Editorials and Commentary
The New AIDS Fight: A Plan as Simple as ABC
March 4, 2003
"There have been suggestions that President Bush was able to promise $10 billion in new money to fight the AIDS pandemic in part because there is now a way to spend the prevention part of this sum (about half) in a way that is acceptable to conservatives. It's true that conservatives favor this approach, but that doesn't mean it doesn't work.Adapted from:
"The initiative is based on what is called the 'ABC Approach.' ... Here is a summary of Uganda's experience.
"We know now that the rate of new HIV infections in Uganda started to decline in the late 1980s. But foreign experts began showing up in force in Uganda only in the early 1990s. Moreover, there were very few condoms in Uganda when the epidemic began to slow; they became widely available only after the experts appeared. ...
"What happened was that beginning in 1986, Uganda tried to bring about nothing less than fundamental change in sexual behavior. ... This is what has become known as the ABC model: Abstain, Be faithful, use Condoms if A and B fail.
"By 1995 ... 95 percent of Ugandans were reporting either one or zero sexual partners in the past year. Moreover, the proportion of sexually active youth declined significantly from the late 80s to the mid-90s. The greatest percentage decline in HIV infections and the greatest degree of behavioral change occurred in those 15 to 19 years old. This was also the group with the fewest AIDS deaths -- showing that it was most likely behavior and not death rates that reduced infection rates.
"Though only 8 percent of Ugandans aged 15 to 49 reported using condoms recently ... the important thing is that those 8 percent engaged in practices that put them at the highest risk of HIV infection.
"... The ABC approach is not about that great conversation stopper, 'abstinence-only.' It is about providing people with more options for preventing AIDS. Some people cannot or will not change their behavior, and so of course they need to use condoms. But while condom use was one of the options Uganda has promoted, faithfulness to one partner is probably the major contributor to the country's success. We need to develop a balanced approach by recognizing that Africa and the West have different types of epidemics and going beyond the fruitless battle between the abstinence and condom camps."
Green, a medical anthropologist at the Harvard School of Public Health, is author of the forthcoming "Rethinking AIDS Prevention."
New York Times
03.01.03; Edward C. Green