African HIV activists want a new model for prevention

Morality isn't enough

ABC is not without its supporters. According to UNAIDS, HIV prevention programs are working. The agency says its 2010 report confirmed that new HIV infections have declined in the past 10 years, and this decline is clearly linked with changes in behavior, along with increased knowledge of HIV, both attributable to ABC. 

Even so, UNAIDS admits, "existing prevention efforts suffer from numerous common weaknesses."

“With two new HIV infections occurring for every individual started on antiretroviral treatment, strengthening HIV prevention remains an urgent global health priority,” UNAIDS said in a statement. But the greatest weakness is that national programs are so often unfocused and poorly planned.  

“National prevention programs are too often made up of a collection of disconnected interventions, and these often lack clear milestones, clearly articulated causal pathways and clear connections with other programs that contribute to achieving the same prevention targets," the statement continues. “Weak investments in joined-up planning, monitoring, and evaluation systems reduce decision makers​’ confidence in existing prevention tools and prevent program planners and implementers from improving prevention efforts over time”

In Byagumisha's eyes, achieving the UN goal of zero new infections, zero discrimination, and zero AIDS-related death will require a comprehensive strategy that addresses HIV in its entirety. 

ABC's flaw, the cleric says, is that it takes a moral and sexual approach only – a deadly approach in African cultures where stigma, shame, denial, discrimination and inaction are all too common reactions – and doesn't teach people the multiple strategies that can prevent the spread of HIV. 

“Abstinence, for example, [also] needs condom use, safe blood, safe circumcision, microbicide, vaccines and so forth,” he says.

“ABC is somehow inaccurate because it seems to portray that once you are faithful you don’t get HIV," Byagumish says. "Yet we know there are very faithful people, there are people who are virgins at marriage, who end up being positive. This means that faithfulness is not safeness.”

Combatting the stigma

Mohammed Karama, an epidemiologist at the Kenya Medical Research Institution, says ABC also fails to create incentives for prevention, such as testing; care and treatment for infected people; and empowering the groups working to counteract the epidemic.

“There is a need for a non-stigmatizing approach that includes everyone," says Mr. Karama. "This will strengthen the efforts against the epidemic. That’s why we have been saying we need to reconsider ABC.” 

Because of the stigma – that HIV/AIDS is the disease that one get from “stealing sex" – many have not taken an HIV test, activists say.

“Many people would like not to know their HIV status. We know nearly 60 percent do not know their statuses and that needs to worry us," says Harriet Kongin, head of stakeholders coordination at Kenya’s National AIDS Control Council. "When we talk about prevention, we are saying there are very few of us who have tested and those who have tested are then aware of what needs to be done, but then what happens to that other 60 percent.” 

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