Fiji’s Health Minister Dr Ratu Antonio Lalabalavu has defended the government’s handling of the country’s HIV crisis.

HIV is surging in Fiji with at least 9000 people — or nearly one percent of the population — reported to be now infected.

There are concerns that the real figure could be significantly higher, with global health experts saying HIV is historically under-reported.

• READ MORE: Other HIV in Fiji reports

The World Health Organisation (WHO) believes the country has been gripped by an “escalating HIV outbreak”.

The island nation declared an HIV outbreak in January last year, with the government calling it “a national crisis” and regional health experts warning that it could spread across the region.

Dr Lalabalavu told Pacific Waves that despite the rising tide of infection the government’s response to the crisis had been “responsible”.

“Look at the [HIV] trend and how it started, it goes way back to 2017, 2018. We are the government that recognised it and now we are doing something about it.”

Budget allocation
The government allocated FJ$10 million (US$4.4 million) in last year’s Budget towards initiatives designed to tackle the problem, he said.

“From last year there have been government initiatives put in place to ensure that we do try and get this under control.”

Alarming stats
The Health Minister revealed some alarming HIV statistics in Parliament earlier this month.

“In 2025, Fiji recorded 2003 new diagnoses, up from 1583 in 2024, with the national rate diagnosis rising to 226 per 100,000, up from 13 per 100,000 in 2019 — a 17-fold increase,” he said.

“Men remain more affected, but the gap is narrowing, showing that infection is increasingly affecting women and families.”

On top of that, a new trend has emerged showing that the number of HIV-positive newborns is on the rise, according to the head of Fiji’s National HIV Outbreak and Cluster Response team, Dr Jason Mitchell.

Sixty babies were born with HIV last year, up from 31 cases in 2024 and more than 3 percent of women attending antenatal care in Fiji were testing positive for HIV, with the number slightly higher in the capital, Suva, Dr Mitchell said.

One baby is being diagnosed with HIV every week due to mother-to-child transmission, and one child is dying every month from advanced HIV disease.

Mother-to-child transmission
Mother-to-baby transmission is a growing concern, according to treatment support worker Dashika Balak.

“They (the mothers) test negatively initially but over the course of the pregnancy they acquire HIV,” Balak said.

“This is a new trend that we are seeing, because these women may not have risky behaviours but most of the partners are injecting drug users and in pregnancy people do have sex.”

Testing during pregnancy is now underway to reduce the risk of transmission to babies, she said.

Dr Lalabalavu has admitted that sexual promiscuity and drug use among youth in particular are huge contributing factors in the HIV epidemic.

Asked exactly how the government planned to address this, he said “a behavioural change programme” was needed to ensure that happens.

“It is part of the plan, you need good planning and a programme to ensure that is implemented across the board,” he said.

“It is not just something for the Ministry of Health, it’s for the various ministries, important stakeholders, the vanua, the church and the family in general.”

Conservative beliefs
Although there were plans to introduce a vital needle and syringe exchange programme, its rollout would take time, Dr Lalabalavu said.

“We will have to tread carefully in terms of how it is accepted within the community, and also we need to look into the legal aspect of it. So we are in the final stages of ensuring that the programme is endorsed.”

Cultural and religious beliefs played a part in the sensitivity around the issue in Fiji, he said.

“First of all, you need to create awareness that by doing this we are not advocating for drug use. That is the challenge and the narrative that we need the general public are aware of,” he said.

“Right now we are looking at avenues to ensure that we get the message to important stakeholders such as the community, the vanua, and religious-based organisations that are here.”

“We want to tap into their capabilities so they can, together with the ministry, pass this message along to their congregations and to the public at large,” he said.

Echoing this, Mitchell told Fiji’s state broadcaster that introducing the programme would not be easy, given the negative reactions in the past when condom use and family planning were phased in.

He said health officials were accused of promoting promiscuity among youth, when they were responding to public health needs.

However, he stressed that the needle and syringe programme was crucial to reducing HIV and Hepatitis C infections in the country.

Needle sharing is described as widespread in group settings, leading to infection clusters within families and communities.

The Health Minister said he expected that by the time the programme went public, it would be well accepted by the people.

This article is republished under a community partnership agreement with RNZ.

