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”There are not so many weapons against AIDS that we can forgo any, nor is any so effective that it makes the others superfluous.”[1]

Research shows that neither condoms alone nor abstinence-only education will bring an end to the HIV epidemic: we must take a balanced approach to educating young people about HIV and AIDS. In many developing nations, abstinence, partner-reduction, and consistent, correct use of condoms have each played a major role in successfully reducing the number of new HIV infections.

In Namibia, educating youth about condoms and safer sex led to youth postponing first sex and being more likely to use condoms when they had sex. Both abstinence and safer sexual practices were part of the educational sessions young people attended.[2]

In Kenya, the HIV rate has declined from 10 percent in the late 1990s to under 7 percent today. Surveys indicate that as Kenyans are becoming more informed about the transmission and prevention of HIV, both age at first sex and use of condoms are rising, and the percentage of adults with multiple partners is falling.[3]

In Tanzania, “the struggle against AIDS…has been multifaceted and multidimensional.”[4] Interventions have included health education programs, condom distribution, and AIDS education in schools. The HIV rate has declined, while condom use, abstinence, and “zero grazing” (faithfulness to one partner) have all increased.

In Zambia, the lifetime risk for AIDS death for boys and girls who are currently 15 years old is projected to be 50 percent. Exposure to an ad campaign promoting both abstinence and condom use resulted in two-thirds of the viewing group deciding to remain abstinent or use condoms (with more committing to abstinence than condoms).[5]

In Thailand, a nationwide AIDS education and condom campaign introduced in 1991 has helped keep the country’s HIV rate at only 2 percent, while the infection rate among sex workers has dropped from 28 percent to 12 percent.[6]

In Cambodia, a government-sponsored AIDS education and “100 percent condom program” has not only significantly reduced the HIV rate, but has dramatically reduced male involvement with sex workers.[6]

In Brazil, famous for its nationwide, government-sponsored AIDS treatment, “persistent and aggressive efforts to prevent new HIV infections have probably played an equal or greater role in slowing the spread of the virus.” Mass media campaigns promoting condom use for both at-risk groups and the general population have helped keep the HIV rate stable at 0.6 percent among Brazilians 15-49 years of age since 2000.[7]

In India, the HIV rate among young adults fell by a third from 2000 to 2004 among young adults. Researchers say the fall is probably due to increased condom use and male abstinence from sex workers.[8] India’s National AIDS Control Organization sponsors both an HIV education programme, and a condom use and distribution program.[9]

In Uganda, the HIV rate peaked at 15 percent in 1991. Officials introduced what has been called the ABC approach, advocating abstinence, monogamy, and condoms in equal measure for the general population; the HIV rate fell, down to 4 percent in 1998.[10] The decline has been attributed to increased abstinence,[11] delayed sexual initiation,[11] partner reduction,[12] and a steep rise in condom use.[13] With the advent of PEPFAR (the President’s Emergency Plan for AIDS Relief), Uganda began to emphasize abstinence over condoms.[14] Uganda’s AIDS Commission Director General David Kihumoro Apuuli announced in May 2006 that the number of new HIV infections in Uganda rose from 70,000 in 2003 to 130,000 in 2005.[15]

In developing areas around the world, a combination of approaches has been proven to work best in the fight against HIV. Researchers recommend that youth be provided complete information, social support, and access to contraceptives.[16] Nations should also encourage partner reduction, an important but often ignored aspect of HIV prevention.[12] In a lengthy review of adolescent reproductive and sexual health initiatives around the world, no increase in sexual risk-taking was associated with providing complete information (including information about abstinence and condoms) to young people.[16] Nations should commit to providing youth with all the tools necessary to slow the epidemic.

References

1. Hearst, N. and Chen, S. “Condom promotion in the developing world: is it working?” Studies in Family Planning 2004 35 (1): 39-47.
2. Stanton BF et al. “Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction intervention: a randomized, longitudinal study.” AIDS. 1998 12(18):2473-80.
3. Dugger, CW. “Why is Kenya’s AIDS rate plummeting?” International Herald-Tribune, May 18, 2006. http://www.iht.com/articles/2006/05/18/news/aids.ph
4. Lugalla, J et al. “Social, cultural, and sexual behavioral determinants of observed decline in HIV infection trends: lessons from the Kagera Region, Tanzania.” Social Science and Medicine 2004. 59(1): 185-198.
5. Underwood, C. et al. “Reducing the risk of HIV transmission among adolescents in Zambia: Psychosocial and behavioral correlates of viewing a risk-reduction media campaign.” Journal of Adolescent Health 2006 38 55e1-55e13.
6. Rai, C. and Penh, P. “Two hard-hit countries offer rare success stories.” Science 2003 301: 1658-1660.
7. Okie, S. “Fighting HIV – lessons from Brazil.” New England Journal of Medicine 354 (19): 1977-1981.
8. Kumar, R. et al. “Trends in HIV-1 in young adults in south India from 2000-2004: a prevalence study.” Lancet 367 (9517): 1164-1172.
9. National Aids Control Organization. “Programs.” Ministry of Health and Family Welfare, Government of India. http://www.nacoonline.org/prog_iec.htm
10. Berry, S. “HIV and AIDS in Uganda.” Avert.org. http://www.avert.org/aidsuganda.htm
11. Stoneburner, R. “Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda.” Science 2004 304: 714-718.
12. Shelton, J. et al. “Partner reduction is crucial for balanced ‘ABC’ approach to HIV prevention.” BMJ 2004 328: 891-893.
13. Cohen, S. “Beyond Slogans: Lessons from Uganda’s ABC experience.” The Alan Guttmacher Institute, 2005. http://www.guttmacher.org/pubs/ib2004no2.html
14. U.S. Department of State. “The President’s Emergency Plan for AIDS Relief.” 2003.
15. Kaiser Family Foundation. “Number of New HIV Cases in Uganda Increasing, AIDS Commission Official Says.” Kaiser Network Daily HIV/AIDS Report: Global Challenges, May 22, 2006. http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=37396
16. Speizer, I. et al. “The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence.” Journal of Adolescent Health 2003 22: 324-348.

Written by Emily Bridges
May 2006 © Advocates for Youth

This publication is part of The Facts series.