After battling the disease for years, Nancy Karipa tested positive for HIV in 1999. She had just given birth to her first child. “It was a turning point for me, with the fear of denial, but I chose action,” Karipa, now 50, told an AIDS awareness event in Papua New Guinea’s capital, Port Moresby, in December. She and the baby received treatment and her baby remains healthy.
Karipa, from East Sepik in northern PNG, is unusual in sharing her story. The stigma surrounding the disease is high in the Pacific nation, but speaking up has never been more important. This year PNG declared HIV a “national crisis”.
UNAids, the UN agency fighting HIV/AIDS globally, says PNG’s epidemic is among the fastest growing in the Asia-Pacific region, along with Fiji and the Philippines.
New infections have doubled since 2010 and it is estimated that only 59% of people living with the virus know they are HIV positive. The increase in infections among women and children is particularly alarming, says UNAids.
Related: Aid cuts have rocked HIV/AIDS care to the core – and will mean millions more infections in the future
“Transmission of [the virus from] from mother to child is very high in Papua New Guinea, one of the highest globally,” says Manoela Manova, UNAids Country Director for PNG.
Changes to funding for HIV support and prevention have hit PNG hard. The suspension of US foreign aid by the Trump administration this year affected hundreds of clinics. Sharp global cuts to UNAids funding are also worrying health providers, and calls for the PNG government to do more are growing.
Manova says that awareness of HIV has decreased over time and now, “it’s like you have the feeling that the epidemic doesn’t exist.”
“That’s the perception in both the public and the political class.”
The crisis in the country of about 10 million people is exacerbated by a combination of factors, including inadequate testing and a lack of awareness. UNAids says PNG will see around 11,000 new cases in 2024, with almost half of all new infections among children and people under 25.
An estimated 2,700 infants were infected with HIV in PNG in 2024. In most cases, mothers did not know their HIV status and did not receive the necessary antiretroviral therapy (ART) that could have prevented transmission to their child.
“Many people don’t know their status and this is the first step in tackling the epidemic [and] to undergo treatment”, says Manova.
US aid freeze hits clinics
The government declared HIV a national crisis in June and put in place an emergency response plan that includes more testing, treatment and support.
Deputy Health Secretary Ken Wai says that while the government is responsible for the supply of medicine, other support services and community outreach have depended heavily on US aid. In January, the Trump administration cut foreign aid, which was distributed through the United States Agency for International Development (USAID), although Wai says some funding has been restored for certain programs.
“USAID funds an organization called FHI360; they help us with data entry, and a lab coordinator helps with the central public health lab,” says Wai.
National AIDS council chairman Wep Kanawi says the government needs to do more to tackle the crisis. The council works to prevent HIV transmission and provide treatment across the country. Kanawi says the government does not receive direct funding from USAID for HIV drugs, but PNG is seeking funding from global non-profit organizations that receive contributions from USAID. This then supports some HIV programs in PNG, including paying staff salaries, he says.
Kanawi says more than 200 government-run or church-run clinics that provide HIV services have lost funding after the US suspended foreign aid earlier this year, without giving more details about the services the clinics provide. Kanawi wants the government to do more and says about K45-K50m ($10m) is needed annually to deal with the epidemic.
“Many of our centers are operating but scaling back operations,” says Kanawi.
Kaugere Clinic in Port Moresby, which provides HIV and other health services, is one of the centers affected by the funding freeze. Rose Marai, a social worker at the clinic, says when aid was suspended by the Trump administration, salaries at the clinic were withheld because there was no funding.
“We were not given a second plan and told to close the clinic, which affected the communities,” says Marai. “I used to get K1,000 ($235) to run a daily awareness program in the communities, but since the funding stopped, I now get K240 monthly.
“I started offering voluntary counseling to referral patients who had already tested positive, STIs and couples with gender-based violence.”
The US Embassy in PNG did not respond to questions about USAID or US funding. In a statement, he said the US was “committed to our partnership with Papua New Guinea”.
“U.S. foreign assistance to PNG, managed through the State Department and other U.S. agencies, includes robust programs of cooperation in security, disaster preparedness, and health.”
At the same time, UNAids has seen what it describes as a “historic funding crisis” this year due to cuts in the US foreign aid budget and cuts from other donor countries. A December report by UNAids said the sudden funding cuts and persistent funding shortfalls “have profound and lasting effects on the health” of millions of people, although it noted that funding for some HIV programs had resumed.
UNAids in PNG says the country has so far been shielded from the blow because Australia has stepped in with additional funding. In October, the Australian government said it would “increase its annual funding for HIV development to almost $10 million this financial year”.
Manova says the additional funding from Australia will help sustain the UNAids office in PNG “for another two years”.
However, concerns are growing in PNG that the outbreak is highlighting the fragility of the health sector and heavy reliance on foreign aid, amid a rise in infections.
Foreign Minister Justin Tkatchenko says the country needs a “back-up position”.
“The long-term strategy is to do it ourselves. We cannot continually rely on other donor partners to help us,” he says.
Rebecca Bush contributed to this report