Fiji’s Minister for Health and Medical Services has revealed the latest HIV numbers in the country to a development partner roundtable discussing the national response.

The minister reported 490 new HIV cases between October and December last year, bringing the 2024 total to 1583.

“Included in this number are 32 newborns diagnosed with HIV acquired through mother-to-child transmission,” Dr Atonio Rabici Lalabalavu said.

• READ MORE: Other Pacific HIV reports

Fiji declared an outbreak of the disease in January. The Fiji Sun reported around 115 HIV-related deaths in the January-September 2024 period.

Fiji’s Central Division reported 1100 new cases in 2024, with 427 in the Western Division and 50 in the Northern Division.

Of the newly recorded cases, less than half — 770 — have been successfully linked to care, of which 711 have been commenced on antiretroviral therapy (ART).

Just over half were aged in their twenties, and 70 percent of cases were male.

Increase in TB, HIV co-infection
Dr Lalabalavu said the increase in HIV cases was also seeing an increase in tuberculosis and HIV co-infection, with 160 individuals in a year.

He said the ministry strongly encouraged individuals to get tested, know their status, and if it was positive, seek treatment.

And if it is negative, to maintain that negative status.

“I will reiterate what I have said before to all Fijians – HIV should not be a death sentence in Fiji,” he said.

In the Western Pacific, the estimated number of people living with HIV (PLHIV) reached 1.9 million in 2020, up from 1.4 million in 2010.

At the time, the World Health Organisation said that over the previous two decades, HIV prevalence in the Western Pacific had remained low at 0.1 percent.

However, the low prevalence in the general population masked high levels of HIV infection among key populations.

This article is republished under a community partnership agreement with RNZ.

Fiji’s Minister for Health and Medical Services has declared an HIV outbreak.

Dr Ratu Atonio Rabici Lalabalavu announced 1093 new HIV cases from the period of January to September 2024.

“This declaration reflects the alarming reality that HIV is evolving faster than our current services can cater for,” he said.

• READ MORE: Other HIV in the Pacific reports

“We need the support of every Fijian. Communities, civil society, faith-based organizations, private sector partners, and international allies must join us in raising awareness, reducing stigma, and ensuring everyone affected by HIV receives the care and support they need.”

In early December, the Fiji Medical Association called on the government to declare an HIV outbreak “as a matter of priority”.

As of mid-December, 19 under-fives were diagnosed with HIV in Fiji.

The UN Development Programme has recently delivered 3000 antiretroviral drugs to Fiji to support the HIV response.

World’s largest epidemic
A report released in mid-2024 showed that in 2023, 6.7 million people living with HIV were residing in Asia and the Pacific, making it the world’s largest epidemic after eastern and southern Africa.

“Among countries with available data, HIV epidemics are growing in Afghanistan, Bangladesh, Fiji, the Lao People’s Democratic Republic, Papua New Guinea and the Philippines,” the report said.

The regional director of UNAIDS Asia Pacific Eamonn Murphy said rising new infections in Fiji “put the entire Pacific region at risk”.

“Prioritisation of HIV by the government is critical for not only the people of Fiji, but the entire Pacific,” he said.

“Political will is the essential first step. There must also be community leadership and regional solidarity to ensure these strategies work.”

UNAIDS said the 1093 cases from January to September was three times as many as there were in 2023.

Preliminary Ministry of Health numbers show that among the newly-diagnosed individuals who are currently receiving antiretroviral therapy, half contracted HIV through injecting drug use. Over half of all people living with HIV who are aware of their status are not on treatment.

Second-fastest growth
“Fiji has the second fastest growing HIV epidemic in the Asia and the Pacific region,” Murphy said.

He said the data does not just tell the story about a lack of services, but it indicates that even when people know they are HIV-positive, they are fearful to receive care.

“There must be a deliberate effort to not only strengthen health systems, but to respond to the unique needs of the most affected populations, including people who use drugs.

“Perpetuating prejudice against any group will only slow progress.”

UNAIDS also said the HIV Outbreak Response Plan called for a combination of prevention approaches.

Since the sexual transmission of HIV remains a significant factor, other key approaches are condom distribution and pre-exposure prophylaxis (PrEP), a treatment taken by an HIV-negative person to reduce the risk of contracting HIV if they are exposed.

