As easy as ABC? Primary prevention of sexually transmitted infections
- Correspondence to: Dr T Stammers Department of General Practice, St George’s Hospital Medical School, Cranmer Terrace, London SW17, UK; tgstammersdoctors.org.uk
Uganda’s ABC programme has led to dramatic decreases in HIV infection rates for over a decade. No country in the world has seen its HIV incidence fall through condom promotion alone. Changes in primary sexual behaviour are always present when HIV rates decline. Safer sex is first about partner choice and then condom use, but both are important. There are valid criticisms of the ABC approach but its critics and proponents alike should work together if the Ugandan success is to be maintained and replicated in other countries.
In this issue, Genuis and Genuis draw renewed attention to the success of the ABC strategy (abstinence, being faithful, condom use) in reducing HIV infection rates in Uganda. They suggest that this approach will provide “an adaptable framework for …STD prevention programmes in other nations”.1
Although initially, there was much debate about the reality of the Ugandan success, few now dispute the overwhelming evidence showing both the extent and duration of the reduction of HIV infection.2 HIV prevalence in Uganda declined from 21.1% to 9.7% from 1991 to 1998 across 15 antenatal clinics, with the greatest declines among the younger age groups. In 21 year old army recruits, the decline was from 18.5% to 4% (1991–2002) and among blood donors, HIV prevalence fell from 24% to 7% (1989–1998).3 While there was some geographical variation, HIV prevalence fell in both urban and rural areas and in both men and women.
There also continues to be a decline in the incidence of HIV in Uganda with a 37% decrease in HIV-1 incidence between the years 1995–99 compared with 1990–94 in a recently reported study.4 As incidence is a better measure of the future trends of the disease than prevalence, it seems probable that Ugandan HIV rates will continue to decline …
