportions, respectively. Variables associated with younger versus older age (15–24 versus ≥25 years) were included in the multivariable analysis. Younger FSW/CSEG had greater odds of having both Neisseria gonorrhoea and Chlamydia trachomatis (aOR:3.2, 95%CI 2.0–5.0), or having either infection (aOR:2.2, 95%CI 1.2–4.1) than older peers. They also had lower odds of having tested for HIV (aOR: 0.6, 95%CI 0.4–0.8). Younger MSM/TGW had greater odds of paying for sex in the <6 months (aOR:2.2, 95%CI: 1.5–3.1) and of having been paid for sex (aOR:1.6, 95%CI 1.1–2.4) than their older peers (≥25 years). Younger MSM/TGW had lower odds of having contact with a peer educator ≤12 months (aOR:0.6, 95%CI 0.4–0.9) and having tested for HIV (aOR:0.6, 95%CI: 0.4–0.9). All key populations have substantial sexual health needs, but those of younger members are greatest. Younger key populations would likely benefit from health services designed specifically for them. [ABSTRACT FROM AUTHOR]

Objective: The type of health education messages that communities and individuals seek to have communicated about the human papillomavirus (HPV) vaccine is important if vaccine programmes are to succeed, especially in settings such as Papua New Guinea (PNG), which have a high burden of cervical cancer, low health literacy and negative experiences of earlier vaccination programmes. This study sought to identify the health education messages that are viewed as most appropriate in such a context. Methodology: A qualitative study using gender-specific focus group discussions (N = 21) and semi-structured interviews (N = 82) was undertaken in three sites in PNG. Sites included both rural and urban locations in Milne Bay, Eastern Highlands and Western Highlands Provinces. Results: Two divergent discourses emerged. One group of participants, largely young people, felt communication messages should stress that HPV is a preventable sexually transmitted infection, which can cause cervical cancer. The other group, mainly members of the older population, believed that messaging should focus on the vaccine as a prevention strategy for cervical cancer. A small minority wanted both aspects of the vaccine discussed. Conclusion: Sensitivity needs to be taken when engaging with communities which have negative experiences of earlier infant immunisation programmes. Ensuring that the health communication needs and priorities of different sections of the populations are taken into account is key to the successful introduction and roll-out of HPV vaccination in this setting.

Papua New Guinea's health system faces ongoing challenges in the provision of maternal and child health and has some of the poorest health indicators in the world. In this paper, we describe the impact of COVID-19 on maternal and child health, as examples of primary health care services. We conducted 131 semi-structured interviews with different population groups in seven provinces (Jul–Nov 2021). A deductive analysis focused on identifying the impact of COVID-19 using the World Health Organization building blocks framework. An inductive analysis explored these impacts for maternal and child health services specifically. We identified three broad themes: service disruption, challenges in access to care and service provision. Service disruption included the closure, suspension and relocation of services and workforce challenges due to healthcare worker absences, redeployment and working within an already constrained health system. Access to care was difficult due to lockdowns and restricted movement. Service provision continued despite the fear staff had of COVID-19. Investing in pandemic preparedness, including an adequately trained and resourced healthcare workforce and facilities able to withstand sustained provision of essential services should be integrated with locally appropriate, and timely community-based information to allay fears and mistrust within the healthcare system. [ABSTRACT FROM AUTHOR]

Community activists, policymakers and researchers have long identified human rights as central to addressing the HIV epidemic. Over the past 10 years, efforts to incorporate human rights into the HIV response have focused on reforming laws which criminalise sex work and male-to-male sex. Laws criminalising sex work and male-to-male sex drive communities underground, making HIV prevention, testing, and treatment efforts more difficult. This article draws on a qualitative study conducted in Papua New Guinea (PNG) which examined stakeholder views on prospects for law reform, the impact of criminal laws on communities, and the role of law reform in addressing the HIV epidemic. While efforts to reform criminal laws related to sex work and male-to-male sex have taken place in PNG, these have been unsuccessful. Stakeholders identified that strategies for addressing criminal laws and the impacts of law reform must be grounded in the PNG context, that there must be material support for community members to engage with criminal laws and human rights, and that dignity rather than HIV should be the justification for law reform. [ABSTRACT FROM AUTHOR]

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.

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.

We conducted biobehavioral surveys among female sex workers (FSW) in Lae and Mt. Hagen, Papua New Guinea (January–December 2017). Respondent-driven sampling was used to recruit FSW aged ≥ 12 years, who were assigned female sex at birth, who spoke English or Tok Pisin, and who sold or exchanged sex for money, goods, or services in the last 6 months. When adjusted for viral suppression, 48.9% of FSW Lae and 61.9% in Mt. Hagen were aware of their HIV positive status. Of these women, 95.3% in Lae and 98.9% in Mt. Hagen were on antiretroviral therapy, and of these, 83.5% in Lae and 87.0% in Mt. Hagen had suppressed viral load. Renewed efforts are needed to increase HIV testing among FSW and provide support to FSW on treatment in both cities to attain viral suppression. [ABSTRACT FROM AUTHOR]

Childhood is a time when children begin to constitute themselves as gendered subjects largely according to social norms that are rigidly framed within dominant discourses of heteronormative binary gender. This paper is based on the life histories of 42 sexuality and gender diverse adult men and transgender women conducted in PNG. Findings offer insight into the ways in which boys transgressed gender norms through dress, play, work within the home and in dance. We argue that gender transgression in childhood is not a contemporary phenomena and such childhood experiences of boys in PNG should be recognised as part of the country's rich cultural diversity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]