UNAIDS support
Through the Australian government’s Indo-Pacific HIV Partnership, UNAIDS is supporting Fiji to scale up prevention approaches.

United Nations Resident Coordinator in Fiji Dirk Wagener said the outbreak declaration and the launch of high-impact interventions, such as needle syringe programmes and PrEP, marked a critical turning point in Fiji’s efforts to combat the epidemic.

“The Joint UN Team on HIV, with UNAIDS as its secretariat, stands ready to provide coordinated and sustained support to ensure the success of these strategies and to protect the most vulnerable.”

The HIV Surge Strategy includes tactics for Fiji to achieve the Global AIDS Strategy targets — 95 percent of all people living with HIV aware their status, 95 percent of diagnosed people on antiretroviral therapy, and 95 percent of people on treatment achieving a suppressed viral load.

This article is republished under a community partnership agreement with RNZ.

Indonesian President Joko “Jokowi” Widodo did something extraordinary in his annual State of the Nation address this week – he issued a plea for tolerance.

“I am sure if the Indonesian people want to remain united, tolerant, and care for their fellow children of the nation, then Indonesia is no longer just a name or picture of a chain of islands on a world map, but rather a force respected by other nations in the world,” Jokowi said.

That reference, in a speech otherwise dominated by upbeat references to infrastructure spending commitments and economic growth projections, suggests a rare, if ambiguous, public recognition by Jokowi of the worsening harassment and discrimination targeting the country’s religious and sexual minorities.

Religious minorities are particularly vulnerable, because of the country’s dangerously ambiguous blasphemy law.

The law’s latest victim is a Buddhist woman facing a possible 18-month prison term for complaining about the loudspeaker volume of a neighborhood mosque.

The surge since 2016 of anti-LGBT rhetoric by government officials, as well as moves to criminalise same-sex relations are linked to a worsening of the country’s HIV epidemic.

Jokowi’s tolerance plea om Thursday is even more remarkable given that he has largely turned a blind eye to LGBT discrimination, and the role of government officials in fomenting it.

Longstanding commitment
Jokowi also used his speech to reiterate a longstanding commitment to “resolve cases of past rights abuses and to improve protection of human rights to prevent similar cases from taking place in the future”.

However, he did not provide any details or timetable for their resolution.

Jokowi’s first-time reference to tolerance in his annual national address might indicate some recognition that he has failed to translate his rhetorical support for human rights into meaningful policy initiatives.

He could also be responding to criticism from domestic human rights activists of his recent choice for his vice presidential running mate, Ma’ruf Amin, a conservative cleric who has played a major role in fueling discrimination against religious and gender minorities.

Jokowi’s challenge now is to back his rhetoric of toleration with substantive policies that will protect vulnerable populations and bring rights abusers to justice.

Phelim Kine is deputy director, Asia Division, of Human Rights Watch.

Lack of funds hampers addressing issues faced by the increasing number of people living with HIV in Papua New Guinea, says Cardinal Sir John Ribat.

Cardinal Ribat, chairman of the Christian Leaders Alliance on HIV/AIDS, said this before handing over the recommendations made at the two-day summit for PNG Christian Leaders Alliance on HIV and AIDS.

He said advocacy was the paramount role of Christian leaders.

Cardinal Ribat said that through their pastoral care duties, they would advocate on outgoing, current and emerging issues that affecting individuals and families such as HIV and AIDS, gender-based violence, stigma and discrimination, access to service and issues affecting key populations.

He said that it was recommended that heads of churches must take a more proactive role in educating and creating a learning environment for our people including the key populations.

“The key advocacy statement from this summit is ‘HIV is not a death sentence’.”

He added that all heads of churches must from now on advocate with that message throughout their church networks.

“The government, through the department of National Planning and Monitoring, must create a physical programme for PNGCLA on HIV and AIDS so that heads of churches can be able to access government development funding through the existing MoU between the church and the government and call it the Church and State Partnership Program.”

Strong concerns
The summit expressed strong concerns regarding the number of people being infected with HIV and also stressing on the continuing sustainability of the existing services that requires a strong commitment for funding.

The summit also called for a renewed national strategy with full cooperation between the government and churches in order to meet the emerging demands on the nation for the care, support and treatment for people living with HIV.

The summit was also told that Papua New Guinea had the highest HIV prevalence among the Pacific nations with a rate of 0.8 percent among the 15-49 age group.

