ABC Approach to HIV Prevention A Policy Approach

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Issues Implications,1995 the time period during which. HIV prevalence was declining key, Beyond Slogans Lessons changes in behavior occurred. From Uganda s Experience Fewer Ugandans were having sex. at young ages The proportion of, With ABC and HIV AIDS young men who had ever had sex. decreased substantially and the,By Susan A Cohen median age at which young women. began having sex rose from 15 9 in, Between the late 1980s and mid STDs as well as unintended preg 1988 to 16 3 in 1995 Importantly.
1990s at a time when HIV AIDS was nancy and the abortions or however among those people who. well on its way toward ravaging Sub unplanned births that inevitably fol were having sex overall levels of. Saharan Africa Uganda achieved an low both in Sub Saharan Africa and sexual activity did not decline. extraordinary feat It stopped the in other parts of the world. spread of HIV AIDS in its tracks and Levels of monogamy increased. saw the nation s rate of infection Meanwhile U S based social conser Sexually active men and women of. plummet As word of the Uganda vatives in and out of government all ages particularly the unmarried. miracle spread journalists even as they pay homage to the ABC were less likely to have more than. researchers policymakers and advo mantra continue to confuse all of one sexual partner in a 12 month. cates all descended to try to ascer these issues For them ABC has period in 1995 than in 1989 Other. tain how it was accomplished become little more than an excuse research has found that the propor. and justification to promote their tion of men reporting three or more. By now Uganda s success story has long standing agenda regarding peo sexual partners also fell during the. become virtually synonymous with ple s sexual behavior and the kind of period. the so called ABC approach to sex education they should receive A. HIV AIDS prevention for Abstain Be for unmarried people bolstered by Condom use rose steeply among. faithful use Condoms And indeed advocacy of B but for most people unmarried sexually active men and. it is clear that some combination of anything but C women Among unmarried women. important changes in all three of who had had sex in the last four. these sexual behaviors contributed Uganda and ABC weeks the proportion who used con. both to Uganda s extraordinary doms at last intercourse rose from. reduction in HIV AIDS rates and to Measuring sexual behavior change 1 in 1989 to 14 in 1995 among. the country s ability to maintain its Among public health experts it is by unmarried men condom use rose. reduced rates through the second now generally agreed that during the from 2 to 22. half of the 1990s Beyond that how critical time period between the late. ever the picture becomes consider 1980s and mid 1990s positive Additional risk factors and epidemi. ably less clear changes in A B and C behaviors ological impact The relationship. occurred and that all of these between individual sexual behavior. ABC refers to individual behaviors changes played a role in reducing and HIV risk is further complicated. but it also refers to the program HIV rates Uganda s HIV prevalence however by many other factors that. approach and content designed to steadily increased until about 1991 overlay a simple A B and C analysis. lead to those behaviors Researchers when it peaked at about 15 30 The risk of exposure is greater for. and public health experts continue among pregnant women in urban example in the presence of other. to study both and to delve into the areas It then turned sharply down STDs and it appears to be lower for. many and varied complex relation ward through the mid 1990s and circumcised men The number of a. ships among them This information reached 5 14 for pregnant urban man or woman s sexual partners. is critical to determining to what women by 2001 matters but so does the duration of. extent the Uganda experience really relationships the extent to which. is replicable and what from that The findings of an analysis released relationships might overlap fre. experience productively might be by The Alan Guttmacher Institute in quency of sex specific sexual prac. exportable to other countries At the November 2003 A B and C in tices how consistently and correctly. same time much more research is Uganda The Roles of Abstinence condoms are used with different. needed into the relevance of the Monogamy and Condom Use in HIV partners and the stage of infection. ABC approach for the prevention of Decline are consistent with the cur of an HIV positive partner. other sexually transmitted diseases rent consensus Between 1988 and. The Guttmacher Report on Public Policy D e c e m b e r 2 0 0 3. In high prevalence settings ascer to be tested and counseled improv early ages is prevalent a similar. taining exactly which behavior ing the status of women involving media campaign is beginning to. change or combinations of changes show results According to a recent. religious organizations enlisting tra, can have the most impact in reduc ditional healers and much more summary from the USAID sponsored. ing HIV infection among the popula YouthNet project More than half of. tion as a whole is the focus of more The evidence therefore points to the youth who recalled the ads said. recent studies Indeed based on the the existence of a range of comple the ads had influenced how they. Uganda experience and drawing on mentary messages and services handle boy girl relationships through. an understanding of the epidemiol delivered by the government and a abstaining from sex not giving into. ogy of STDs more generally scien wide diversity of nongovernmental sexual pressure and always using a. tists are now concluding that other organizations To be sure those mes condom contraceptive when having. things being equal even if absolute sages included the importance of sex. monogamy is not attained having both young people delaying sexual. fewer sexual partners especially initiation and zero grazing HIV AIDS rates also are declining in. concurrently may be the most sig monogamy But contrary to the Cambodia Thailand and the. nificant behavior change for a popu assertions of social conservatives Dominican Republic three other. lation overall Whether this is that the case of Uganda proves that countries where various combina. always the most significant protec an undiluted abstinence only mes tions of ABC behavioral changes. tive factor at the individual level sage is what makes the difference appear to have played an important. may be another matter there is no evidence that abstinence role In Cambodia and Thailand the. only educational programs were epidemic spread mainly through. Creating behavior change It is not even a significant factor in Uganda prostitution Both countries are. possible to make a direct and simple between 1988 and 1995 adopting a 100 condom use pol. link between the changes that took icy