*EPF106 07/12/2004
AIDS Conference Participants Debate "ABCs" of AIDS Prevention
(Condoms alone cannot ensure prevention, researchers say) (680)

By Charlene Porter
Washington File Staff Writer

Bangkok, Thailand -- Thousands of delegates from every continent have come together for the XV International AIDS Conference, being held for the first time in its almost 20-year history in Southeast Asia. At this July 11-16 meeting, conferees are united in the belief that the AIDS epidemic is among the most devastating plagues ever visited on humankind.

Beyond that point, however, unity dissolves and delegates find themselves sharply divided. The 17,000 delegates representing AIDS scientists, clinicians, activists and policy-makers have widely divergent views on how to fight the epidemic, how to prevent its spread, and how to provide more treatment and care to people living with AIDS.

One controversial issue at this session of a conference organized biennially by the International AIDS Society is the so-called ABC approach to AIDS prevention. Adopted as a central principle of the U.S. plan to provide emergency AIDS assistance to 15 countries and modeled on a strategy developed in Uganda, ABC stands for "abstinence, be faithful, and use condoms."

Critics of the U.S. policy say that the strategy is ideologically based, attempting to export a conservative view about sexuality. The U.S. Agency for International Development (USAID), one of the frontline agencies implementing ABC, brought together a panel of outside experts July 11 to present the case that the three-point ABC approach is more effective than the distribution and promotion of condoms as a single strategy alone.

Leading the discussion, USAID's Dr. E. Anne Peterson said, "We are trying to take a database approach to something that has become quite political."

The panel included two social researchers who have studied the effectiveness of prevention programs. Douglas Kirby of ETR Associates, who has studied prevention strategies in Africa, said, "There is no single silver bullet."

Norman Hearst of the University of California, San Francisco, has investigated the implementation of condom-promotion programs internationally and reported that a variety of studies averaged together give condoms an 85 percent effectiveness rate in preventing disease. However, those studies are conducted in controlled situations, among motivated subjects such as "discordant couples," that is, couples in which one partner is HIV-positive and the other is not.

"We won't get that scale [of effectiveness] in a real-world situation," Hearst said.

Uganda is among the most frequently studied nations because of its success in controlling an escalating HIV-infection prevalence in the early 1990s. Uganda adopted the ABC approach and achieved a significant decline in HIV prevalence, from a peak of around 15 percent to 5 percent by 2001.

"The three strategies complement each other; they are evolving and dynamic," said Samuel Okware of Uganda's Ministry of Health.

This complementary approach is what the United States is advocating in its 15 target nations of the President's Emergency Plan for AIDS Relief, said Peterson. It is "very much a balanced program" in which abstinence and faithfulness are advocated to promote healthy sexual lifestyles while condoms are promoted for high-risk groups.

The success of the ABC approach in Uganda was also dependent on the strong leadership demonstrated by President Yoweri Museveni, Okware said. The Ugandan chief executive spoke about the dangers of AIDS transmission and the importance of prevention in virtually every public appearance, the Ugandan health official said, and ordered all his ministers to do the same.

The panel discussion was marked by stories of success and failure in attempts to prevent transmission. Serara Mogwe, representing the University of Botswana's School of Nursing, said, "Our big mistake was placing emphasis on the ����C' [condoms] and hardly any emphasis on ����A' [abstinence] and ����B' [faithfulness to a single partner]."

Botswana has an estimated HIV prevalence rate of almost 33 percent, according to the latest global report from the Joint U.N. Programme on HIV/AIDS.

Mogwe said another reason for Botswana's ineffective AIDS prevention strategy was that the nation had adopted a program based on Western models without proper adaptation to local considerations.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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