Article Text

Download PDFPDF
Original research
Considerable distance to reach 90-90-90 targets among female sex workers, men who have sex with men and transgender women in Port Moresby, Papua New Guinea: findings from a cross-sectional respondent-driven sampling survey
  1. Avi J Hakim1,
  2. Steven G Badman2,
  3. Damian Weikum1,
  4. Angelyne Amos3,
  5. Barne Willie3,
  6. Rebecca Narokobi3,
  7. Josephine Gabuzzi3,
  8. Simon Pekon4,
  9. Martha Kupul3,
  10. Parker Hou3,
  11. Herick Aeno3,
  12. Ruthy Neo Boli3,
  13. Joshua Nembari3,
  14. Sophie Ase3,
  15. John M Kaldor2,
  16. Andrew J Vallely2,3,
  17. Angela Kelly-Hanku2,3
  18. On behalf of the Kauntim mi tu Study Team
  1. 1 Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Kirby Institute for Infection and Immunity, UNSW Sydney, New South Wales, Australia
  3. 3 Sexual and Reproductive Health, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
  4. 4 Papua New Guinea National Department of Health, Port Moresby, Papua New Guinea
  1. Correspondence to Avi J Hakim, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; hxv8{at}


Objective To characterise the Joint United Nations Programme on HIV/AIDS 90-90-90 cascade among female sex workers (FSW) and men who have sex with men (MSM)/transgender women (TGW) in Port Moresby, Papua New Guinea (PNG).

Methods We conducted respondent-driven sampling surveys among FSW and MSM/TGW in Port Moresby, PNG from June to October 2016. All participants spoke English or Tok Pisin and were aged >12 years. FSW had to be born female and sell/exchange sex with a male in the past 6 months. MSM/TGW had to be born male and have oral/anal sex with another male-born person in the past 6 months. Participants were interviewed and offered rapid HIV diagnostic and viral load testing. HIV viral suppression (VS) was defined as <1000 copies/mL.

Results We recruited 674 FSW and 400 MSM/TGW; HIV prevalence was 15.2% (95% CI 11.7 to 18.8) and 8.5% (95% CI 5.0 to 11.9), respectively. Among FSW living with HIV, 39.0% (95% CI 26.6 to 51.4) self-reported having been diagnosed; of them 79.6% (95% CI 62.7 to 96.5) self-reported being on antiretroviral therapy (ART), and 54.1% (95% CI 31.8 to 76.4) achieved VS. Among MSM/TGW living with HIV, 24.4% (95% CI 4.7 to 44.1) self-reported having been diagnosed; of them 43.9% (95% CI 33.6 to 54.8) self-reported being on ART, and 86.1% (95% CI 71.1 to 93.9) achieved VS.

Conclusions ART use among those aware of their HIV status is encouraging. However, the generally low awareness of infection status among FSW and MSM/TGW with HIV and the low VS among FSW on ART indicate an urgent need for innovative strategies to increase testing uptake and ART adherence among these populations. Monitoring drug resistance may be warranted.

  • surveillance
  • hiv
  • hiv testing
  • epidemiology (general)
  • Female sex workers
  • men who have sex with men
  • transgender women

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Jackie A Cassell

  • Contributors AJH and AK-H designed the study and conceived of the manuscript. SGB and AJV led the biomarker component of the study. DW and AJH analysed the data. AA supervised the study, which was implemented by BW, RN, JG, SP, MK, PH, HA, RNB, JN and SA. JK provided technical direction. AJH and JMK contributed substantially to the writing of the manuscript. All authors reviewed the manuscript.

  • Funding This project has been supported by the Government of Australia, the Global Fund to Fight AIDS, TB and Malaria, and the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement Number 1 U2G GH001531-01 to Cardno. This publication was also supported by the CDC under the terms of Cooperative Agreement Number NU2GGH002093-01-00 to the Public Health Institute.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the PNG NDOH Medical Research Advisory Committee (#15.12), the Research Advisory Committee of NACS (#RES14004), the PNG Institute of Medical Research’s Institutional Review Board (#1508) and the ethics committee of UNSW Sydney (#HC15355). The protocol was reviewed according to the Centers for Disease Control and Prevention’s (CDC) human research protection procedures and was determined to be research, but CDC was not engaged (#2015–262).

  • Provenance and peer review Not commissioned; externally peer reviewed.