What is the ABC model of HIV prevention?
The ABC approach to HIV/AIDS prevention in its basic form suggests that public health work in prevention, education, and health promotion around HIV transmission should take a three pronged approach, emphasizing abstinence, monogamy, and condom use.Definitions of the ABC approach vary. There are at least two different definitions of the ABC approach, and the differences are crucial.
UNAIDS defines ABC as including information on:
- Abstinence or delaying first sex
- Being safer by being faithful to one partner or by reducing the number of sexual partners
- Correct and consistent use of condoms for sexually active young people, couples in which one partner is HIV-positive, sex workers and their clients, and anyone engaging in sexual activity with partners who may have been at risk of HIV exposure.
The President's Emergency Plan for AIDS Relief (PEPFAR) which legally requires adherence to an ABC model, defines ABC as:
- Abstinence for youth, including the delay of sexual debut and abstinence until marriage
- Being tested for HIV and being faithful in marriage and monogamous relationships
- Correct and consistent use of condoms for those who practice high-risk behaviors.
The crucial difference in these definitions is that the US definition does not allow information about condom use for young people, or to anyone who isn’t identified as practicing “high-risk” sexual behaviors.
Do ABC models work to prevent HIV transmission?
This is a difficult question to answer with any certainty. ABC is just a catch phrase, and most programs include information on abstinence, monogamy, and condom use. Every ABC program is slightly different.Those who claim that the ABC model works often point to the success of HIV prevention in Uganda in the 1990s.
As a result of progressive leadership, there was a broad and powerful response to the spread of HIV in Uganda. The government started and supported programs that included public awareness media campaigns, training teachers to provide HIV/AIDS education, and getting community leaders and religious leaders involved in the spread of information and education about HIV/AIDS. They didn’t stop there. They encouraged a variety of social initiatives including bettering the status of women, fighting stigma of HIV, improving testing facilities across the country, and providing better care for people already infected. Importantly, there was also a dramatic increase in the distribution and use of condoms. The result was a decrease in HIV transmission rates.
While it is impossible to give the credit to any one of these initiatives, it seems clear that a broad and multi-faceted approach to HIV prevention can have a positive impact on transmission rates.
According to Avert, a UK based HIV/AIDS charity, there is no evidence to suggest that the term “ABC” was ever used in Uganda, and the current ABC model differs in significant ways from the Ugandan approach.
