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Strategies in HIV prevention: the A-B-C approach

2004; Elsevier BV; Volume: 364; Issue: 9439 Linguagem: Inglês

10.1016/s0140-6736(04)17050-5

1474-547X

Álvaro Alonso, Jokin de Irala,

HIV/AIDS Impact and Responses

In your July 24 Editorial (p 303),1The Lancet Is it churlish to criticise Bush over his spending on AIDS?.Lancet. 2004; 364: 303-304Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar you write that the A-B-C (Abstinence, Be faithful, and use Condoms) HIV prevention strategy is difficult to achieve in developing countries, many of them with the highest worldwide prevalence of HIV. However, there is a growing amount of evidence, suggesting that this approach for HIV prevention is effective even in developing countries. Indeed, at the same AIDS conference that Bush politics on AIDS were blamed for their focus on abstinence, the Ugandan President Yoweri Museveni remarked on the success of their programme,2He Yoweri Kaguta Museveni. XV International Conference on AIDS and STDs on Political Commitment and Accountability. Bangkok, Thailand. July 12, 2004.Google Scholar which involves encouraging individuals to delay sexual intercourse (abstinence), reduce casual sex, and increase their use of condoms.3US Agency for International Development What happened in Uganda? A case study. USAIDS, Washington2003http://www.usaid.gov/our_work/global_health/aids/Countries/africa/uganda_report.pdfGoogle Scholar The reduction in HIV prevalence in Uganda has been remarkable, and is clearly associated with changes in sexual behaviour. The achievements of Uganda's comprehensive programme have been compared with those that might have been obtained with an HIV vaccine with 80% effectiveness.4Stoneburner RL Low-Beer D Population-level HIV declines and behavioral risk avoidance in Uganda.Science. 2004; 304: 714-718Crossref PubMed Scopus (363) Google Scholar Comparison of changes in lifestyles in Uganda with those of neighbouring countries indicates that sexual partner reduction, more than condom use, has been of paramount importance in curbing the HIV epidemic.4Stoneburner RL Low-Beer D Population-level HIV declines and behavioral risk avoidance in Uganda.Science. 2004; 304: 714-718Crossref PubMed Scopus (363) Google Scholar Simplistic criticism of A-B-C strategies, based on moral or ideological grounds rather than science, should be avoided. This approach has had impressive results in the only country where it has been implemented. So, why should it not be tested in other countries? Make no mistake, those sociocultural determinants (such as forced intergenerational sex) that make abstinence difficult,1The Lancet Is it churlish to criticise Bush over his spending on AIDS?.Lancet. 2004; 364: 303-304Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar are the same determinants that make condom use difficult; women's empowerment is crucial.