What's Papua New Guinea's most pressing problem: corruption, lawlessness, secession?
None of these, says infectious diseases expert John McBride. It's the AIDS virus that potentially threatens to undo the South Pacific's biggest economy.
"Our findings and those of other investigators indicate that there is the potential in PNG [Papua New Guinea] for a large-scale economic and humanitarian disaster," said McBride, of James Cook University in Australia.
McBride spent three months working at the Port Moresby General Hospital last year under a pilot World Health Organization program to introduce anti-retroviral drugs. He said economic projections for the impact of HIV/AIDS on the economy included a fall in the workforce of up to 38 percent by 2020.
Australia has pledged A$600 million (US$444 million) over the next five years to fight HIV-AIDS in Papua New Guinea.
The government of Prime Minister Sir Michael Somare appears not up to the task of tackling the epidemic, but rather is focused on holding on to power. The Highlands and other remote regions are effectively independent, while Port Moresby, the capital, is in the grip of armed gangs who terrorize the police and rob and rape with impunity.
A report from the Center for Independent Studies in Canberra warned that "when criminals and politicians go unpunished people lose respect for state laws and the authority of central government collapses."
In an address earlier this year to the UN in New York, Australian Foreign Minister Alexander Downer said that even the other smaller island states of the South Pacific were at risk of a HIV/AIDS epidemic.
"Our concern is that the Asia-Pacific region could become another epicenter of the epidemic to rival Africa," Downer said.
Coping with an AIDS epidemic is particularly difficult in a country on the brink of chaos. Don Baxter, director of the Australian Federation of AIDS Organizations, told a recent conference of AIDS experts in Barcelona that cultural change was necessary to combat the disease.
It had happened in Australia, he said, but the chances of it happening in the South Pacific were slim.
"There is no other way to contain the epidemic except equipping people with the individual capacity to avoid becoming infected," he said.
In countries where domestic violence is considered a private matter and where rape is rampant and goes unpunished, the prospects of containing the epidemic are poor, the conference heard.
AIDS is now the primary cause of death in Port Moresby General Hospital. Earlier this year the bodies of 17 infants that went unclaimed at the hospital were buried three to a grave. AIDS was the most likely cause of the children's death.
By 2015 more than 1.5 million out of a population of 5.2 million in Papua New Guinea could be infected by AIDS. The virus is spreading chiefly among heterosexuals and the number of babies being born with the virus is increasing.