HIV SEROSURVEILLANCE IN PAPUA-NEW-GUINEA

To determine human immunodeficiency virus-1 (HIV-1) prevalence in low- and high-risk populations in Papua New Guinea (PNG), anonymous unlink ed serosurveillance was conducted in government-administered antenatal and sexually transmitted disease (STD) clinics at six sites beginning in June 1989. Although 3 of 1233 samples were HIV positive in a pilot study, none of 7948 samples was HIV positive during the first full ye ar of serosurveillance (June 1989 - May 1990). HIV-infected people are also identified in PNG through clinical diagnostic testing. Although underreporting is probably substantial, 45 HIV-infected people had bee n identified in PNG (population 3.6 million) through diagnostic testin g between 1987 and the end of the first serosurveillance year (May 199 0). In view of the steadily emerging clinical problem of acquired immu ne deficiency syndrome (AIDS) in PNG, the negative results of serosurv eillance required explanation. Three possibilities are proposed: 1) th e sample size chosen could fail to detect a case 5 % (or more) of the time under the likely conditions of this survey; 2) the populations ch osen for surveillance may not, yet, be those in which HIV is circulati ng at this early stage of the epidemic in PNG; and 3) laboratory error could account for some false negative results. The first two of these , alone or in combination, are most likely. Limited surveillance conti nued in PNG in 1991 and 1992. By June of 1992, 5 of an additional 6035 serosurveillance samples had tested positive. All 5 were among 2000 s amples from a single site, the Port Moresby STD Clinic. In addition to surveillance, further clinical diagnostic testing had identified a to tal of 118 HIV-infected people by June of 1992. While AIDS has clearly made its presence felt in Papua New Guinea, overall HIV prevalence ap pears low. A high incidence of STDs, particularly of genital ulcerativ e conditions, suggests the potential for rapid dissemination of HIV in Papua New Guinea over the next several years.