At its most recent meeting on March 29 and 30, the President's Advisory Council on HIV/AIDS (PACHA) unanimously passed a resolution urging President Bush and U.S. Department of Health and Human Services (HHS) Secretary Tommy Thompson to consider adopting the "ABC" model for HIV/AIDS-prevention campaigns in the U.S.1 "ABC" represents a three-point message for risk reduction: abstain, be faithful, use condoms.
Programs based on "ABC" are attracting a lot of attention in the international fight against HIV/AIDS, and Uganda is one of the most widely publicized examples of their success. Uganda implemented an "ABC" campaign and has experienced a reduction in HIV prevalence rates from 30 to 10.5 percent between 1998 and 2001. Uganda's current HIV prevalence is 6.2 percent.2
The suggestion to adopt an "ABC" approach is part of PACHA's on-going efforts to urge the government to do more to fight HIV/AIDS in the U.S. In a recent interview with the Washington Blade, Brent Minor, a Washington, D.C. AIDS activist and PACHA member, said, "everyone supports the global AIDS effort, and we praise the president for pushing it, but many of us also think more needs to be done to address the epidemic right here at home."
Advocates of reproductive and sexual health maintain that while it is important to demand heightened HIV-prevention efforts in the U.S., the Bush Administration appears to hold a misconstrued view of the "ABC" model. The current administration redefines "ABC" in two significant ways: by promoting abstinence as the paramount means for all people to remain sexually safe and healthy, and by failing to provide resources for information about condoms or the resources to supply condoms.
Domestically, HIV/AIDS-prevention experts criticize the Bush Administration for down-playing the need for accurate, comprehensive sexuality education and prevention programs that include information on condoms.3 Thompson has disputed this criticism, claiming that the Administration-including the Centers for Disease Control and Prevention-include condom messages in prevention programs and fund programs by private groups that promote condom use.4 The federal government, however, provides more than $140 million in funds for abstinence-only-until-marriage programs and President Bush has proposed doubling that amount in Fiscal Year 2005.
Internationally, the President's Emergency Plan for AIDS Relief: The U.S. Five-Year Strategy to Fight Global HIV/AIDS (the U.S. Strategy), which will provide grants to support HIV/AIDS prevention, treatment, and care in 14 countries in Africa and the Caribbean, ostensibly applies "ABC." The U.S. Strategy, however, presents these three equally important risk reduction strategies as a hierarchy with abstinence-only-until-marriage programs as the principal method of prevention for all people. "The Bush Administration single-mindedly focuses on the 'abstinence' component of 'ABC,' placing abstinence-until-marriage programs at the heart of the U.S. Strategy's prevention component," said Bill Smith, director of public policy at SIECUS.
The U.S. Strategy limits condom education and distribution to "high-risk" groups, i.e. "prostitutes" and "sero-discordant couples," couples in which one partner is HIV-positive and the other is HIV-negative. Advocates point out that in the countries where the U.S. Strategy will provide aid, HIV prevalence rates are so high that every sexually active person can be considered "high risk." The U.S. Strategy does not support providing information about condoms as part of a broad campaign targeting the general population.5 "The Bush Administration claims to support the 'ABC' approach when addressing HIV/AIDS in other countries," said Smith, "the U.S. Strategy, however, redefines 'ABC' by relegating condoms to the very fringes of prevention work."
Data shows that each piece of the "ABC" model must be promoted in all segments of the population in order for prevention campaigns to be effective. In Uganda, sexuality education occurs in schools, and public radio delivers information on negotiating safer sex and delaying the age at which individuals first have sex.6 Social marketing of condoms is also a component and has increased condom usage from seven percent nationwide to over 50 percent in rural areas and over 85 percent in urban areas.7
Sophia Mukasa Monico, a native Ugandan and a senior AIDS officer at the Global Health Council, testified last year to the U.S. Senate Foreign Relations Committee about "ABC" in Uganda. "I am deeply concerned when I hear people taking a single element of our successful national program, like abstinence, out of context and ascribing all of our achievement to that one element. All three elements must be implemented together in order for prevention to work" she said.8
HIV/AIDS advocates hope that PACHA's resolution will accurately portray the "ABC" model and that it will motivate the Bush Administration to support comprehensive prevention programs. PACHA's resolution also includes language about condom effectiveness, which indicates it may describe a comprehensive, uncensored version of "ABC."9
"PACHA is in a good position to define 'ABC' as it will be applied in the United States. The Administration says it wants to support evidence-based prevention programs, and the 'ABC' model, in its complete form, has proven effective," said Bill Smith.
PACHA's resolution also calls on Bush and Thompson to "exercise bold leadership in raising domestic HIV prevention awareness as a part of the strategy to reduce new HIV infections…with a long-term goal of no new infections."10
The exact text of the final resolution is not yet available to the public. According to the PACHA office, it should be posted on the website within 45 days of the meeting. SIECUS will continue to monitor the resolution and any action taken by the Bush Administration.
- L. Chibbaro Jr., "AIDS panel endorses Uganda prevention methods: Panel tables motion calling on Bush to appoint AIDS czar 'immediately,'" Washington Blade, Friday, April 2, 2004. Available on-line.
- "Uganda's HIV Prevalence Remains Stable After Years of Decline, Surveillance Report Says," Kaiser Daily HIV/AIDS Report, March 23, 2004. Available on-line.
- L. Chibbaro Jr., "AIDS panel endorses Uganda prevention methods."
- President's Emergency Plan for AIDS Relief: The U.S. Five-Year Strategy to Fight Global HIV/AIDS, pages 9,23-24. Accessed on-line. See also "Bush Praises Uganda Aids Fight," BBC News, July 11, 2003. Available online.
- "Uganda Reverses the Tide of HIV/AIDS," World Health Organization. Accessed on-line.
- "Senate Foreign Relations Subcommittee 'Praises' Uganda's 'ABC' HIV/AIDS Prevention Method at Hearing," Kaiser Daily HIV/AIDS Report, May 21, 2003. Available on-line.
- L. Chibbaro Jr., "AIDS panel endorses Uganda prevention methods."