Barriers and Facilitators for Adherence to Antiretroviral Therapy in Papua New Guinea

Kelly, Angela M.; Worth, Heather; Man, Nik Normanieza Nik; Nosi, Somu; Emori, Rebecca; Mek, Agnes; Akuani, Frances; Kupul, Martha; Kepa, Barbara; Walizopa, Lucy; Pirpir, Lawrencia; Cangah, Brenda; Siba, Peter; Frankland, Andrew; Rawstorne, Patrick

doi:10.2174/157016210794088191

Cited by 19 publications

(32 citation statements)

References 32 publications

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“…The prevalence of foreskin cutting in this study was higher than the 25.8% longitudinal cut and 3.4% circumferential cut documented in recent studies in plantation workers in the Highlands region, but similar to studies in the national capital [61-63,65]. The deliberate approach to include participants from diverse geographic locations and cultural backgrounds allowed a sample with a similar regional proportionality to the PNG population.…”

Section: Discussionsupporting

confidence: 67%

“…A National HIV/AIDS Behavioural Surveillance Study in 2006 documented 26 – 70% of men had some form of foreskin cut, however the study did not differentiate between the ‘round cut’ or ‘straight cut’ [61]. More recent studies have made the distinction [62,63] and found 25 - 50% of men had some form of foreskin cut, with considerable diversity in the extent and type of foreskin cut reported. Qualitative studies are expanding knowledge about beliefs and practices of the various styles of foreskin cutting, and their implications for HIV prevention in PNG [45,46,57].…”

Section: Introductionmentioning

confidence: 99%

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Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

et al. 2013

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BackgroundMale circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country’s 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG.MethodsCross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two ‘rural development’ sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work.ResultsQuestionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10 – 20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection.ConclusionAlthough 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

et al. 2013

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“…Additionally, the role of others, particularly health care workers, influencing a person’s beliefs and therefore decisions about sexual behaviour were also deemed important. This is not surprising since adherence to ART was also related to following instruction from the doctor/health care worker [46]. As people stay on treatment and as people live longer it will be important to chart if and how sexual behaviour changes and if the meanings ascribed to sexual intercourse and condom use similarly alter.…”

Section: Discussionmentioning

confidence: 99%

Sexual risk behaviour, marriage and ART: a study of HIV-positive people in Papua New Guinea

et al. 2013

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BackgroundThe prevention of intimate partner transmission of HIV remains an important component of comprehensive HIV prevention strategies. In this paper we examine the sexual practices of people living with HIV on antiretroviral therapy (ART) in Papua New Guinea (PNG).MethodIn 2008, a total of 374 HIV-positive people over the age of 16 and on ART for more than two weeks were recruited using a non-probability, convenience sampling methodology. This accounted for around 18% of adults on ART at the time. A further 36 people participated in semi-structured interviews. All interviews were thematically analysed using NVivo qualitative data analysis software.ResultsLess than forty per cent (38%) of participants reported having had sexual intercourse in the six months prior to the survey. Marital status was by far the most important factor in determining sexual activity, but consistent condom use during vaginal intercourse with a regular partner was low. Only 46% reported consistent condom use during vaginal intercourse with a regular partner in the last six months, despite 77% of all participants reporting that consistent condom use can prevent HIV transmission. Consistent condom use was lowest amongst married couples and those in seroconcordant relationships. The vast majority (91.8%) of all participants with a regular heterosexual partner had disclosed their status to their partner. Qualitative data reinforced low rates of sexual activity and provided important insights into sexual abstinence and condom use.ConclusionsConsidering the importance of intimate partner transmission of HIV, these results on the sexual practices of people with HIV on ART in PNG suggest that one-dimensional HIV prevention messages focussing solely on condom use fail to account for the current practices and needs of HIV-positive people, especially those who are married and know their partners’ HIV status.

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“…While the epidemic in PNG is primarily linked to heterosexual transmission [17,18] and the national population estimate is now below 1 per cent, considerably higher rates of HIV are found amongst more at risk populations such as people who sell sex. A 2010 bio-behavioural survey in Port Moresby [19] found that 17% of the sex worker population were HIV-positive. PNG is urgently trying to find alternative means of stemming the incidence of HIV.…”

Section: Introductionmentioning

confidence: 99%

“…In a study conducted among attendees at an STI clinic in Lae, Morobe Province [28], a fifth of men reported having undergone full MC (20.3%) while over 40% reported having a dorsal slit and 16% reported a penile insert. Unpublished data from the most recent integrated bio-behavioural survey of sex workers in Port Moresby [19,40] found that of the males who sold sex 55.26% reported having undergone a penile cut of some form with proportionally fewer self identifying transgender than men reported being cut (46.4% vs 60.4% respectively). Of those that reported a cut slightly more than half (52.4%) reported a dorsal slit or other cut that was not round and did not result in full foreskin removal.…”

Section: Introductionmentioning

confidence: 99%

More than just a cut: a qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea

Kelly

Kupul

Trumb

et al. 2012

BMC Int Health Hum Rights

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BackgroundMale 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.MethodsA 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.ResultsOf 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.ConclusionsThe 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.

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Barriers and Facilitators for Adherence to Antiretroviral Therapy in Papua New Guinea

Cited by 19 publications

References 32 publications

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea

Sexual risk behaviour, marriage and ART: a study of HIV-positive people in Papua New Guinea

More than just a cut: a qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea

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