The regional manager for the National Aids Council Secretariat, Valentine Tangoh said while
presenting his report that the Highlands region had a prevalence rate of more than 1 percent in HIV cases, placing Enga as the province with the highest rate (1.7 percent), followed by Morobe (0.77 percent). However,  National Capital District had 1.29 percent and Western Province 1.1 percent.

Tangoh said it was more concentrated in certain geographical locations within key population and groups but it was clear that it is mostly concentrated in the Highlands region with the prevalence rate more than 1 percent.

HIV prevalence of 1 percent or more was recorded mainly in the four Highlands provinces.

Enga had a prevalence rate of 1.7 percent, followed by Jiwaka (1.6 percent), Western Highlands (1.3 percent) and Eastern Highlands with 1 percent.

Sex workers
“Studies also indicate a high prevalence of HIV among female sex workers at 19 percent, male sex workers at 8.8 percent and 23 percent among transgender males.”

Tangoh said the main purpose of this summit was to unite all church leaders to inform and empower heads of churches in Papua New Guinea on the current HIV status, reports and studies as well as achievements and the response gaps of HIV and AIDS of the country.

This would create an opportunity for heads of churches to deliberate on HIV and related sensitive issues that are affecting the country and how they can advocate as a collective voice to deal with these issues.

Annette Kora is a Loop PNG reporter.

• Cardinal Ribat calls on PNG churches to ‘work together’ over HIV

The year 2016 was a landmark year for the Philippines with HIV (human immunodeficiency virus) setting annual and monthly records that are the highest since the country started counting HIV incidence 33 years ago.

This coincides with a new development plan for the country that is targeting a reverse trend for the number of new HIV detections in a year, meaning the growth rates of new infections are declining.

The year-end dataset of the Department of Health’s HIV and AIDS (acquired immunodeficiency syndrome) Registry of the Philippines (HARP) noted that there were 750 cases in December 2016 alone, a month’s high.

The year 2016 tallied a total of 9,264 cases (including 1,113 full-blown AIDS cases and 439 deaths). The 33-year-total of recorded HIV cases, including deaths, is already near the 40,000 mark (39,622).

With the 9,264 total in 2016, the DOH said an average of 25.38 Filipinos have contracted HIV in a day. This contrasts with only one person a day in 2008.

Though latest 2017 figures are yet to be released, a Manila social hygiene clinic physician told Asia Pacific Report the unnamed centre had received 31 cases alone last month.

The Philippines passed a reproductive health law five years ago but it has yet to be fully implemented given court cases and strong opposition from the Catholic Church and from pro-life advocates.

Condom distribution plan
Months into the Rodrigo Duterte administration, the president had issued Executive Order 12 calling for the immediate implementation of Republic Act 10354 (Responsible Parenthood and Reproductive Health Act 2012).

Recently, health officials said recently DOH was set to distribute condoms.

Even schools are target distribution centres, say health officials, but Catholic-run schools and universities are vehemently opposing it.

Year-on-year, there were more adolescent deaths in 2016 (88 compared with 64 in 2015). HIV cases reported among Filipinos aged 15-to-24 at the time of their being reported reached 10,720 cases.

But a significant number — more than 60 percent of the 39,622 cases — contracted HIV through homosexual contact.

The Philippines is said to be a “low-prevalence” HIV country, with the 39,622 cases well below one percent of the total Philippine population. However, its annual growth rates of HIV infection rate are among the fastest in the Asia-Pacific region, says a December 2016 report by the US-based Human Rights Watch.

“The country’s growing HIV epidemic has been fuelled by a legal and policy environment hostile to evidence-based policies and interventions proven to help prevent HIV transmission,” HRW said.

HRW criticisms
Human Rights Watch also criticised the Philippine government for “failing to adequately target HIV prevention measures at men who have sex with men (MSM)”, also citing the “woefully inadequate” HIV prevention education in schools and the “non-existent” commercial marketing of condoms to MSM populations.

In reply, Archbishop Socrates Villegas, D.D., president of the Catholic Bishops’ Conference of the Philippines (CBCP), said condom distribution in schools “will stimulate immorality”.

