The most effective strategies come from within communities

In an era of increasingly complex HIV/AIDS analyses and responses, Shelton et al reaffirm the simple truth that without multiple sexual partnerships, an HIV epidemic would not occur and that by extension partner reduction is the most obvious, yet paradoxically neglected, approach to the prevention of HIV (p 891).1 They note that in the ABC model for preventing AIDS/HIV (abstinence, or deferred sexual inception—A, be faithful, or partner reduction—B, and condom use—C), sexual deferral and condom use have persuasive advocates but partner reduction does not.

Their analysis of the vital part played by partner reduction in reducing HIV infection in Western gay communities, Uganda, and Thailand is timely. We face a crisis in HIV prevention. The successes in Uganda and Thailand occurred 15 years ago, and in the intervening period no national declines of similar clarity or scope have occurred. Similarly, in HIV prevention research, the heady days of the Mwanza sexually transmitted infections trial were succeeded by the disappointing findings (albeit explicable) in the more ambitious Rakai sexually transmitted infections trial, the Masaka triplet IEC (information, education, and communication) and sexually transmitted infections trial, and most distressingly, the recent Mwanza adolescent trial.2^–5 Shelton et al's analysis may help …