Angela and her team at the Kirby Institute and the PNGIMR undertake research around the sexual, reproductive and maternal health of men and women in PNG, directly influencing government policy, improving sexual health and awareness, and demystifying cultural stigmas.
The Challenge: High STI and HIV rates causing fatalities
PNG is one of the most geographically and culturally diverse regions in the world. Health services for sexual, reproductive and maternal health is improving but significant and enduring challenges remain. The country has the highest HIV rate in the Pacific region, with the epidemic clustered among key populations such as women and girls who sell and exchange sex, and sexually diverse men. Sex work and homosexuality remain criminalised. Members of both marginal groups face discrimination and violence, limiting their access to healthcare even further. PNG also has some of the highest rates of treatable sexually transmitted infections globally, and one of the highest maternal mortality rates in the world with around 1,300 women dying every year as a result of pregnancy-related problems.
UNSW's solution: Provide research and evidence to influence government policy
UNSW has seconded Angela to the PNG Institute of Medical Research (PNGIMR), a statutory body of the PNG Government that conducts research on major health problems in PNG. Based in PNG full time, Dr Angela Kelly-Hanku is head of PNGIMR’s Sexual and Reproductive Health Unit. This unit conducts research to improve the sexual, reproductive and maternal health of Papua New Guineans with policy relevant interdisciplinary research.
Current projects Angela and her team are undertaking include research around the prevention of parent to child transmission of HIV, maternal health, HIV drug resistance and HPV vaccine acceptability. Angela was recently awarded funding from the NHMRC to undertake qualitative research on tuberculosis (TB) in PNG. She has also received ARC funding to undertake anthropological research on couples with mixed HIV status. In other projects, they are looking at ways to scale up point of care screening for cervical cancer.
In a recently completed project, Angela and her team published a study that estimated the sizes of key marginal populations in PNG, such as sex workers, men of diverse sexualities, and transgender people. The study determined the prevalence of STIs and HIV in these groups and the likelihood of them seeking help from local healthcare providers. This was the first research of its kind in PNG. Results revealed each marginal group has much higher rates of STIs and HIV compared to the rest of the country. For example, in one province they found one in four sex workers has HIV. More than half of gay men were found to have never been tested for HIV, and three out of four men in the second largest city, Lae, reported having experienced violence related to their sexuality or sexual identity. Transgender people are choosing to hide their gender identity when accessing health services and one in three reported feeling ashamed of themselves. Many are not using condoms and face the risk of violence because of cultural stigmas around their work and sexuality. Angela and her team use research like this to advocate for changes in laws that discriminate against people who work for sex and people’s sexual origin as well as to inform national and regional HIV and STI policy and programing.
The Impact: Change government policy to improve healthcare, raise public awareness
Angela Unit’s provides research and evidence the PNG Government incorporates into its decisions around healthcare strategies and delivery. Angela and her team work with the National Department of Health and the WHO and UNAIDS to devise strategies around healthcare policy, and they participate in working groups on HIV that report back to the parliament, ultimately helping to increase HIV testing and treatment services and limit the spread of the disease. In undertaking this work, the Unit is also helping to build local research capacity.
The Unit’s work with marginalised groups provides an improved roadmap for the treatment, care and provision of other services for marginalised people affected by HIV and STIs. Angela works directly with representative organisations to assist in the interpretation of data, to train them in key information, and empower them generally so these groups can lobby for rights themselves. This ultimately increases public awareness and respect for marginalised groups, ameliorating stigmas around sex and sex-based violence.
Dr Angela Kelly-Hanku is a Scientia Fellow and has a co-joint appointment between UNSW and the PNG Institute of Medical Research where she is Head of the Sexual and Reproductive Health Unit. Prior to joining the Kirby in 2016 she worked in the Faculty of Arts and Social Sciences at the Former National HIV Social Research Centre and then later with the School of Public Health and Community Medicine. An anthropologist by training, she is a social scientist undertaking innovative and timely interdisciplinary research that advances UNSW’s goals of building an equitable and just society.