A Papua New Guinea–Australia HIV Research Partnership: generating new knowledge, building capacity and forging new friendshipsadmin
A Papua New Guinea–Australia HIV Research Partnership: generating new knowledge, building capacity and forging new friendships
HIV Australia | Vol. 12 No. 2 | July 2014
Partnerships of mutual benefit are often forged to confront a common challenge. One such challenge is how to address HIV in Australia’s nearest neighbour, Papua New Guinea (PNG).
With a wide range of cultures, a largely rural population and a host of other development issues, PNG is a tough environment in which to conduct public health research.
In order to overcome some of these obstacles, researchers formed a collaboration between three universities: James Cook University in Australia, and the faith-based Papua New Guinean Universities of Pacific Adventist University and Divine Word University.
This article describes that partnership, outlines our research capacity building activities and describes how colleagues become friends while contributing to the national and regional HIV response.
A range of intervention measures have been sought by both Australia and PNG, to help control rates of HIV in PNG.
In addition to increasing testing, improving HIV treatment and making condoms more available, another approach being considered in PNG is male circumcision.
Between 2005 and 2007, a number of international studies showed that the risk of HIV transmission during heterosexual sex was reduced by 50–60% when men were circumcised.3-6
Following these findings, the World Health Organization recommended that male circumcision be scaled-up in countries with high rates of HIV transmission among heterosexuals,7 and where the majority of men remain uncircumcised.8-10
These findings and the recommendation to scaleup circumcision rates sparked great interest in PNG, given its high rates of HIV primarily among the heterosexual population, limited traditional male circumcision practices and the lack of any national medical male circumcision program.
In the planning phase, this project carefully considered the challenges of conducting research into male circumcision for HIV prevention in PNG and decided that collaboration was the best approach.
Researchers from James Cook University (JCU) in Australia had more experience and expertise in study design, data management and publication while researchers from PNG had more experience and expertise in interacting with local cultures, the logistics of data collection and local interpretation of study results.
As found in other health research in the Pacific, the collaborative blending of these skills was fundamental to the success of the program.11
The sensitive nature of HIV and male circumcision was an obstacle in itself. Papua New Guineans do not talk openly about sex and so in initial stages, desensitising workshops were organised to practise data collection techniques and improve data collection skills.
In addition, our team was aware that language can be a daunting challenge for non-Papua New Guineans.
The official language in PNG is English but the common, everyday language is Tok-Pisin and each of the 800 different cultural groups that make up PNG has their own language.
The JCU researchers needed to be able to understand the meaning of conversations, and know what is the acceptable form of greeting and so on.
Apart from language, a mixture of religious backgrounds and diversities in geography, culture and beliefs adds to the complexities of public health research in PNG.
In addition to that, the different rates of HIV across the country and limited health services means that any HIV prevention campaign involving male circumcision would need to be informed by local evidence. We therefore wanted to know how PNG people felt about male circumcision.
Did they know that male circumcision had health benefits and could help prevent HIV? What were women’s views and what were men’s views? Do the views differ by religion or geographic region?
We wanted to have answers to these questions and at the same time, we wanted to boost the capacity of PNG academics to be independent researchers.
While PNG academics were keen to undertake research, their experience with large HIV studies was limited.
Apart from a few senior leaders, most academics in PNG are not trained or sufficiently qualified to undertake independent research.
Therefore, in addition to contributing towards HIV response in PNG, our project had a key focus on research capacity building and supporting PNG researchers to attain higher qualifications.
This allows skilled and qualified PNG researchers to not only lead local and regional HIV research but also contribute to quality of teaching and learning at PNG universities.
A ‘learn by doing’ approach was taken to build research capacity. Potential lead researchers at PNG universities were identified and given lead roles early in the collaboration.
Many other potential PNG researchers were involved and most of them participated in various capacity building activities.
These included workshops on data collection, data analysis and writing for publication, presentation at scientific meetings and participation at a national policy forum.
Several PNG researchers from our group are now undergoing masters and doctoral level studies at universities in PNG, Philippines and across Australia.
This improvement in research capacity is one step in the process of enabling PNG to improve the search for workable solutions to the HIV epidemic and other development issues.
Our study needed to progress within a ‘give and take’ setting – an avenue for mutual benefit. JCU researchers led the team in study design and capacity building and PNG researchers provided the enabling environment for data collection and to make data understandable.
All three collaborating universities hosted workshops to improve research capacity and to explore the research topic.
We went on to present results in numerous local, national and international conferences and forums12-19 and produced a comprehensive paper published by BMC Public Health, Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea.20
We also published a paper on the processes we used to conduct the research together, Researching male circumcision for HIV prevention in Papua New Guinea: a process that incorporates science, faith and culture.21
Looking back, the collaboration has been a huge success. Involvement of PNG researchers, some of whom had lead roles, was a winning factor in recruiting study participants, collecting and analysing data and writing for publication.
Additionally, the opportunity for capacity building provided by the study was a rare achievement for a research project.
Less experienced researchers were up-skilled to conduct research independently. Two of the PNG academics are currently lead investigators on a number of HIV research projects in PNG. A JCU member of the team has also enhanced her research skills and is currently in the final stages of her doctoral studies about women and HIV in PNG.22
While this partnership received its share of positive comments, one most notable was a remark uttered by a respected senior academic from one of the collaborating PNG universities.
In his comments during a feedback presentation, he mentioned that this project was one of very few that not only included capacity building as a vital component of its research activities but actually fulfilled those capacity building plans.
He reiterated that future research in PNG would do well to follow the same lines with emphasis on capacity building. On a people-to-people level, something else eventuated that is important to mention. Over the life of the project, lasting friendships were formed between researchers.
