Partner reduction is crucial for balanced "ABC" approach to HIV prevention

doi:10.1136/bmj.328.7444.891

BMJ 2004;328:891-893 (10 April), doi:10.1136/bmj.328.7444.891

Education and debate

Partner reduction is crucial for balanced "ABC" approach to HIV prevention

James D Shelton, senior medical scientist, office of population and reproductive health¹, Daniel T Halperin, senior technical adviser, office of HIV/AIDS¹, Vinand Nantulya, senior adviser², Malcolm Potts, Bixby population professor³, Helene D Gayle, director of HIV, tuberculosis, and reproductive U⁴, King K Holmes, director⁵

¹ Bureau for Global Health, US Agency for International Development, 1300 Pennsylvania Avenue, Washington, DC 20523-3700, USA, ² Global Fund for AIDS, Tuberculosis and Malaria, Geneva, Switzerland, ³ University of California, Berkeley 94720 USA, ⁴ Bill and Melinda Gates Foundation, Seattle, WA 98102, USA, ⁵ Center for AIDS and Sexually Transmitted Diseases, University of Washington, Seattle 98104, USA

Correspondence to: D Halperin dhalp{at}worldwidedialup.net

Behaviour change programmes to prevent HIV have mainly promotedcondom use or abstinence, while partner reduction remains theneglected component of ABC

The first 150 words of the full text of this article appear below.

The key to preventing the spread of HIV, especially in epidemicsdriven mainly by heterosexual transmission, is through changingsexual behaviour. Interest has been growing in an "ABC" approachin which A stands for abstinence or delay of sexual activity,B for be faithful, and C for condom use (box).¹ Although "befaithful" literally implies monogamy, it also includes reductionsin casual sex and multiple sexual partnerships (and relatedissues of partner selection) that would reduce higher risk sex.While most of the often polarised discussion surrounding AIDSprevention has focused on promoting abstinence or use of condoms,^w1w2 partner reduction has been the neglected middle child ofthe ABC approach.

Epidemiological importance of partner reduction

It seems obvious, but there would be no global AIDS pandemicwere it not for multiple sexual partnerships. The rate of changeof sexual partners—especially concurrent partners—isa crucial determinant in the spread of sexually transmittedinfections,^w3 including HIV.² Moreover, . . . [Full text of this article]

Role in HIV prevention successes

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Other examples of partner reduction

Implications for behaviour change programmes

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