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Introduction: In the 30 years since its identification in Papua New Guinea the response to HIV and its subsequent spread has waxed and waned and taken new directions as the social and biomedical environment changed. More than 30 years later the surveillance system continues to falter and there has still not been a national survey on which estimates can be based. Absent a functioning surveillance system, PNG ‘’estimates’’ the size of the epidemic from time to time based on mathematical models of the epidemic. This has resulted in widely varying estimates and confusion about the course of the epidemic. After appearance of the virus PNG struggled to design and implement an effective response. A new government at the end to the 1990s saw a strengthened response and formation of a National AIDS Council (NAC) located, eventually, in the Office of the Prime Minister. Around the same time PNG commenced a process of decentralizing government services to provinces and districts. DOH was expected to continue to provide services even though overall control now was with the NAC and responsibility for services was decentralized.Discussion: PNG is now reliant on mathematical models to estimate the course of the epidemic. Even though the most recent results indicate a fall in incidence since 2005, two recent reviews indicate that programs have not been effective at most levels and that the dual architecture of the government response has failed to adjust to the decentralization of government activities. Thus we now have the situation where models indicate lower prevalence than originally projected even though interventions are apparently ineffective and we have no reliable independent data to indicate why? There are two lessons from the PNG experience. First, the importance of establishing an effective HIV surveillance system. And second, realization that the NAC approach, originally seen as a panacea by donors and agencies, has not worked in PNG. The critical thing now is to return control of the HIV/AIDS program to the DOH on the condition that, except for surveillance and setting standards, it decentralizes the program to provinces and districts.
The size and course of the HIV epidemic in Papua New Guinea (PNG) is unclear. The HIV surveillance system is not working and the government is reliant on estimates of the number of people with HIV derived from mathematical models. Estimates from successive models vary widely. At the same time assessments of the HIV control program conclude that programs are not being implemented as planned. There is little public discussion of these conundrums. The purpose of this paper is to generate discussion about the importance of resurrecting the surveillance system and of decentralizing program implementation.