Dr Diana Mendoza, from a Manila-based social hygiene clinic, told Asia Pacific Report the Philippines could prevent an HIV epidemic especially through empowering citizens through awareness and protection.

In Tacloban City, site of supertyphoon Haiyan in 2013, a Catholic parish priest said that instead of condom distribution in schools, an “ABC method” may work: “A – abstinence from sex outside marriage; B – be faithful to one another; and C – conversion of heart to the value of love and sacredness of sex as a gift of God in marriage”.

This “ABC” advice from Father Raymund Sotto of the St. Rafael the Archangel parish in Tacloban City counters the policy advice of the World Health Organisation (WHO): the proper and consistent use of condoms will be “highly effective: in preventing HIV and other sexually-transmitted infections (STIs).

The recently-released 2017-2022 Philippine Development Plan under the Duterte administration noted the “substantial increase” in newly-diagnosed HIV cases since 2010. The report added that the “the increased reported cases may be due to better surveillance and testing methods.”

The Duterte government will also propose to the Philippine legislature to amend the current Philippine HIV and AIDS Prevention and Control Act 1998 (Republic Act 8504) to make the law “more responsive and relevant” to the current rise of HIV cases in the country, the PDP reported.

Jerome Villanueva and Roy Abrahmn Narra are graduate journalism students of the University of Santo Tomas, Manila. Catholic diocesan priest Father Casibjorn Qiua is taking up a graduate degree in communication from the same university.

• The 20177-2022 Philippine Development Plan

In 1936, Dutch geologist Jean Jacques Dozy climbed the world’s highest island peak: the forbidding Mount Carstensz, a snow-covered silver crag on what was then known as Dutch New Guinea. During the 4800m ascent, Dozy noticed an unusual rock outcrop veined with green streaks. Samples he brought back confirmed exceptionally rich gold and copper deposits.

Today, these remote, sharp-edged mountains are part of West Papua, Indonesia, and home to the Grasberg mine, one of the biggest gold mines – and third largest copper mine – in the world.

Majority-owned by the American mining firm Freeport McMoRan, Grasberg is now Indonesia’s biggest taxpayer, with reserves worth an estimated $100bn (£80bn).

But a recent fact-finding mission (by the Brisbane Archdiocese’s Catholic Justice and Peace Commission) described a “slow-motion genocide” (pdf) taking place in West Papua, warning that its indigenous population is at risk of becoming “an anthropological museum exhibit of a bygone culture”.

Since the Suharto dictatorship annexed the region in a 1969 UN referendum largely seen as a fixed land grab, an estimated 500,000 West Papuans have been killed in their fight for self-rule.

Decades of military and police oppression, kidnapping and torture have created a long-standing culture of fear.

Local and foreign journalists are routinely banned, detained, beaten and forced to face trial on trumped-up charges. Undercover police regularly trail indigenous religious, social and political leaders.

And children still in primary school have been jailed for taking part in demonstrations calling for independence from Indonesia.

“There is no justice in this country,” whispered one indigenous villager on condition of anonymity, looking over his shoulder fearfully. “It is an island without law.”

****

Dozy had not set out to find gold in 1936; his goal was to scale the region’s highest glacial peak. But his discovery sparked the interest of Freeport Sulphur – later to become Freeport Minerals Company and then, through a 1981 merger with the McMoRan Oil and Gas Company, Freeport McMoRan – whose board of directors included the well-connected Godfrey Rockefeller (serving from 1931 until the early 1980s) and Henry Kissinger (1988-1995).

Today, indigenous tribes such as the Kamoro and the Amungme claim their communities have been racked with poverty, disease, oppression and environmental degradation since the mine began operations in 1973.

“We are a coastal people, and we depend on the environment,” says the Kamoro’s chief, Hironimus Urmani, in Tipuka, a lowland village down-river from the Grasberg mine.

“Nature is a blessing from God, and we are known by the three Ss: sago [trees], sampan [canoes] and sungai [rivers]. But life is very difficult now.”

Urmani motions to the river opposite, languishing green and motionless. He claims that tailing sediment from the mine has raised the riverbed, suffocating the fish, oysters and shrimp on which the Kamoro diet and economy are traditionally based. A 2012 report from Earthworks and MiningWatch Canada (pdf) asserts that mine waste from Grasberg has “buried over 166 sq km of formerly productive forest and wetlands, and fish have largely disappeared”.

