New Republic Examines How Behavior Modification Helped Stem HIV/AIDS Infection in Uganda
The May 27 issue of the New Republic examines how Uganda's "ABC" HIV/AIDS prevention program has primarily used behavior modification to lower HIV infection rates and how that model could be applied to the rest of Africa. ABC, which began in 1987 after President Yoweri Museveni became aware that many soldiers in the army were HIV-positive, stands for "Abstain, Be Faithful, or wear a Condom." The program focuses primarily on abstinence before marriage and fidelity inside of marriage, and has "little to do" with condoms. The approach has paid off: Fewer Ugandan women ages 15 and older report having multiple sex partners overall, down to 2.5% in 2000 compared to 18.4% in 1989, and men have recorded "[s]imilar but smaller" declines in multiple sex partners. In addition, the percentage of pregnant women testing positive for HIV at antenatal clinics declined from 21.2% in 1991 to 6.2% in 2001.
Applying the Model
Some anthropologists and epidemiologists studying Uganda's success in lowering HIV rates say that the country's experience "suggests that abstinence and fidelity may be the keys to whipping AIDS in Africa," as heavy emphasis on condom promotion in other countries such as Botswana and South Africa seems to have failed. According to a February USAID study, Uganda's prevention model could reduce the AIDS rate in some sub-Saharan African nations by 80%, approximately the same efficacy level that an HIV vaccine would be required to have to be approved by the FDA. Orchestrating such programs may prove problematic because of the "public health establishment's preference for condoms over abstinence and fidelity," the New Republic reports, noting that programs that were supposed to work on behavior modification, such as the USAID-funded AIDSCAP, which was run by Family Health International, instead encouraged workers to talk about STD treatment and condom usage. "It was considered too moralistic to stress abstinence and fidelity," David Wilson, a USAID consultant from the University of Zimbabwe, explained. But it seems that the approach is "catching on," the New Republic reports, adding that USAID has seemed "more receptive" to abstinence- and fidelity-based approaches since Daniel Halperin, a medical anthropologist, joined its office of HIV/AIDS last year. The agency, which shied away from supporting faith-based groups that promote abstinence and fidelity in the past, now appears "likely to boost assistance" to a $1 million pilot project that provides faith-based and community groups in Africa with grants (Allen, New Republic, 5/27).