While our initial four year study (2010–2013) to investigate the acceptability and feasibility of male circumcision for HIV Prevention in PNG has ended, we continue to collaborate across a number of follow-up studies that have emerged.
Work on these studies will further strengthen existing relationships. The collaborating researchers, especially the lead partners do not see themselves as being mere colleagues; they have gone beyond that, seeing themselves now as friends.
One would frequently hear collaborators offer to their travelling colleagues to, ‘come and stay with us at our house’.
That kind of offer comes from relationships that have grown roots, relationships that will care for the shortcomings and triumphs of its partners in the years to come.
The direct consequence of links like these is a solid regional partnership that can help improve the HIV response and other development issues for PNG, Australia and surrounding Pacific island nations.
1 Divine Word University, Papua New Guinea;
2 James Cook University, Australia; and
3 Pacific Adventist University, Papua New Guinea
1 National AIDS Council. (2006). Papua New Guinea National Strategic Plan on HIV/ AIDS 2006–2010. Government of Papua New Guinea, Port Moresby.
2 New Guinea National AIDS Council Secretariat. (2013). Papua New Guinea HIV Prevalence: 2012 Estimates. Papua New Guinea National AIDS Council Secretariat, Port Moresby.
3 Auvert, B., Taljaard, D., Lagarde,E., Sobngwi-Tambekou, J., Sitta, R., Puren, A. (2005). Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial. PLoS Medicine, 2(11), e298.
4 Bailey, R., Moses, S., Parker, C., Agot, K., Maclean, I., Krieger, J. , et al. (2007). Male Circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet,369(9562), 643–656.
5 Gray, R.,Kigozi, G., Serwadda, D., Makumbi, F.,Watya, S.,Nalugoda, F., et al.(2007). Male Circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet, 369(9562), 657–666.
7 In recognition of the fact that male circumcision only provides partial protection from HIV transmission, WHO recommends that circumcision be used in combination with other prevention strategies, such as HIV testing and counselling and the promotion of safer sex practices. See: WHO, (2014), op cit.
9 World Health Organization (WHO), Department of Reproductive Health and Research and Joint United Nations Programme on HIV/AIDS (UNAIDS). (2014). Male Circumcision: Global trends and determinants of prevalence, safety and acceptability. WHO, UNAIDS, Geneva. Retrieved from: www.who.int
10 Redman-MacLaren, M., MacLaren, D., Harrington, H., Asugeni, R., Timothy- Harrington, R., Kekeubata, E., et al. (2012). Mutual research capacity strengthening: a qualitative study of two-way partnerships in public health research. Biomed Central, 11(79). doi: 10.1186/1475-9276-11-79
12 MacLaren, D., Tommbe, R., Mafile’o, T., Redman-MacLaren, M., Browne, K., McBride, W. (2011). I was circmcised in my uncle’s coconut plantation’: location and techniques of penile cutting in Papua New Guinea, in 20th World Congress for Sexual Health.12–16 June 2011, Glasgow.
13 MacLaren, D., Tommbe, R., Mafile’o, T., Redman-MacLaren, M., Browne, K., McBride, W. (2011a). ‘My brother told me it was for my own good’ – reasons for penile cutting in Papua New Guinea. Journal of Sexual Medicine, 8(1), 229.
14 MacLaren, D., et al. (2011). Stronger or tougher: reasons for penile cutting in Papua New Guinea. Presentation delivered at the Australasian HIV/AIDS Conference 2011, 26–28 September 2011, Canberra.
15 MacLaren, D., Tommbe, R., Redman- MacLaren, M., Browne, K., Mafile’o, T., Manineng, C., and McBride, W. (2011). ‘I was cut under the plantation palms’: techniques and locations of penile cutting in Papua New guinea, in ASHM Conference. Presentation delivered at the Australasian HIV/AIDS Conference 2011, 26–28 September 2011, Canberra.
16 Tommbe, R., Asugeni, L., MacLaren, D., Redman-MacLaren, M., Mafile’o, T. (2012). What can be Learned about Male Circumcision and HIV Prevention from a Cohort of Students and Staff at a Papua New Guinea University: research report. Pacific Adventist University, Port Moresby.
17 MacLaren, D., Tommbe, R., Mafile’o, T., Redman-MacLaren, M., Browne, K., and McBride, W. (2011). Implications of Male Circumcision for HIV Prevention in Papua new Guinea: Possibilities and Challenges. Journal of Sexual Medicine, 8, 230–230.
18 MacLaren, D., et al. (2011). Implications of male circumcision for HIV prevention in Papua New Guinea: possibilities and challenges. Presentation delivered at the 20th World Congress for Sexual Health, 12–16 June, 2011, Glasgow.
19 Tommbe,R. , MacLaren, D., Redman- MacLaren, M., Mafile’o, T., Asugeni, L., McBride, W. (2013). Researching male circumcision for HIV prevention in Papua New Guinea: a process that incorporates science, faith and culture. Health research policy and systems/BioMed Central, 11(1), 44–44.
20 Tommbe,R. , MacLaren, D., Redman- MacLaren, M., Mafile’o, T., Manineng, C., Fregonese, F., Redman-MacLaren, M., et al. (2013). Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea. BMC Public Health, 13, 818.
21 Tommbe,R., et al. , (2013), op. cit.
22 Redman-MacLaren, M., Mills, J., Tommbe, R., MacLaren, D., Speare, R., McBride, W. (2013). Women and HIV in a moderate prevalence setting: an integrative review. BMC Public Health, 13(1), 552–552.