‘We need to earn money’
Although most Kamoro still try to eke out a living fishing and foraging for food, they struggle to find paid work, says Urmani. “We need to earn money. But now we face major competition from non-Papuan migrants.”

Locals fear that the government’s controversial transmigration programme, which resettles Indonesians from high-density islands such as Java to low-population areas, is wiping out their population completely. Indigenous Melanesian Christians – they comprised 96 percent of the population in 1971 (pdf) – now make up a 48 percent minority, with numbers expected to fall to 29 percent by 2020 if migration rates continue.

Clashes between the indigenous Christians – and migrant Indonesian Muslims – have also resulted in riots, fires and injuries.

“Land has been taken away, directly by Freeport … and indirectly, as the Indonesian settlers have appropriated it,” says Dr Agus Sumule, professor of agricultural socio-economics at the University of Papua.

“The stresses [on indigenous people] are intense,” says Sumule. “They have been very negatively impacted.”

The Indonesian government signed over to Freeport the right to extract mineral wealth from the Grasberg site in West Papua in 1967. A 2002 report (pdf) from the International Institute for Environment and Development (IIED) details that land agreements were not negotiated with the Amungme until 1974, a year after the mine opened, and with the Kamoro in 1997.

The compensation paid for Kamoro and Amungme land has been mainly in the form of communal benefits, such as the building of homes, schools and places of worship. The IIED report notes, “Perceptions of land rights and historic compensation claims are a continuing source of dissatisfaction and conflict in the mining area.”

Recent census data shows Papua’s GDP per capita at $3510, compared to the Indonesian average of $2452. Yet Papua has the highest poverty rate in the country, nearly three times the national average. It also has the highest infant, child and maternal mortality rates in Indonesia, as well as the worst health indicators, and the poorest literacy rates.

Scale of destitution
The scale of destitution is best observed from the highland Amungme village of Banti, just 20 miles down from the Grasberg mine.

Estimates from Earthworks suggest that Freeport dumps as much as 200,000 tonnes of mine waste, known as tailings, directly into the Aikwa delta system every day. The practice has devastated the environment, according to Earthworks and locals, turning thousands of hectares of verdant forest and mangroves into wasteland and rendering turgid the once-crystal waters of the highlands.

The tailings from the Grasberg mine are so rich with ore that Papuans walk for as long as a week to get here. Crowding the length of the river and the delta wasteland, thousands of unlicensed panners shore up small sections to slow the river’s flow and dig into the thick sediment on the side.

Although some of these panners are located within Freeport’s official mining operations, they are not evicted or controlled in any way, they said. Instead, they claim they sell their findings to the police and military who work as security on the mine. (An anonymous Freeport source also confirmed this).

One of the panners, Martine Wandango, 25, bends over her pail of water as she filters out rocks and searches for ore. “You can only survive with money, and you can only find money from gold,” says Martine, who followed her husband to the delta 15 years ago by walking 60 miles over the mountains from their remote highland village.

“I work really hard as I want to give my children better lives, so they can go to school. But it isn’t enough, so she helps me here mining,” says Martine of her daughter, nine, who swings a gold pan in her hands. “On a good day, I can get three grammes, which I sell either to the police or [to buyers] in Timika.”

A tiny village when Freeport arrived here 40 years ago, Timika is now a boom town dotted with bars, brothels, gold-processing shops and various military personnel. Under Indonesian law, Freeport is a designated “strategic industry”, which mandates that external security for the mine, its access roads and its pipelines all be provided exclusively by Indonesia’s security forces.

Freeport never implicated
Freeport has never been implicated in any human rights abuses allegedly committed by the Indonesian military in Papua.

Freeport McMoRan, based in Phoenix, Arizona, did not respond to multiple requests for comment.

The company’s website defends its method of disposal of tailings at Grasberg, managed by PT Freeport Indonesia (PTFI), an affiliate company: “PTFI’s controlled riverine tailings management system, which has been approved by the Indonesian government, uses the unnavigable river system in the mountainous highlands near our mine to transport tailings to an engineered area in the lowlands where the tailings and other sediments are managed in a deposition area.”

