The collapse of the initial response to AIDS in the mid 1990s meant that the new National AIDS Council Secretariat, (NACS) headed by Malau, and its AusAID Support Project (NHASP), had to start from scratch in 2000. Their approach, with the MTP as their charter, was to address all sectors and all provinces, without establishing priorities. Despite the substantial funding available, it was clear from reviews during 2002–4 that, although there were achievements, there were major difficulties, particularly in mobilizing provincial AIDS committees, NGOs and other sectors, including the Department of Health. A National Strategic Plan of HIV/AIDS (2004–8) was drawn up, again without priorities, and in December 2004 the government accepted a longstanding proposal that the National AIDS Council be transferred to the Department of the Prime Minister and Cabinet.

In December 2004 a further epidemiology workshop estimated a national prevalence rate of 1.7 per cent, the highest in the Pacific region and amongst the highest in Asia. At the same time a survey by the Australian Strategic Policy Institute, advising the Australian government, found that Papua New Guinea’s deteriorating services and infrastructure, high crime rates, economic stagnation and corruption were symptoms of a systemic lack of capacity to provide effective government. It warned that ‘the institutions of governance in PNG have weakened to the point that they might collapse under the effects of … a full-blown AIDS crisis [that] will now be very hard to avoid’ (ASPI 2004, 9). In July 2005 the head of UNAIDS, Dr Peter Piot, labelled Papua New Guinea as at greatest risk in Asia and the Pacific of an African-type of generalized epidemic: ‘That’s the one county, I would say I think is really getting out of hand’.

Anthropologists have repeatedly found that local understanding of HIV in Papua New Guinea is contingent on cultural beliefs and practices and that generalized prevention messages are reinterpreted in these terms (Lepani 2005; Wardlow 2002). Accommodating Papua New Guinea’s exceptional cultural diversity within viable public policy has been a substantial hurdle in all domains since the dawn of colonial rule and perhaps reaches an apogee in the development of policy on AIDS.