in brothels and it is yielding. place in Uganda and the policies or Beyond Uganda positive results In the Dominican. programs that may have caused Republic meanwhile the infection. them to happen The widely held Encouraging signs also are beginning rate has slowed mainly due to men. view among Ugandans and outside to emerge from other countries having fewer sexual partners as well. analysts though is that increases in where HIV AIDS had become a gen as to increased condom use. all three of the ABC behaviors led to eralized epidemic In Zambia for. reduced HIV rates following a com example HIV rates appear to be Finally Brazil has so successfully. prehensive national message that declining at least among urban stemmed the tide of HIV AIDS that. HIV prevention was of the utmost youth The U S Agency for only half the number of Brazilians are. importance to the country and the International Development USAID infected today as the World Bank had. responsibility of all of its citizens notes that clear positive changes in predicted only a few years ago. The message was delivered in differ all three ABC behaviors have taken Brazil s case may be atypical in one. ent ways through a multiplicity of place Indeed it would seem that the sense because of the government s. approaches programs and types of HEART Helping Each Other Act decision to make free antiretroviral. organizations and was buttressed by Responsibly program a major drugs available to anyone who quali. a level of political commitment to USAID funded media campaign fies for AIDS therapy But it is equally. forthrightly addressing the AIDS cri there may deserve much of the atypical within Latin America. sis that was unique among African credit This program which was because of the government s decision. governments President Yoweri designed for and by youth promotes to promote frank talk about sex as. Museveni himself exhorted both abstinence and condom use well as condom distribution pro. Ugandans and still does to practice One year after the campaign s initia grams Indeed the Brazilian Health. A B and C Further as Harvard tion indications are that young peo Ministry announced plans in August. medical anthropologist Edward ple exposed to its comprehensive 2003 to distribute condoms to sexu. Green observed recently ABC is far messages are 46 more likely to be ally active high school students in. from all that Uganda has done delaying or stopping having sex and five Brazilian cities to prevent not. Uganda he noted pioneered 67 more likely to have used a con only HIV AIDS but also teenage preg. approaches towards reducing stigma dom the last time they had sex nancy Officials are particularly con. bringing discussion of sexual behav compared with those who were not cerned about preventing HIV positive. ior out into the open involving HIV exposed teenage girls from becoming pregnant. infected people in public education and then transmitting HIV AIDS to. persuading individuals and couples In Jamaica where HIV rates are still their newborn infants. relatively low but sexual activity at, The Guttmacher Report on Public Policy D e c e m b e r 2 0 0 3. Beyond HIV and ABC have merit should not strict absti from the risk of HIV AIDS from her. Despite the evidence from Uganda nence fatigue be considered a clear husband who may have other sexual. and these other countries U S HIV and present danger partners And for a young woman. prevention policy is focused on pro who has so far abstained from sex. moting abstinence Indeed Global To be sure living in the midst of high altogether must she wait until she is. AIDS Coordinator Randall Tobias HIV AIDS prevalence can be a strong already sexually active until she is. personally endorsed a provision in motivator for behavior change As entitled to the full and accurate. recently enacted U S law requiring Harvard s Green wrote recently in information necessary to protect. that at least one third of all U S countries where infection rates herself from unplanned pregnancy. assistance to prevent HIV AIDS glob exceed 30 and funerals for family and disease These are just some of. ally be reserved for abstinence and friends are held several times a the questions raised by the ABC. until marriage programs U S week abstinence and faithfulness are approach to sexual risk reduction. AIDS Policy Priority on Treatment attractive alternatives to death. Conservatives Approach to Presumably more and more careful What happened in Uganda. Prevention TGR August 2003 page condom use would be an attractive between the late 1980s and mid. 1 In effect this makes abstinence alternative in the face of these cir 1990s happened in a specific place. until marriage advocacy the single cumstances as well and the experi and time and under very specific cir. most important HIV AIDS prevention ence of high prevalence communities cumstances There is much to be. intervention of the U S government in the United States from roughly the learned from it But advocates and. same time period during which policymakers seeking the simplicity. Social conservatives pressed for this Uganda turned its rates around indi of a single program model to repli. result because at least with regard cates that indeed this was so The cate should be cautioned that. to the general population they dis critical questions therefore become Uganda s experience may have lim. miss the effectiveness of risk reduc What behaviors may be more or less ited implications even for making. tion strategies such as those that realistic for individuals to both further gains in that country let. promote correct and consistent con achieve and sustain especially as alone for other countries other time. dom use Some like Joseph Loconte the imminent crisis begins to ebb periods and the range of reproduc. of the Heritage Foundation go fur And how best can they be encour tive health concerns beyond HIV. ther denouncing even those pro aged to do so that women and men face Public. grams that target particular high risk health experts and researchers. groups with risk reduction messages Finally that Brazil and Jamaica to meanwhile have a special responsi. on the grounds that they legitimize name just two countries have linked bility to recognize and explicate the. promiscuity prostitution and illegal HIV AIDS prevention strategies with complexities of these questions. drug use Instead he and others the prevention of unintended preg even as they redouble their efforts to. advocate a strict risk elimination nancy is a reflection of the complex answer them. approach which itself must be realities of life and sexual relation. ABC approach for the prevention of other sexually transmitted diseases STDs as well as unintended preg nancy and the abortions or unplanned births that inevitably fol low both in Sub Saharan Africa and in other parts of the world Meanwhile U S based social conser vatives in and out of government even as they pay homage to the ABC

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