Beyond ABC: Newer
Approaches to Preventing HIV/AIDS
Hi, my name is
[PRESENTER NAME]. IÕm [PRESENTER ROLE]. Welcome to ÒBeyond ABC: Newer
Approaches to Preventing HIV/AIDS.Ó
For many years,
governments and non-governmental organizations have promoted an ÒABCÓ approach
to preventing HIV/AIDS. ÒABCÓ stands for Abstain from sex until marriage, Be
faithful to a single partner, and use a Condom every time you have sex. ThatÕs
all certainly good advice, and if we can get more people to follow it, we will
reduce the spread of HIV, the virus that causes AIDS.
But is ABC the whole
story? Is it the best we can do? ABC has some known limitations. This video
discusses those limitations and additional things we can do to prevent the
spread of HIV.
One problem with ABC
is that it assumes that a person has control over their own body and the
ability to get help if their rights are violated. Obviously, if a person is in
a culture where they do not have equal rights, they may not be able to follow
the ABC guidelines. This often happens to women in cultures where gender
inequality is the norm. For example, women may contract HIV through rape,
marital rape, or their husbandÕs infidelity. Women may be unable to flee an
abusive marriage for fear of poverty and starvation or of losing their
children. These problems are discussed in more detail in our video called
ÒEnding Gender Inequality: A Key to Stopping HIV.Ó
Because of these
realities, a broader acronym was recently developed called S.A.V.E.[1]
This means Safer practices, Access to antiretroviral medications, Voluntary
counseling and testing, and Empowerment/Education. LetÕs talk about what each
one of these things mean.
ÒSafer practicesÓ includes
some parts of the ABC message. For example, choosing abstinence until marriage,
being faithful to a single partner, and using a condom every time you have sex
are all examples of safer practices that are better than alternatives like
unprotected sexual activity. However, SAVE recognizes that ABC isnÕt a message
that is helpful to women and girls who arenÕt able to control whether they have
sex, who they have sex with, under what conditions they have sex, whether
condoms are used, and whether their partner is honest with them about their
fidelity.
ÒAccess to AIDS
medicationsÓ recognizes that for people who are already HIV positive or for
risk reduction of the HIV negative partner of those already positive, itÕs
crucial that AIDS medications (known as antiretroviral medications, or ARVs for
short) be made readily available to all who need them. Making AIDS medications readily
available is critical to stopping the spread of HIV. People treated with AIDS
medications have lower viral loads, are less infectious, and are therefore only
one twenty-fifth as likely to transmit HIV to others.[2]
Voluntary counseling
and testing recognizes that all people in every country must have access to
counseling and be encouraged to get counseled in the modes of transmission of
HIV. Additionally, it recognizes that
all people must have access to testing.
If everyone were aware and educated about how HIV is transmitted, with
additional focus on stigma reduction and testing with universal access to AIDS
medication and nutrition, it would be a great step forward for HIV prevention.
Reducing HIV stigma
will in turn make individuals more willing to be tested. When testing is
available but treatment is not, people are unlikely to seek testing because
they see possible negative consequences such as stigma, discrimination, and
domestic violence if they receive a test result of "HIV positive" but
no benefits. When people know that if they are HIV positive they can get
treatment that will prolong their life, they are more likely to seek testing.
ÒEducation/EmpowermentÓ
recognizes that awareness and knowledge, combined with the ability to act on it,
reduces the spread of HIV/AIDS. People need education about HIV so they
understand how it is transmitted, how to reduce their risk, how and why to get
tested, and that there is treatment. Broad-based education is also necessary to
reduce cultural stigma about HIV. But education alone is not enough. Education wonÕt help you if you donÕt
have control over whether you have sex, with whom, and on what terms.
Education/Empowerment
is also part of another ÒBeyond ABCÓ approach known as ÒDEFÓ for Disclosure in
safety, Education/empowerment, and Female-controlled prevention methods.[3]
LetÕs discuss
Disclosure and Female-controlled prevention methods in detail.
Disclosure in Safety
Women in particular
often fear that if they disclose their HIV-positive status to their partner or
husband, they may suffer harm as a result. They fear consequences like domestic
abuse, being ejected from the household, losing their children, being
ostracized in their community, losing their job, and loss of family
support—even if they were faithful to their husband and infected by him!
Steps like training police and law enforcement officials on the links between
HIV/AIDS and domestic violence, ensuring that there is a functioning legal
system people have confidence in, and providing shelters for women who fear
domestic violence can all help create an environment that enables disclosure in
safety.
