End of an idyll as Aids soars in South Pacific

One faraway region will be watching this week's international Aids conference in Barcelona with growing fear. While developed nations such as Britain are learning to live with Aids, the South Pacific is just beginning to grapple with the problems that the West faced 20 years ago.

One faraway region will be watching this week's international Aids conference in Barcelona with growing fear. While developed nations such as Britain are learning to live with Aids, the South Pacific is just beginning to grapple with the problems that the West faced 20 years ago.

The South Pacific, thanks to its relative isolation, is the last part of the world to be hit by the disease. The first cases were reported less than a decade ago, and the spread was initially slow. But Aids has now gained a significant foothold and is causing increasing concern, particularly in Papua New Guinea (PNG), where an African-scale tragedy is feared.

As some of the world's leading scientists prepared to gather in Barcelona, United Nations Aids experts warned last week that 68 million people could die by 2020 without a dramatic rise in prevention and treatment programmes. They said the epidemic had not yet peaked, and called for urgent action to tackle spiralling infection rates.

In Western countries HIV-positive people are surviving for years, thanks to the development of combined anti-retroviral drugs. In the South Pacific, many people do not even know how the virus is transmitted, and many of those infected are unaware of their plight.

Health educators in the region are fighting the same ignorance, apathy and misconcep- tions that hindered the early stages of the war against Aids in the West. The same moral dilemmas that confronted developed nations in the early 1980s are being painfully debated – exacerbated, in many parts of the Pacific, by the influence of fundamentalist Protestant churches.

Education campaigns are also complicated by cultural factors, such as reticence about sexual matters. In PNG most of the population lives in remote tribal villages where the subject of Aids is still taboo. "These are people who have never seen a condom," said Andrew Peteru, HIV/Aids adviser for the South Pacific Community, a regional development organisation.

A recent report by AusAID, the Australian government aid agency, estimated that 15,000 people in PNG – amounting to 0.33 per cent of the population – are HIV-positive. Few doubt that those figures represent the tip of the iceberg and experts warn that the epidemic could wipe out an entire generation.

"People who get sick in Port Moresby [the capital] go home to their villages without necessarily knowing what's wrong with them," said Clive Moore, a South Pacific expert at Queensland University. "They may well put it down to sorcery. Even if they had an inkling, there are no drugs to treat it. Then there is the shame. They are often rejected by their tribes and their families."

Clement Malau, a public health officer with the National Aids Council Secretariat in Port Moresby, said at least 17 per cent of prostitutes in the capital were HIV-positive. "It's the same as in Africa a decade or so ago," he said. "We're seeing exactly the same trends."

While PNG is experiencing the Pacific's worst epidemic, the disease is also spreading at an alarming rate in countries such as Samoa and Fiji, where whole families are infected.

There are rising numbers of cases in the tiny nations of Kiribati and Tuvalu, whose main source of income is seafaring; most young men work overseas in the world's merchant navies. There is also growing concern in Tahiti, a big tourist destination, and in the Solomon Islands, which are frequented by fishing boats from Korea, Taiwan and Japan. The Solomons, where the war against Aids has been handicapped by civil unrest, recently launched a poster campaign politely urging its citizens to "protect the ones you love".

"The reality is that the disease is now present in every country in the Pacific, and is spreading through the populations," said Mr Peteru. "It has taken hold, and we are now starting to see patterns of mainly heterosexual transmission." Most countries in the region have developed national Aids strategies, but have been slow to commit the necessary funds.

Different attitudes towards gender and sexuality in the Pacific are obstructing efforts to combat the disease, according to Dr Moore. In some areas, divisions between gay and straight are fluid. "You can't say, 'Let's go and look for the gay community', because it's invisible and includes all manner of people," he said.

In many parts of Melanesia, ritual homosexuality is common. In PNG, it is the custom among certain tribal groups to share wives. Myths – such as the notion that sleeping with virgins can cure Aids – encourage unsafe sex.

It is all a far cry from the West's romanticised image of the South Pacific as a carefree Utopia. If that image ever reflected reality, it no longer does: Aids has invaded paradise.