Was the “ABC” Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda's Decline in HIV?

Background to the debate: Uganda is one of the few African countries where rates of HIV infection have fallen, from about 15 percent in the early 1990s to about five percent in 2001. At the end of 2005, UNAIDS estimated that 6.7 percent of adults were infected with the virus. The reasons behind Uganda's success have been intensely studied in the hope that other countries can emulate the strategies that worked. Some researchers credit the success to the Ugandan government's promotion of “ABC behaviors”—particularly abstinence and fidelity. Uganda receives funds from the United States President's Emergency Plan for AIDS Relief, which promotes the ABC approach with a focus on abstinence-driven public health campaigns. Other researchers question whether the ABC approach was really responsible for the decline in HIV infection. Critics of the ABC approach also argue that by emphasizing abstinence over condom use, the approach leaves women at risk of infection, because in many parts of the world women are not empowered to insist on abstinence or fidelity.

[1]  Peer education and HIV/AIDS: Past experience, future directions , 2000 .

[2]  D. Halperin,et al.  Sexual behavior HIV and fertility trends: a comparative analysis of six countries. Phase I of the ABC study. , 2003 .

[3]  N. Hearst,et al.  Condom promotion for AIDS prevention in the developing world: is it working? , 2004, Studies in family planning.

[4]  S. Becker Couples and reproductive health: a review of couple studies. , 1996, Studies in family planning.

[5]  Orc Macro Uganda Demographic and Health Survey 2000-2001 , 2001 .

[6]  Jonathan Cohen,et al.  The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda , 2006, Reproductive health matters.

[7]  Orc Macro,et al.  Enquête démographique et de santé : Rwanda 2005 , 2006 .

[8]  C. Sobritchea,et al.  Exploring the realities of HIV/AIDS-related discrimination in Manila, Philippines , 2005, AIDS care.

[9]  S. Watkins Navigating the AIDS Epidemic in Rural Malawi , 2004 .

[10]  F. Leach Gender, education and training: an international perspective. , 1998, Gender and development.

[11]  J. Odwee,et al.  Has the HIV/AIDS epidemic changed sexual behaviour of high risk groups in Uganda? , 2003, African health sciences.

[12]  Unaids Aids,et al.  Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections , 2004 .

[13]  Orc Macro,et al.  Tanzania HIV/AIDS Indicator Survey 2003-04 , 2005 .

[14]  Uganda. Uganda Demographic and Health Survey 1995 , 1996 .

[15]  Jacquelyn C. Campbell,et al.  Ending Violence against Women , 2010 .

[16]  P. Ghys,et al.  Trends in antenatal HIV prevalence in urban Uganda associated with uptake of preventive sexual behaviour , 2006, Sexually Transmitted Infections.

[17]  Emmanuel M. Kaijuka Uganda demographic and health survey , 1989 .

[18]  H. Gayle,et al.  The time has come for common ground on preventing sexual transmission of HIV , 2004, The Lancet.

[19]  David P. Wilson,et al.  Partner reduction and the prevention of HIV/AIDS , 2004, BMJ : British Medical Journal.

[20]  A. Gage,et al.  Factors associated with self-reported HIV testing among men in Uganda , 2005, AIDS care.

[21]  Cohen Sa Promoting the "B" in ABC: its value and limitations in fostering reproductive health. , 2004 .

[22]  V. Nantulya,et al.  Uganda's HIV Prevention Success: The Role of Sexual Behavior Change and the National Response , 2006, AIDS and Behavior.

[23]  E. M. Murphy Being born female is dangerous for your health. , 2003, The American psychologist.

[24]  Zimbabwe,et al.  Zimbabwe Demographic and Health Survey 1994 , 1989 .

[25]  J. Csete Policy paralysis: a call for action on HIV / AIDS-related human rights abuses against women and girls in Africa. , 2003 .

[26]  J. Leslie,et al.  Female Nutritional Status across the Life-Span in Sub-Saharan Africa. 1. Prevalence Patterns , 1997 .

[27]  Johanna Bockman,et al.  United Nations High Commissioner for Refugees (UNHCR) , 2003 .

[28]  M. Glanz Rethinking AIDS Prevention: Learning From Successes in Developing Countries , 2005 .

[29]  M. Gupta Selective Discrimination against Female Children in Rural Punjab, India , 1987 .

[30]  S. Declich,et al.  A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife. , 2006, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[31]  M. Greene,et al.  Men and reproductive health programs: influencing gender norms. , 2003 .

[32]  E. Marseille,et al.  HIV/AIDS in Uganda , 2003 .

[33]  J. Kaboggoza,et al.  Uganda country report. , 2003 .

[34]  H. Gayle,et al.  Partner reduction is crucial for balanced “ABC” approach to HIV prevention , 2004, BMJ : British Medical Journal.

[35]  Daniel Low-Beer,et al.  Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda , 2004, Science.

[36]  B. D. Miller,et al.  Social class, gender and intrahousehold food allocations to children in South Asia. , 1997, Social science & medicine.

[37]  Kenya.,et al.  Kenya Demographic and Health Survey 2008-09 , 2004 .

[38]  N. Stromquist Women in the Third World : an encyclopedia of contemporary issues , 1998 .

[39]  Malawi,et al.  Malawi Demographic and Health Survey 2004 , 2001 .

[40]  B. Agarwal Gender and command over property: A critical gap in economic analysis and policy in South Asia , 1994 .

[41]  P. Spiegel,et al.  AIDS, conflict and the media in Africa: risks in reporting bad data badly , 2005, Emerging themes in epidemiology.

[42]  W. Wakabi Condoms still contentious in Uganda's struggle over AIDS , 2006, The Lancet.

[43]  D. Kennedy Twilight for the Enlightenment? , 2005, Science.