Female-Controlled
Prevention Methods
The condom is the
most effective tool we have for preventing HIV transmission during sexual
activity such as vaginal, oral, and anal sex. Unfortunately, a condom canÕt be
used without the manÕs knowledge and cooperation. This means that a woman who
is in a sexual relationship with a man who refuses to use a condom is unable to
use the most effective barrier method to protect herself from infection. It would be a great step forward if
there were proven female-controlled methods for reducing the risk of HIV
transmission. Scientists are currently studying whether technologies such as
microbicides are effective for preventing HIV transmission.[4]
Medically Performed
Male Circumcision (With Counseling)
Tests in 2005 and
2006 showed that medically performed male circumcision with counseling is a
safe and effective way of reducing a manÕs risk of contracting HIV through
heterosexual intercourse.[5] Tests in
Uganda, Kenya, and South Africa showed that medically performed male
circumcision with counseling reduced a man's risk of contracting HIV by half or
more. It is important to note that these tests only proved that men would be at
lower risk of contracting HIV through heterosexual sex. It has not been proven
whether there is a risk reduction for a manÕs female partner and if so, how
much. It is also unknown whether circumcision reduces the risk of HIV
transmission during anal sex between men. Circumcision is definitely no
guarantee against HIV infection and is no substitute for safer practices like
using a condom. Circumcised men must continue to use condoms just like
uncircumcised men for their own protection and for the protection of their
partner. However, medically performed male circumcision, accompanied by
appropriate counseling about the need for continued safer sex practices, is
clearly one more tool we can use to slow the spread of HIV, particularly in
areas such as Africa where there is a heterosexual epidemic of HIV and access
to condoms can be limited.
Significantly
slowing the spread of HIV will require not only the ABC approach, but also
additional methods such as the ones we have discussed in this video. By
focusing on testing and access to AIDS medications, education and empowerment
to those at risk, and the use of newer methods and techniques to reduce
transmission, we will help prevent the further spread of HIV/AIDS. This is
[PRESENTER NAME].
This script was reviewed for accuracy and
approved by Becky Kuhn, M.D. on July 30, 2011.
References:
"Christian
AidÕs HIV unit replaces ABC with SAVE in its comprehensive HIV
programmes." 21 March 2006 news release from Christian-Aid.org.uk.
http://www.christian-aid.org.uk/news/media/pressrel/060321p.htm
Fleishman, Janet.
ÒBeyond ÔABCÕ: Helping Women Fight AIDS.Ó Commentary. 29 June 2004 Washington
Post p. A23.
http://www.washingtonpost.com/wp-dyn/articles/A13501-2004Jun28.html
Jha, Alok.
"Taking prevention of AIDS beyond ABC: British doctors lead European
search for microbicides to stop transmission of HIV." 22 March 2004
Guardian. http://www.guardian.co.uk/uk_news/story/0,3604,1174871,00.html
McNeil, Donald G.,
Jr. "Early H.I.V. Therapy Sharply Curbs Transmission." 12 May 2011
New York Times. http://www.nytimes.com/2011/05/13/health/research/13hiv.html.
Accessed 25 July 2011.
National Institute
of Allergy and Infectious Diseases. "Adult Male Circumcision Significantly
Reduces Risk of Acquiring HIV." 31 December 2006 news release.
http://www.nih.gov/news/pr/dec2006/niaid-13.htm
[1] Christian-Aid.org.uk, "Christian AidÕs HIV unit replaces ABC with SAVE in its comprehensive HIV programmes," 21 March 2006 news release. http://www.christian-aid.org.uk/news/media/pressrel/060321p.htm
[2] McNeil, Donald G., Jr. "Early H.I.V. Therapy Sharply Curbs Transmission." 12 May 2011 New York Times. http://www.nytimes.com/2011/05/13/health/research/13hiv.html. Accessed 25 July 2011.
[3]Janet Fleishman, ÒBeyond ÔABCÕ: Helping Women Fight AIDS,Ó Commentary, 29 June 2004 Washington Post p. A23. http://www.washingtonpost.com/wp-dyn/articles/A13501-2004Jun28.html
[4]Alok Jha, "Taking prevention of AIDS beyond ABC: British doctors lead European search for microbicides to stop transmission of HIV," 22 March 2004 Guardian. http://www.guardian.co.uk/uk_news/story/0,3604,1174871,00.html
[5] National Institute of Allergy and Infectious
Diseases, "Adult Male Circumcision Significantly Reduces Risk of Acquiring
HIV," 31 December 2006 news release.
http://www.nih.gov/news/pr/dec2006/niaid-13.htm