Since 2022, ASHM’s Supporting Triple Elimination in PNG and Timor-Leste (STEPT) program has collaborated with local implementing partners, governments and health care workers to strengthen local health systems. By working together using a locally led, sustainable, and inclusive approach, STEPT aims to reduce parent-to-child transmission of HIV, hepatitis B, and syphilis in Papua New Guinea (PNG) and Timor-Leste.
In Dili, Timor Leste, STEPT has had a transformational effect on Formosa Community Health Centre (Formosa CHC)’s antenatal services, where the project’s implementation is supported by local partner Maluk Timor.
In the past at Formosa CHC, pregnant women diagnosed with HIV or syphilis were often immediately referred to the national hospital. Formosa CHC midwives reported feeling unprepared to manage such cases and were frequently fearful of providing care, particularly for women living with HIV.
However, with training, clinical mentoring, and improved point-of-care testing procedures under the STEPT project, this is changing. An integrated and collaborative approach to on-the-job learning has seen midwives taking a more active role in managing testing, counselling, follow-up, and internal referrals to relevant clinical teams—building their confidence and ensuring women living with HIV are not lost to care.
Where there was once uncertainty, there is now greater understanding and confidence. Midwives involved in the STEPT project feel more capable of caring for women with HIV and syphilis throughout pregnancy and childbirth, and of safeguarding the health of babies. What was once considered too ‘complex’ or ‘risky’ to handle as part of antenatal care is increasingly embedded as part of routine person-centred maternal care.
Better understanding breaking down stigma
Alongside these improvements in clinical care is a crucial decrease in fear and stigma around HIV, aided by the close involvement of peer workers at Formosa CHC, as well as the integration of disability inclusion and stigma reduction principles into training. Clinical staff who have participated in these training activities reported a perceptible attitudinal shift, from concerns about “catching HIV” to pride in supporting healthy pregnancies for all women, regardless of HIV status or disability.
As shown by the story of Cristina*, stigma-free and understanding care is vital for keeping women living with HIV engaged in care and feeling supported in their community.
At just 16 years old, Cristina was diagnosed with HIV during routine antenatal care at her local community clinic. After being referred to Formosa CHC for ongoing antenatal care and access to antiretroviral treatment, Cristina slowly began to feel more at ease.
“At first, I didn’t feel comfortable,” she recalled. “But the more I came back and spoke with the midwives, the more I felt safe. I wasn’t worried they would tell anyone.”
Formosa CHC staff’s respectful and confidential approach helped rebuild her trust and confidence. The team supported her through appointments, explained the treatment process, and reassured her that her baby could be born HIV-free if she followed her care plan.
They also provided linkages to peer support for Cristina and her family, who were initially fearful and made her live separately. But after Cristina’s cousin spoke with one of the doctors on the triple elimination team who shared accurate information with the family, attitudes began to shift. Cristina’s mother has since connected with a peer worker, which has helped the family better understand and support her.
When Cristina gave birth unexpectedly at another clinic, the team quickly coordinated with Formosa doctors to ensure the newborn received timely prophylaxis at home to prevent the transmission of HIV.
Going forward, Cristina says she feels hopeful thanks to the support of Formosa CHC and the STEPT project throughout her journey.
“I know the staff here will support me and my baby. I can ask them anything.”
*Name has been changed for anonymity.
The above article is adapted from the Supporting Triple Elimination in Papua New Guinea and Timor Leste (STEPT) Midterm Review (2025). Learn more about the impact of the STEPT project by accessing the full report here.
