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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. |