A 2009 report by the company says it utilises levees to contain tailings in the deposition area, and that the tailings management programme costs Freeport McMoRan $15.5m (£12.7m) each year. According to the report, company monitoring of aquatic life in the rivers found that fish and shrimp were suitable for consumption, as regulated by Indonesian food standards, while water quality samples met Indonesian and US Environmental Protection Agency drinking water standards for dissolved metals. In a 2011 BBC report (pdf) on alleged pollution in the area surrounding Grasberg, the company says that the tailings management method was chosen because studies showed the environmental impact caused by its waste material was reversible.

Elsewhere on its website, the company says: “We are committed to respecting human rights. Our human rights policy requires us (and our contractors) to conduct business in a manner consistent with the Universal Declaration of Human Rights, and to align our human rights due diligence practices with the United Nations Guiding Principles on Business and Human Rights (UN Guiding Principles).”

The company also emphasises its work with indigenous people in West Papua. A 2015 Freeport McRoRan report on working towards sustainable development said: “PTFI has engaged with indigenous Papuan tribes for decades, including through numerous formal agreements to promote workforce skills training, health, education and basic infrastructure development … In 2015, PTFI continued to evaluate the effectiveness of alternate options for Kamoro community members whose estuary transport routes are impacted by sedimentation associated with the controlled riverine tailings management system. Provision of smaller sized boats, in addition to 50 passenger vessels, for route flexibility as well as additional local economic development programmes were identified as additional mitigation measures during the year.”

Back in the area surrounding the Grasberg mine, many Papuans, struggling for work, find themselves pulled into the bar and sex industries that cater to the miners, particularly around the highland village of Banti. Here brothels and bars line up side by side, allegedly with help from the Indonesian military, who are said to supply sex workers and alcohol, according to a Freeport source who wished to remain anonymous.

Newfound promiscuity
Indigenous chiefs have watched as a newfound promiscuity has brought sexually transmitted infections that have ravaged their communities. “Traditional Papuan culture forbids free sex, but alcohol makes our communities vulnerable,” says the Amungme chief, Martin Mangal. “And brothels make it easy to contract HIV.”

HIV rates in West Papua are of “epidemic” proportions, according to the UN, 15 times higher than anywhere else in Indonesia. Driven almost entirely by unsafe sex, HIV is also far more prevalent among indigenous Papuans. Yet the existence of only one hospital – built by Freeport – means that most people, particularly those in remote highland villages, don’t get the help they need.

Late last year, the Indonesian president, Joko Widodo, claimed he was willing to work towards a “better Papua”: “I want to listen to the people’s voices.”

However, human rights violations have actually increased since Widodo took power, according to Indonesia’s Commission for the Disappeared and Victims of Violence (Kontras), which has logged 1,200 incidents of harassment, beatings, torture and killings of Papuans by Indonesian security forces since his election in 2014.

The Indonesian government did not respond to multiple requests for comment. The country’s military has consistently denied any wrongdoing in Papua.

Despite everything, there have been small glimmers of hope. This summer, Dutch human rights law firm Prakken D’Oliveira submitted a formal legal complaint against Indonesia to the UN Human Rights Council, accusing the government of “long-term, widespread and systematic human rights violations” and the “complete denial of the right to self-determination of the people of West-Papua”.

Later this year, West Papua is expected to be granted full membership of the Melanesian Spearhood Group, an important sub-regional coalition of countries including Fiji, Vanuatu and Papua New Guinea.

The Brisbane commission, which warned of the risk of genocide, is calling on Indonesia to allow Papua, once and for all, the right to self-determination.

Yet some fear the opportunity for change in Papua is long gone.

“Is healing even possible?” asked Professor Agus Sumule, shaking his head. “It could be too late.”

Susan Schulman is an award-winning video/photojournalist. She moved from her native New York to London in 1990. During the past 10 years she has chronicled many of the world’s forgotten tragedies, from the horrors of childbirth in Sierra Leone and child soldiers in Sudan to the wretched plight of gold miners in the Amazon basin. This article was first published in The Guardian and has been republished here with the permission of both the author and The Guardian. Go to The Guardian for full images and resource links.

How mining and militarisation led to an HIV epidemic in Papua

Martina Wanago was sick. In fact, she was sure she would die. She had contracted HIV, which has reached epidemic proportions here in Indonesia’s remote and restive province of Papua. And like many of those infected, she didn’t know what was wrong with her.

