Personal ViewHIV/AIDS: sex, abstinence, and behaviour change
Section snippets
The failure of prevention in Africa
Current HIV seroprevalence maps for Africa (figure)1 demonstrate the failure of prevention programmes. This failure is so for the entire continent south of the Sahara, with the possible exceptions of Uganda and Senegal, for reasons that remain unclear and are much debated.
Abstinence and ABC
Here, we propose a way in which rational engagement with the question of abstinence as an intervention may be reformulated to improve the understanding of a complex scientific and ideological area of debate, opening the way for a new appraisal of how to take forward the vital question of prevention in African—and other—contexts. Recent reports from Uganda suggest that AIDS policy there is being trimmed to fit with viewpoints consistent with those often described in the USA as “the Christian
What was ABC in practice?
The ABC terminology has recently been thoroughly discussed by authors such as Edward Green.5 Green draws heavily on the Ugandan experience, claiming that condom use did not feature in the early years of the Ugandan response to HIV. That conclusion is supported by earlier work from Low-Beer and Stoneburner,7, 8 which re-examined the results of two behavioural surveys conducted in 1989 and 1995 in Uganda, and compared findings with experience in other African nations. The authors state the
Misusing the ABC message
Today, however, some groups and funders are invoking ABC to give credence to very specific and limited prevention messages. In particular, the Bush administration has invoked the Ugandan success to justify an ABC approach. It has been criticised by Human Rights Watch,13 and others,3, 14, 15 for promoting unproven abstinence programmes at home and abroad, including in Uganda, from whom the USA has supposedly learned so much, and where observers now fear there may be a growing restriction on the
The meaning of “sex”
A recent survey of US adolescents showed that many of them did not consider oral sex as “sex”.20 This finding has been confirmed by a number of other studies.21, 22, 23 The importance of this finding is twofold. First, it underlines that the cultural meanings of sex cannot be assumed to be the same in different societies and social groups, or even between subgroups of the US population. Second, the social and economic context within which sex occurs may influence perceptions of risk and
Linking sex, behaviour, and context
It is likely that in harsh conditions, whether in Africa or elsewhere, transactional survival sex is likely to be more common.24, 33, 34 By contrast, a very simple view of sex has driven prevention agendas since the beginning of the epidemic. Standard public-health prevention theory has been based on the assumption that education leads to rational behaviour change. However, an approach focusing on education alone and on an expectation of individual behavioural responses may not be appropriate
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Cited by (60)
Multilevel determinants of teenage childbearing in sub-Saharan Africa in the context of HIV/AIDS
2017, Health and PlaceCitation Excerpt :For example, the apparent relationship between socio-economic development and teenage childbearing outlined above is likely to vary by HIV/AIDS context. Furthermore, HIV prevention strategies, including the ABC campaign, that have been adopted in various SSA countries to curb the spread of HIV (Barnett and Parkhurst, 2005; Parikh, 2007; Coates et al., 2008) are likely to influence teenage childbearing and HIV risk in different ways. While delayed sexual debut or abstinence (A) and use of condom (C) will reduce risk of both HIV and pregnancy, being faithful (B) or reduction of multiple casual partners may not necessarily reduce teenage pregnancy risk, especially if this leads to committed relationships or early marriage (Duflo et al., 2014) in the absence of contraceptive use.
Millennium development goals and women's reproductive health and justice in African countries in the era of global neoliberalism, neoconservatism and fundamentalism
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2021, International Journal of Environmental Research and Public HealthThe Religion-Gender Nexus in Development: Policy and Practice Considerations
2021, The Religion-Gender Nexus in Development: Policy and Practice ConsiderationsDevelopment, sexual cultural practices and HIV/AIDS in Africa
2018, Development, Sexual Cultural Practices and HIV/AIDS in Africa