0.3 Sexuality/personal relationships  (Page 3/4)

It is now clear that Uganda's decline in HIV prevalence followed positive changes in all three ABC behaviors: increasedabstinence, including deferral or greatly reduced levels of sexual activity by youth since the late 1980s; increased faithfulness and partnerreduction behaviors; and increased condom use by casual partners. In Uganda's particular circumstances, the most significant of these appearto be faithfulness or partner reduction behaviors by Ugandan men and women, whose reported casual sex encounters declined by well over 50 percentbetween 1989 and 1995. This conclusion is supported by comparisons with other African countries.

In addition, abstinence, deferral of sexual activity by youth, and condom use played substantial roles in reducing HIVprevalence. Uganda's successful combination of ABC approaches appears rooted in a community-based national response in which both thegovernmental and nongovernmental sectors, including faith-based organizations, succeeded at reaching different population groups withdifferent messages and interventions appropriate to their need and ability to respond. Young persons who had not yet begun to have sex werecautioned to wait. If a young person had just begun to have sex, then he or she should return to abstinence. If a person was already sexually active, he orshe should adopt the practice referred to locally as "zero grazing" - faithfulness in marriage or partner reduction outside of marriage. Forthose who could not heed this advice, free and affordable condoms were distributed and promoted.

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, thereis growing evidence from other countries as well. In Thailand, the first Asian country to face a severe AIDS epidemic, commercial sex was the mainsource of HIV infection. In the early 1990s, the government successfully instituted a "100 percent condom use" policy in commercial sexestablishments, 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. In addition to condom use, partnerreduction in Thailand undoubtedly had a substantial effect on slowing the country's HIV/AIDS epidemic. As in Uganda, the government's willingnessto address the epidemic openly was crucial.

Zambia, Cambodia, and the Dominican Republic are other countries in which various combinations of ABC behaviors havecontributed 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 othercommunity-based organizations was crucial in promoting these changes. As occurred in Uganda, the main reported change was a large decline in casualsex 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 and2000). In the Dominican Republic, partner reduction by men and increased condom use with non-regular sexual partners also appear to have slowed thespread of infection.