A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea

Background: In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. This paper examines the socio-ecological factors that encourage or hinder HIV treatment initiation and adherence among HIV positive members of key populations in PNG. Methods: As part of a larger biobehavioural survey of key populations in PNG, 111 semi-structured interviews were conducted with FSW, MSM and TGW, of whom 28 identified as living with HIV. Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence. Results: Enablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and nonjudgmental and supportive HIV service provision. Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services. Conclusion: Exploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations

Confidential, accessible point-of-care sexual health services to support the participation of key populations in biobehavioural surveys: lessons for Papua New Guinea and other settings where reach of key populations is limited

To achieve the UNAIDS 90-90-90 targets at a national level, many countries must accelerate service coverage among key populations. To do this, key population programs have adopted methods similar to those used in respondent-driven sampling (RDS) to expand reach. A deeper understanding of factors from RDS surveys that enhance health service engagement can improve key population programs. To understand the in-depth lives of key populations, acceptance of expanded point-of-care biological testing and determine drivers of participation in RDS surveys, we conducted semi-structured interviews with 111 key population participants (12–65 years) were purposefully selected from six biobehavioral surveys (BBS) in three cities in Papua New Guinea. Key populations were female sex workers, men who have sex with men, and transgender women. Four reasons motivated individuals to participate in the BBS: peer referrals; private, confidential, and stigma-free study facilities; "one-stop shop" services that provided multiple tests and with same-day results, sexually transmitted infection treatment, and referrals; and the desire to know ones’ health status. Biobehavioral surveys, and programs offering key population services can incorporate the approach we used to facilitate key population engagement in the HIV cascade

Making meaning out of objects : self, connectedness and belonging among sexuality diverse men and transgender women in Papua New Guinea

Objects in our everyday lives range from the mundane to the highly significant and can be understood and interpreted in various ways. In a Pacific society such as Papua New Guinea, making meaning out of objects and storytelling provides great insight into (our) culture. However, much of the attention given to material culture historically and culturally in Papua New Guinea is directed at documenting objects from the past, and often the objects possessed by cis-gender men. Much less attention has been given to the material culture of individuals and communities of sexuality diverse men and transgender women in Papua New Guinea. As part of a life history study among sexuality diverse men and transgender women in Papua New Guinea this chapter explores meanings of objects significant to these people. These non-human objects, sometimes reflecting significant people and relationships, speak to kinship and family, identity and self-courage, justice and human rights, providing new insights into the lives of Papua New Guineans, frequently framed via discourses of risk

Gender diversity among 'boys' in Papua New Guinea : memories of sameness and difference in early childhood

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

Developing a culturally appropriate illustrated tool for the self-collection of anorectal specimens for the testing of sexually transmitted infections: lessons from Papua New Guinea

Abstract Background Papua New Guinea (PNG) has a high prevalence of sexually transmitted infections (STIs). There is increasing evidence that anorectal STIs are important in terms of the dual epidemics of HIV and STIs in this setting. At the time of this study, anorectal STI testing was not possible, and there was no mechanism for self-collection of anorectal specimen among at risk ‘key populations’. This paper documents the development of a culturally appropriate tool that has been used to facilitate self-collection of anorectal specimens with key populations in PNG. Methods This qualitative study involved four focus groups conducted with a purposive sample of 35 participants, including female sex workers, men who have sex with men and transgender women in Port Moresby and Goroka in 2015. During focus groups, participants reviewed and provided critical feedback for the adaption of a previously piloted and published pictorial anorectal specimen collection tool for use with key populations in PNG. Results The final instruction tools are presented in English language and Tok Pisin. To develop these, participants feedback resulted in six key areas of the existing instruction document being modified to ensure it was appropriate for use in PNG. These included translating complex words for sexual health issues (i.e. ‘STIs’, ‘anorectal STIs’, ‘anus’, ‘anal sex’), biomedical instruments (i.e. ‘specimen bottle’, ‘specimen packet’ and ‘swab’), and aspects of the clinical procedure (i.e. inserting the swab 3–4 cm into the anus to collect a specimen). The visual identity of the graphics was redesigned to localise the images for use in PNG. Conclusions This paper describes the development of a culturally and linguistically appropriate tool for a biomedical and clinical intervention with key populations in PNG based around self-collection of anorectal specimens for molecular STI testing. The final tools have been used to facilitate the self-collection of anorectal specimens following a clear clinical protocol during a large bio-behavioural survey in PNG