There "would be no global AIDS pandemic were it not for multiple sexual partnerships," and more should be done to encourage people to reduce their number of sexual partners, according to an "Education and debate" article written by officials from several organizations and published in the April 10 issue of BMJ, BBC News reports (BBC News, 4/8). James Shelton, senior medical scientist for USAID's Office of Population and Reproductive Health; Daniel Halperin, senior technical adviser for USAID's Office of HIV/AIDS; Vinand Nantulya, senior adviser for the Global Fund to Fight AIDS, Tuberculosis and Malaria; Malcolm Potts, a University of California-Berkeley population professor; Helene Gayle, director of HIV, TB and reproductive health for the Bill & Melinda Gates Foundation; and King Holmes, director of the University of Washington Center for AIDS and Sexually Transmitted Diseases, write that the "key to preventing the spread of HIV, especially in epidemics driven mainly by heterosexual transmission, is through changing sexual behavior." The authors say that "interest has been growing" in the "ABC" method of HIV prevention -- abstinence, be faithful, use condoms -- and although "be faithful" implies monogamy, it "also includes reductions in casual sex and multiple sex partnerships ... that would reduce higher risk sex.
According to the authors, "most of the often polarized discussion surrounding AIDS prevention" has focused on abstinence and condom use, while partner reduction "has been the neglected middle child of the ABC approach." The authors say that it is "imperative to begin including (and rigorously evaluating) messages about mutual fidelity and partner reduction in ongoing activities to change sexual behavior." They also call for "[f]ormative research" to determine "which changes are feasible for each audience, and programs should then build on behavior changes that people already seem willing to make." The authors conclude, "We have a public health responsibility to help people understand the strengths and limitations of each component and not promote one to the detriment of another. Rather than arguing over the merits of abstinence versus condoms, it is time for the international community to unite around a balanced, evidence-based ABC approach" (Shelton et al., BMJ, 4/10).
In an accompanying editorial, David Wilson, senior monitoring and evaluation specialist for the World Bank's Global HIV/AIDS Program, writes that it is a "simple truth" that without multiple sex partnerships the HIV/AIDS pandemic would not occur and "by extension, partner reduction is the most obvious, yet paradoxically neglected approach to the prevention of HIV." Wilson says that the "Education and debate" authors' position that partner reduction is the "potential centerpiece of a unified ABC approach is good common sense." Wilson adds that partner reduction "is good epidemiology, not good ideology, and we must ensure that the ABC approach remains sufficiently scientifically grounded to withstand shifting ideological sands." He concludes, "[W]e must foster endogenous responses founded primarily on the resources, capital and leadership within communities while enhancing research to ensure these responses are understood, evaluated and illuminated by science" (Wilson, BMJ, 4/10).
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