title: 'Good culture, bad culture': polygyny, cultural change and structural drivers of HIV in Papua New Guinea.
abstract: Culture is often problematised as a key structural driver of HIV transmission in Papua New Guinea. Official HIV programmes, as well as church teachings, tend to focus on customary marital practices of polygyny and bride price payments as 'harmful traditions'. This focus can oversimplify the effects of current and historical nuances of cultural, political and economic change on sexual concurrency and gender inequality. Community-based healthcare workers in Southern Highlands Province explain that customary marital practices are now highly reconfigured from their traditional forms. A recent mining boom has financially advantaged local and travelling men, who are driving an increase of sexual concurrency, transactional sex and inflation of bride price payments. Healthcare workers suggest that the erosion of important social relationships and kinship obligations by the expanding cash economy has caused an intensification of individual male power while enhancing the vulnerability of women. Yet without the means to challenge the effects of uneven economic development, healthcare workers are left to target 'culture' as the central influence on individual behaviours. A commitment to address structural inequality by political leadership and in HIV prevention programmes and a careful contextualisation of cultural change is needed.
authors.affiliation: a Australian Institute of Health Innovation , Macquarie University , Sydney , Australia.|b School of Public Health and Community Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Patti
authors.identifier: http://orcid.org/0000-0002-9628-7987
authors.initials: P
authors.lastname: Shih
authors.affiliation: b School of Public Health and Community Medicine , University of New South Wales , Sydney , Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Worth
authors.affiliation: c Faculty of Health , University of Technology Sydney , Sydney , Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Travaglia
authors.affiliation: d Sexual & Reproductive Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.|e The Kirby Institute for Infection and Immunity in Society , University of New South Wales , Sydney , Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly-Hanku
mesh_terms: D003469:Culture; D005783:Gender Identity; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D006801:Humans; D007407:Interviews as Topic; D008393:Marriage / Q000208:ethnology / Q000523:psychology; D010219:Papua New Guinea / Q000453:epidemiology; D011209:Power, Psychological; D012725:Sexual Behavior / Q000208:ethnology / Q000523:psychology; D012922:Social Change
keywords: Cultural practices; HIV transmission; Papua New Guinea; culture; risk; sexual concurrency