0.3 Sexuality/personal relationships  (Page 4/4)

Balancing and Targeting a Comprehensive ABC Approach

A USAID-funded review of data finds the need for appropriately balanced and targeted ABC approaches. This study hasanalyzed 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 multiplesexual partnerships occurred in Uganda and Zambia during the 1990s, while comparable changes appear not to have occurred in Cameroon, Kenya, orZimbabwe. Condom use increased greatly in all of the countries.

In September 2002, USAID hosted a meeting of technical experts from HIV/AIDS programs and research institutions to consider theevidence regarding ABC behavior change approaches to HIV prevention. The meeting identified areas of consensus that may have importantimplications for program planning and decision making:

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, balancedABC 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 interventionspromoting 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 stilllargely confined to high-risk populations, in which correct and consistent condom use is relatively easy to implement. In many Africancountries, the epidemic is more generalized and thus requires an appropriate mix of A, B, and C approaches.

Continuing studies are needed. Continuing studies in other countries will yield more evidence of the most effective balance ofABC approaches in different settings. Senegal, for example, has achieved Uganda-like behavior change with a balanced ABC program in alow-prevalence setting. Further study of such successes is needed to consider their potential application elsewhere.

The a-b-c approach: abstinence

Abstinence means avoiding sex. Sex can have different definitions for different people. Some people define sex aspenis-in-vagina intercourse. Others may include oral sex, anal sex, or even kissing and touching. The way you define "sex" determines whatactivities to avoid if you want to abstain. For the purpose of this page, we will focus on abstaining from penis-in-vagina intercourse because thegoal of these materials is to help you prevent pregnancy.

Please remember that it's OK to go through periods of your life, or periods of time within a single relationship, in which you wantto abstain and periods in which you want to have sex. The decision to have sex is YOUR decision, each and every time.

Advantages:

• Abstinence is free and available to everyone.
• It's extremely effective at preventing both pregnancy and infection.
• It can be started at any time in your life.
• Abstinence may encourage people to build relationships in other ways.
• It may be the course of action which you feel is right for you and makes you feel good about yourself.

The a-b-c approach - be faithful

To "B-e Faithful" as a means of AIDS prevention means to remain loyal to one's sexual partner. By doing such, one lowers the risk ofexposure to HIV-infected individuals. By choosing to remain in a faithful, committed relationship each partner is choosing to be exclusive and onlyhave sexual intercourse with one another. Thus, if you choose to be sexually active, rather than to abstain from sex, being faithful to your sexulpartner is the next step in the ABC prevention plan as a way to reduce the risk of transmitting HIV.

The a-b-c approach: condoms

Studies have shown that latex condoms are highly effective in preventing HIV transmission when used consistently andcorrectly. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexualrelationships with HIV-infected people. The studies found that even with repeated sexual contact, 98-100 percent of those people who used latexcondoms correctly and consistently did not become infected.

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