Ugandan Official Says Abstinence Is Top Anti-AIDS Strategy
July 9, 2008 - 5:45 AMA Ugandan health official is challenging popular conceptions that his continent’s devastating AIDS pandemic can only be solved through increased use of condoms.
In the face of worldwide efforts to combat AIDS in Africa with contraceptives and treatment, the head of Uganda’s National AIDS Prevention Committee, the Rev. Sam Ruteikara, said worldwide efforts to combat AIDS in Africa with contraceptives are not as effective as the strategy that Uganda in particular has used successfully: the ABC Plan.
ABC stands for “Abstain, Be faithful, or use Condoms (as a last resort.)” The main message of the campaign, said Ruteikara, is for individuals to “stick to one partner,” and that condoms should only be promoted as a last resort.
Under the ABC program, the proportion of Ugandans infected with AIDS and HIV plunged from 21 percent in 1991 to just 6 percent in 2002.
“(The ABC Plan advocates) telling men and women to keep sex sacred,” Ruteikara wrote in a column in the June 30 Washington Post.
“To save sex for marriage and then remain faithful is telling them to love one another deeply with their whole hearts,” he added. “Most HIV infections in Africa are spread by sex outside of marriage: casual sex and infidelity. The solution is faithful love.”
Though some AIDS experts, including some international pharmaceutical suppliers, maintain that African sexual behavior simply cannot be changed, Ruteikara rejects that assertion as “too broad and oversimplified.”
“If the share of men having three or more sexual partners in a year drops from 15 percent to 3 percent, as happened in Uganda between 1989 and 1995, HIV infection rates will plunge. It is that simple,” he said.
Dr. James Chin, a clinical professor of epidemiology at University of California at Berkeley, however, questioned Ruteikara’s assertions.
While simple statistics show a decline in Uganda’s HIV infections after the implementation of its ABC program, Chin told Cybercast News Service that he thinks the success of abstinence in reducing AIDS in Uganda “has been overrated,” and that abstinence alone cannot drive down rates of the epidemic
“I’m not saying what they did was not effective in preventing a lot of HIV infections, but I think the situation in Uganda was reaching a sort of natural peak around ’86 and ’87, and that’s when they instituted their program [ABC],” Chin said.
“The program may have blunted the epidemic a little bit, but I don’t think they can take full credit for the subsequent decline,” he added.
Chin also believes that abstinence alone is not effective in certain situations.
“In Southeast Asia where commercial sex is a problem, abstinence can be preached, but I don’t think it will have too much effect,” he said.
“If you take a look at the situation in California, we basically have no epidemic HIV transmission in the heterosexual population,” he said, “so preaching abstinence to teenagers and young adults would add very little to HIV prevention because 90-plus percent of HIV transmission in California is among men who have sex with men and inject drugs.”
Chin said abstinence needs to be combined with other strategies to work in Africa. Worldwide, he said, abstinence alone “just doesn’t make sense in terms of HIV prevention.”
Other experts say the Ugandan model should not be underestimated.
Shepherd Smith, president and founder of the Institute for Youth Development, told Cybercast News Service that the biggest predictor of the disease is the number of lifetime sexual partners.
“The more partners one has, the more risk they entail. What influences number of lifetime partners? Age of sexual debut,” Smith said.
“We should do all we can to get young people to delay sexual activity,” he said. “Just looking at it from a totally scientific perspective, you would have to say that promoting abstinence is the first and most important thing you can do. And it’s absolutely universal.”
Linda Klepacki, an analyst for sexual health at Focus on the Family Action, a conservative group, said that AIDS prevention methods should always be tailored to specific geographic areas and demographics.
Though abstinence is always a good universal message, she said, culture, mores and cultural tradition all play an important role in intervention attempts.
“Uganda was the first country to successfully decrease its AIDS rate, but these efforts were marred when the international community came in and tried to implement its own prevention campaign without an understanding of what was driving the epidemic,” Klepacki told Cybercast News Service.
“These people didn’t understand that sex between faithful life partners was a message that resounded brilliantly within the Ugandan psyche,” she said. “Instead, millions of dollars were spent in campaigns focusing on condoms and contraceptive efforts which ultimately led to an increase in their AIDS rate.”
Ruteikara echoed that sentiment, adding that the international AIDS experts were “wrong” but “had the financial power to force their casual sex agendas upon us.”
"In the fight against AIDS, profiteering has trumped prevention,” he said. “AIDS is no longer simply a disease; it has become a multi-billion dollar industry."