African Nations’ Experience with ABC Prevention Method ‘Mixed’ as Reported at AIDS Conference
African nations on Monday at the XVI International AIDS Conference in Toronto reported a "distinctly mixed report card" about their experiences with the HIV/AIDS prevention strategy known as ABC -- which stands for abstinence, be faithful and use condoms -- the Washington Post reports (Brown, Washington Post, 8/15). By law, at least one-third of HIV prevention funds countries receive through the President's Emergency Plan for AIDS Relief -- a $15 billion, five-year program -- must be used for abstinence-until-marriage programs (Kaiser Daily HIV/AIDS Report, 4/5). The experiences of Botswana, Kenya and Nigeria with the ABC model "are not likely to end debate over whether ABC represents a balanced message of proven value or heavy-handed moralism out of touch with the reality of youth, Africa and gender equality," the Post reports. The following was reported at the conference.
- Botswana: An interim evaluation compared behavior of people participating in Botswana's Total Community Mobilization program with those who were not involved in the program. Through the program, 450 counselors went door-to-door to distribute prevention advice, encourage HIV testing and refer HIV-positive individuals to treatment. According to the initial research, people contacted by the program were more likely to mention abstinence and condom use as HIV prevention methods, but they were not more likely to mention being faithful. In addition, people who had been contacted by the program were more likely to have obtained an HIV test in the previous year and to have discussed HIV testing with a sex partner. However, those individuals were not more likely to remain faithful to a partner, and, when they had additional sex partners, they were no more likely to use a condom than those who had not been contacted by the program.
- Kenya: According to a survey about ABC messages conducted among 1,400 teenagers, half of the respondents could define abstinence correctly and state why it was important as an HIV prevention method, though only 23% could explain faithfulness and its importance, and only 13% could explain the importance of condoms. In addition, about half the teenagers "spontaneously offered negative opinions about condoms," the Post reports.
- Nigeria: In Nigeria, a seven-year project funded by USAID and the U.K. Department for International Development counseled young people ages 15 to 24 with the ABC message and measured their attitudes and behaviors about 18 months before and after the program, comparing the measures with those of people not involved in the program. Researchers found that young women who received counseling increased their condom use in their last nonmarital sexual encounter by 15 percentage points and that men increased their condom use by 11 percentage points. People who were not counseled did not increase their condom use, and researchers did not observe a reduction in the number of sex partners among those who were counseled.
Philadelphia Program To Be a Model
Prevention strategies in a Philadelphia sex education curriculum are being adopted for use in Kenya, the Post reports. According to a study of the program -- under which 662 black sixth and seventh graders in Philadelphia received several sex education messages -- about 48% of the group receiving abstinence-only messages had had sexual intercourse at least once, compared with 61% who had received a message mentioning condoms and other prevention strategies. According to researchers, the students in the abstinence-only program who had had sex were as likely to know about condoms and use them as those receiving the full ABC prevention strategy (Washington Post, 8/15).
Advocates', Experts' Response to ABC
The focus on abstinence under the U.S. HIV prevention strategy hinders efforts to curb the pandemic, HIV/AIDS advocates attending the AIDS conference said Sunday, AFP/Khaleej Times reports (AFP/Khaleej Times, 8/13). Jodi Jacobson, executive director of the nongovernmental organization Center for Health and Gender Equality, said abstinence and fidelity are not viable options in many cultures, adding, "[T]he U.S. has put $15 billion in HIV, ... but more money is not always a good thing when it follow[s] bad policy." Jacobson also said that the current ABC model "fails to address fundamental realities in a meaningful way." Melissa Ditmore of the Network of Sex Work Projects, and some other advocates also said other U.S. policies, such as one that prohibits federal funding for groups that do not denounce commercial sex work, also undermine efforts to fight the spread of HIV among groups at an increased risk of contracting HIV (AFP/Khaleej Times, 8/13). "No government in the Western world has the right to dictate policy to African governments around the way in which they respond to the pandemic," U.N. Special Envoy for AIDS in Africa Stephen Lewis said Monday at the conference, adding, "That kind of insipient neocolonialism is unacceptable. ... We're saying to Africa: 'This is how you will respond to the pandemic,' and that's not appropriate because African governments are eminently capable of deciding what their priorities are and what the response should be" (Agence France-Presse, 8/14). Mark Dybul, the ambassador for the Office of the U.S. Global AIDS Coordinator, has said, "The notion that there's an excessive focus on abstinence is just untrue," adding, "The debate in Western and Northern capitals about A versus C just misses the point entirely and actually misses the reality on the ground in Africa." Dybul said that the ABC approach has been adopted in many African countries -- such as Uganda, where HIV prevalence has decreased. The Rev. J.P. Heath of the South African Network of Religious Leaders Living with AIDS said that abstinence is effective as an HIV prevention strategy in Africa and that it should not overshadow other components of the ABC model (AFP/Khaleej Times, 8/13).
Kaisernetwork.org is serving as the official webcaster of the conference. View the guide to coverage and all webcasts, interviews and a daily video round up of conference highlights at http://www.kaisernetwork.org/aids2006.