Islands of Love, Islands of Risk: Culture and HIV in the Trobriands

2. “In the Process of Knowing”

31 CHAPTER 2 “In the Process of Knowing” You know, we Trobriand people are not like other parts or places, our customs are different, about love and all this; they are really different from other places. If we, if the sickness comes—or maybe it is already here—and we are not faithful or honest to each other, then some years’ time it will be a very big problem. Because what I heard from a health worker, there is no treatment and no cure and whoever is sick will die. I think we might have only a few people left. —Elizabeth, aged early thirties, 29 July 2003 Because we are living in this place, we believe in our traditional customs. We are still believing. —Amanda, twenty-year-old Trobriand woman, 24 June 2003 Custom is very, very important on Trobriand Islands. Through custom come realities. Belief becomes reality. —Ethel Jacob, community leader, 23 September 2003 These three statements by Trobriand women of differing generations distill the central question of how HIV and models of prevention are understood in relation to cultural knowledge, sexual values, and practices. Generalized assumptions and moralities about sexual behavior and the risk of disease, which permeate global HIV prevention orthodoxy, are both contested and incorporated into local models of meaning as Trobrianders contemplate the presence of HIV in their lives. As in other parts of rural Papua New Guinea, estimates of the number of people living with HIV in the Trobriands are highly speculative, given limited primary health services and the absence of HIV voluntary counseling and testing facilities (VCT).1 At the time this research was undertaken in 2003, only a few Trobrianders had direct experience with the clinical and social manifestations of diagnosed HIV seropositivity. There were several unconfirmed reports of people returning home to the Trobriands after having tested HIV-antibody positive in urban centers, and there were a few anecdotal reports of people dying from HIVrelated illness. AIDS was speculated to be the probable cause of death in a number of instances, especially if the deceased suffered prolonged, degenerative illness after 32 ISLANDS OF LOVE, ISLANDS OF RISK having traveled or resided outside of the islands. Speculation was based as well on the numbers of deceased arriving in coffins from other parts of the country for burial at home. In 2001, the first confirmed case of HIV was reported by the Losuia District Health Center after serum testing was conducted at the Central Public Health Laboratory in Port Moresby. The district health extension officer (HEO) requested the test after the patient failed to respond to drug treatment for diagnosed tuberculosis . The HEO called this the “first homegrown case” because the patient had never traveled outside of Kiriwina (T. Elliot, HEO, pers. comm.). Only seventeen years old, the female patient died at home in the village within six months of confirmed diagnosis. A further confirmed case in 2004 involved a pregnant woman in her early twenties, diagnosed during routine antenatal testing while residing in Port Moresby. Her baby died at three months of age and the young woman died a month later after returning home to the Trobriands to bury the child. Notwithstanding the indeterminacy of HIV prevalence in the Trobriand population , the discursive presence of the epidemic is palpable. The islands are inundated with the paraphernalia of the national awareness campaign—caps, T-shirts, posters. AIDS awareness stickers are used to decorate schoolbooks and betel-nut lime containers, and they appear on house walls and doors. Talk about HIV and AIDS has also gained prominence through various community-based awareness activities and the informal exchange of information. The last several years have seen an increase in HIV training workshops for health workers, teachers, local government officials, and church and community leaders, organized through the provincial and district governments and the churches. Prior to my research in 2003, awareness activities were a component of two separate research projects conducted by the PNG IMR.2 The Trobriand paramount chief has consistently endorsed the various activities over the years, reinforcing support and interest among community and church leaders. A main channel for HIV communication in the Trobriands has been the village birth attendants (VBA) program. Established in the early 1990s with funding and technical support from UNICEF, the VBA program involves more than 140 women volunteers who have received basic training in clinical birthing procedures and reproductive health, including HIV awareness. Every village in the Trobriands has at least one trained VBA, and several villages...