From Globe to Ground: Rethinking health promotion in a global economy: Women, HIV/AIDS & Papua New Guinea

Belinda Crockett

School of health and Social Development, 

Deakin university, Burwood Victoria

This qualitative investigation explores the global HIV/AIDS epidemic and pays particular attention to the complex interplay of macro and micro forces involved in determining the spread of the virus in developing countries. In recent years there has been a resurgence of interest in international health and the role of bilateral and multi-lateral agencies in HIV/AIDS prevention and care. This is related to the increasing attention being paid to issues of development and the impacts of health sector reform on resource poor countries in light of the real threat posed by HIV/AIDS. However, it is becoming increasingly problematic to provide support (including both financial and technical) for national AIDS programs in countries like Papua New Guinea. This is for a number of reasons, not the least of which being that the global HIV/AIDS epidemic is more complex now than ever before. 

Mining, poverty, IDU and sex work, are increasingly becoming interdependent factors in the spread of HIV/AIDS in many resource poor countries. Additionally, the majority of programs for HIV in developing countries are donor funded, donor driven and donor managed and there has been little research into the delivery of programs. This research focuses on Papua New Guinea and draws upon basic principles of health promotion in shaping a critical analysis of the underlying assumptions of dominant models and frameworks used in preventing HIV in Papua New Guinea (and globally), in order to present an evidence-based discussion on “what works.” 

This discussion is broadly contextualized by a structural analysis of the role of powerful forces such as globalization, structural violence, poverty, gender inequality, health system reform, technical assistance and donor aid, in terms of how they shape individual, community and population vulnerabilities to HIV. 

A “rapid ethnographic” methodology was employed to collect data. Six focus group discussions with women took place in two coastal yet very different regions in Papua New Guinea. The aim was to explore issues around how to prevent HIV in local contexts based on the experiences of the women in this study. Also carried out in Papua New Guinea were fifteen in-depth interviews with National AIDS Council Staff (NACS) and staff from the National HIV/AIDS Support Project (funded by AusAID). 

Finally, a further eighteen in-depth interviews were held in Melbourne and Canberra with Australian HIV and development specialists. Through “thematic” analysis, a range of key issues emerged, including: the politics of support programs; problems associated with donor aid programs and priorities; and the notion of conflicting agendas between support staff and local staff. Discussion around how to facilitate a more productive and mutually supportive counter-parting relationship formed a key part of the analysis. Other themes that are discussed include gender-power relationships, the complex nature of the epidemic in Papua New Guinea, and how the country is responding to HIV/AIDS. Narratives of the women who participated in the study are also interwoven with themes of local participation in relation to HIV prevention campaigns, to tell a story of the impact of HIV, gender relations and social and economic change on daily life in the village.