EVIDENCE FROM OTHER COUNTRIES
While Uganda provides the most dramatic example of the effect of
ABC behavior changes on slowing the spread of HIV infection, there
is growing evidence from other countries as well. In Thailand, the
first Asian country to face a severe AIDS epidemic, commercial sex
was the main source of HIV infection. In the early 1990s, the government
successfully instituted a "100 percent condom use" policy
in commercial sex establishments, and this policy was widely credited
with drastically reducing the spread of HIV infection. In addition
to increased condom use, between 1990 and 1995, the proportion of
men reporting paying for sex also declined by more than 50 percent.
Also, partner reduction in Thailand undoubtedly had a substantial
effect on slowing the country's HIV/AIDS epidemic. As in Uganda,
the government's willingness to address the epidemic openly was
crucial.
Zambia, Cambodia, and the Dominican Republic are other countries
in which various combinations of ABC behaviors have contributed
to declines in HIV prevalence. In Zambia, some decline in prevalence
appears to have occurred among urban youth during the 1990s, during
which time national surveys reported clear, positive changes in
all three ABC behaviors. The grassroots involvement of faith-based
and other community-based organizations was crucial in promoting
these changes. As occurred in Uganda, the main reported change was
a large decline in casual sex among both men and women. Cambodia
is replicating Thailand's success in applying a 100 percent condom
policy in commercial sex establishments. Also similar to Thailand,
the country has experienced a steep decline in the number of men
visiting sex workers (from 27 to 11 percent between 1996 and 2000).
In the Dominican Republic, partner reduction by men and increased
condom use with non-regular sexual partners also appear to have
slowed the spread of infection.
BALANCING AND TARGETNG A COMPREHENSIVE ABC APPROACH
A USAID-funded review of data finds the need for appropriately
balanced and targeted ABC approaches. This study has analyzed how
ABC behaviors appear to have affected HIV prevalence in three countries
where prevalence has declined (Uganda, Zambia, and Thailand) compared
to three countries where there is little evidence of a decline (Cameroon,
Kenya, and Zimbabwe). In the case of the five African countries,
it found that significant delays in the onset of sexual activity,
declines in premarital sex, and large declines in extramarital sex
and multiple sexual partnerships occurred in Uganda and Zambia during
the 1990s, while comparable changes appear not to have occurred
in Cameroon, Kenya, or Zimbabwe. Condom use increased greatly in
all of the countries.
There is a clear need for a balance of A, B, and C interventions.
One approach should not be favored over another. Approaches should
instead be combined as appropriate based on the local cultural context
as well as the state of the HIV epidemic.
Interventions need to be targeted for efficiency and respond to
crucial differences among target groups. For example, balanced ABC
approaches might be implemented in the form of A interventions promoting
sexual deferral to youth; B interventions promoting partner reduction
to those not in monogamous relationships; and C interventions promoting
condom use to highly sexually active groups, especially sex workers
and their clients, and people living with HIV/AIDS.
The nature of the epidemic is a major factor in determining the
appropriate balance. In Southeast Asia, HIV/AIDS is still largely
confined to high-risk populations, in which correct and consistent
condom use is relatively easy to implement. In many African countries,
the epidemic is more generalized and thus requires an appropriate
mix of A, B, and C approaches.
^TOP ZERO GRAZING CAMPAIGN >
American Medical Association
(AMA) Manual of Style: Borders T. HIV-AIDS Course, Chapter 4 – Sexuality
and Personal Relationships [Connexions Web site]. March 17, 2006.
Available at: http://cnx.org/content/m13340/1.3/.
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