PSI's Position on the ABC Approach

The following is excerpted from The Lancet and describes PSI's position on the ABC approach:

"The ABC (Abstain, Be faithful/reduce partners, use
Condoms) approach can play an important role in reducing
the prevalence of HIV in a generalised epidemic, as occurred in Uganda. All three elements of this approach are essential to reducing HIV incidence, although the emphasis placed on individual elements needs to vary according to the target population. Although the overall programmatic mix should include an appropriate balance of A, B, and C interventions, it is not essential that every organisation promote all three elements: each can focus on the part(s) they are most comfortable supporting. However, all people should have accurate and complete information about different prevention options, including all three elements of the ABC approach.

"Thus, when targeting young people, for those who have
not started sexual activity the first priority should be to
encourage abstinence or delay of sexual onset, hence emphasising risk avoidance as the best way to prevent HIV and other sexually transmitted infections as well as unwanted pregnancy. After sexual debut, returning to abstinence or being mutually faithful with an uninfected partner are the most effective ways of avoiding infection. For those young people who are sexually active, correct and consistent condom use should be supported. Young people and others should be informed that correct and consistent condom use lowers the risk of HIV (by about 80–90% for reported “always use”) and of various sexually transmitted infections and pregnancy, and they should be cautioned about the consequences of inconsistent use. Prevention programmes for young people in and out of school should be expanded, and parents should be supported in communicating their values and expectations about sexual behaviour.

"When targeting sexually active adults, the first priority
should be to promote mutual fidelity with an uninfected
partner as the best way to assure avoidance of HIV infection. The experience of countries where HIV has declined suggests that partner reduction is of central epidemiological importance in achieving large-scale HIV incidence reduction, both in generalised and more concentrated epidemics. People who have a sexual partner of unknown HIV status should also be encouraged to practise correct and consistent condom use and to seek counselling and testing with their partner.

"When targeting people at high risk of exposure to HIV infection (ie, engaging in commercial sex, multiple partnerships, anal sex with high-risk partners, or sex with a person known or likely to be infected with HIV or another sexually transmitted infection), the first priority should be to promote correct and consistent condom use, along with other approaches such as avoiding high-risk behaviours or partners. The identification and direct involvement of most-at-risk and marginalised populations is crucial, particularly (but not only) in more concentrated epidemics, where such populations account for a large proportion of infected people. It is also critical to expand prevention programmes designed specifically for people living with HIV/AIDS."

2004. "The time has come for common ground on preventing sexual transmission of HIV" The Lancet, 364(9449):1913-1915 Daniel Halperin et al.