“All I could do was just wait for God to call me,” Wanago said, closing her eyes as firelight flickered on her face in a traditional roundhouse in Kambele, a remote artisanal mining village deep in cloud-shrouded mountains.

But it was here, in this unlikely spot, that she found salvation. Or rather, she found treatment – at the Waa Waa Hospital in the nearby community of Banti.

The hospital was built by Freeport McMoRan, one of the world’s largest mining companies, based in Phoenix, Arizona. It is one of very few positive developments that the industry has brought to indigenous Papuans.

For decades, the Philippines had dodged the global AIDS crisis. Things have changed, however. There is now a full-blown AIDS crisis in the country, as seen in the growing statistics.

According to the latest data from the Philippine Department of Health’s Epidemiology Bureau, the number of individuals with HIV newly diagnosed per day rose to 22 last year, from just one in 2008, four in 2010, nine in 2012 and 17 in 2014.

In just one month in 2015 (July), there were 682 new cases registered, 17 percent more than the same month the previous year. Ninety-four percent of them were male and the average age was 27.

Half of the individuals diagnosed as HIV positive belong to the 25-to-34 year age group, while 30 percent were youth aged 15 to 24.

In terms of modes of transmission, the most common was sexual contact (663 cases), and eight percent of the sexually transmitted cases were among males who have sex with males. The other modes of transmission were needle sharing among drug users (17 cases) and mother-to-child transmission (two cases).

Tracing its beginnings in the Philippines, HIV infection in the country was first reported in 1984. Between January 1984 and July 2015, a total of 27,138 cases were reported, with the most dramatic increase in the number of cases happening in the past five years, according to the same government data.

Eighty-four percent (or 22,714) of the 27,138 diagnosed cases have been reported since January 2010.

In the early years of the epidemic, from 1984 to 1990, 62 percent (133 of 216 cases) were female. However, from 1991, more males were reported to be infected with HIV.

Between 2010 and 2015, males comprised 95 percent (21,601) of the reported 22,714 cases.

Younger generation
As the years have progressed, individuals diagnosed HIV positive have increasingly come from the younger generation.

‘The age group with the biggest proportion of cases has become younger: from 2000 to 2004, it was 30 to 39 years; from 2005 to 2009, it was 25 to 34 years; and from 2010 to 2015, it was 20 to 29 years.

Notably, the proportion of People Living with HIV in the 15-to-24 age group increased from 20 per cent in 2005-09 to 28 per cent in 2010-15,’ the latest Health Department report said.

Dr Joven Cuanang, neurologist and chair of a private hospital in the Philippines, said that because of the growing incidence of HIV in the Philippines, the medical community feels the urgent need to raise the public’s awareness of the issue, adding that “It’s already an epidemic”.

Cuanang explained that in his hospital, St Luke’s Quezon City, the top three neurologic complications of HIV are infections of the central nervous system, malignancies and lymphomas. Other HIV-related complications on the rise include dementia, viral infections and neuropathies.

According to Cuanang, healthcare workers are becoming more and more aware of the problem and he stresses that most cases of HIV/AIDs are preventable by good health education.

Against this backdrop of a growing health crisis, the Philippine Congress recently eliminated contraceptive funding in the 2016 national budget. This cuts vital support for lower-income Filipinos who rely on state-provided contraceptive services for protection from sexually transmitted diseases and for safe birth-spacing and family planning.

Poorer segments
According to a report published in 2013, up to 50 percent of pregnancies in the Philippines are unintended, largely due to lack of availability of modern contraceptive services, especially among the poorer segments of society.

“The budget cut threatens to roll back hard-fought gains in maternal health and reductions in infant mortality over the past decade made possible by government-subsidised or free contraceptive services,” Human Rights Watch (HRW) said in a commentary, adding that it also risks exacerbating the country’s HIV crisis.

The United Nations Population Fund has also criticized the congressional action as a threat to “the basic human right to health as well as the right to reproductive choices”.

According to the UN, the Philippines is “one of only a handful of countries at risk of a full-blown AIDS epidemic”.

As things stand, the Philippines is indeed facing an AIDS crisis. Authorities must do more by raising awareness, improving public education on the issue and, at the risk of earning the ire of the Catholic Church, keep on distributing free condoms, especially to the poor.

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