After battling illness for years, Nancy Karipa tested positive for HIV in 1999. She had just given birth to her first child. “It was a crossroads moment for me, with the fear of rejection, but I chose action,” said Karipa, now 50, during an AIDS awareness event in Papua New Guinea’s capital Port Moresby in December. She and the baby received treatment, and her child 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 that fights HIV/Aids globally, says that the epidemic in PNG 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 of infections in women and children is particularly alarming, says UNAids.
Related: Aid cuts have shaken HIV/Aids care to its core – and will mean millions more infections ahead
“The transmission of [the virus from] from mother to child is very high in Papua New Guinea, one of the highest in the world,” says Manoela Manova, UNAids country director for PNG.
Changes in funding for HIV support and prevention have hit PNG hard. The suspension of US foreign aid by the Trump administration this year has affected hundreds of clinics. A sharp global cut in funding for UNAids is also worrying health providers, and calls are growing for the PNG government to do more.
Manova says that HIV awareness has decreased over time and now, “it’s like the feeling that the epidemic doesn’t exist”.
“That is the perception both in the public and in the political class.”
The crisis in the country of about 10 million people is exacerbated by a combination of factors, including inadequate testing and lack of awareness. UNAids says PNG will register around 11,000 new cases in 2024, with almost half of all new infections among children and people under 25.
It is estimated that 2,700 infants were infected with HIV in PNG in 2024. In most cases, mothers were unaware of their HIV status and did not receive the necessary antiretroviral therapy (ART) that could prevent transmission to their baby.
“Many people do not know their status and that is the first step to address the epidemic [and] to be given 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.
The deputy secretary of health, Ken Wai, says that while the government is responsible for drug supplies, other support services and community communication depend heavily on the aid of the United States. 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 specific programs.
“USAID funds an organization called FHI360; they help us with data recording, and one lab coordinator assists in the central public health lab,” says Wai.
The President of the national aid council, Wep Kanawi, says that the government must do more to address 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 seeks funding from global non-profit organizations that receive contributions from USAID. That in turn supports some HIV programs in PNG, including paying staff salaries, he says.
Kanawi says more than 200 government-run clinics or churches that provide HIV services have lost funding after the United States suspended foreign aid earlier this year, without providing further details on the services the clinics provide. Kanawi wants the government to do more, saying that about K45-K50m (US$10m) every year is needed to deal with the epidemic.
“Most of our centers are operating but they are reducing their 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 that when aid was suspended by the Trump administration, salaries at the clinic were kept because there was no funding.
“There was no second plan given to us and we were told to close the clinic, which had affected the communities,” says Marai. “I used to get K1,000 (US$235) to run a one day awareness program in the communities but since the funding stopped I now get K240 every month.
“I started doing voluntary counseling of referral patients who have already been tested positive, STI and couples of gender violence.”
The US embassy in PNG did not respond to questions about USAID or US funding. In a statement, she said the United States is “committed to our partnership with Papua New Guinea”.
“US foreign assistance to PNG, managed through the State Department and other US agencies, includes robust programs in security cooperation, disaster preparedness and health.”
At the same time, UNAids this year saw what it describes as a “historic funding crisis” due to cuts in the US foreign aid budget and cuts from other donor countries. A December report by UNAids said sudden funding cuts and persistent funding shortfalls “are having profound and lasting effects on the health” of millions of people, although it noted that funding for some HIV programs has resumed.
UNAids in PNG say the country has so far been protected from the hit as Australia has stepped in with additional funding. In October, the Australian government said it would “increase its annual funding for HIV development to almost A$10m this financial year”.
Manova says additional funding from Australia will help maintain the UNAids office in PNG “for another two years”.
Still, concerns are growing in PNG that the epidemic will highlight the health sector’s fragility and heavy reliance on foreign aid, amid a surge in infections.
Foreign Minister Justin Tkatchenko says the country needs a “back-up position”.
“The long-term strategy is being done by us. We cannot constantly rely on other donor partners to help us,” he says.
Rebecca Bush contributed to this report