Low and middle income countries must do more to prevent spread of AIDS, experts say

The "ABC" approach (Abstinence, Being Faithful, using
Condoms) has been promoted as the cornerstone of prevention
activities. Some authors have argued that this approach was
credited for the decline in HIV infection rates in Uganda.
Others have criticized this approach saying that too
much emphasis is put on "A" (Abstinence)rather than on "C"
(Condom use).

If one considers "B" (being faithful) as a part of this
strategy, a simple question such as "would being faithful to
a HIV-positive partner prevent one from being infected?".
This question is not asked in order to negate the noble
value of fidelity, rather to point out that something is
missing. The missing link is a "T" (Testing). It makes sense
to B(e) faithful to partner who is HIV-negative. The only
way to be sure of this is to go for testing.

Moreover, if one considers "C", the emphasis has been on
supplying condoms in order to make them available and
accessible. Yet despite their availability, condoms are
still very much less used by the people most at risk. The
underlying factors responsible for this low usage have not
been adequately addressed. The message out there is still
"condomize", but nothing new has been introduced for over a
decade.

It is for this reason that "L" (Loving, Love) is needed as
part of the new approach. Condom use should be advertised as
a show of love, a proof that if one does not know his/her
status, using condom means genuinely expressing concern for
the partner. Hence, the messages on the actual wearing of
condoms should move from "banana demonstrations" to getting
the message that wearing a condom is an act of love, a proof
of a shared responsibility, a loving experience.

In conclusion, the "more" that developing countries should
do is (1) to invest heavily in VCT (voluntary ,
counselling, and testing) or better in HCT
(health,counselling, and testing); (2) to innovate in terms
of HIV prevention and or health promotion messages that are
sent out there. Together they make "TABCL" (as "Thabsile", a
common girl's name in Southern Africa)

References

Bob Roehr. Low and middle income countries must do more to
prevent spread of AIDS, experts say
BMJ 2009; 339: b4739 [Full text]

Murphy EM et al. Was the "ABC" approach responsible for
Uganda's decline in HV? Plos Medicine Sept 2006;3(9):e379

Peterman, T.A., Tian, L.H., Warner, L., Satterwhite, C.L.,
Metcalf, C.A., Malotte, K.C., Paul, S.M., Douglas, J.M. & Respect -2
Study Group, (2009) Condom use in the year
following a sexually transmitted disease clinic visit.
International Journal of STD & AIDS. 20:9-13.

Competing interests:
None declared