The Uganda Think Tank on AIDS (UTTA) in a report says that after many years of harmonious implementation of the ABC, and recognition of the fact that positive behavior changes informed by ABC messages collectively contributed to the declining HIV infection rates, HIV/AIDS activists are perturbed with the stagnant prevalence over the years and question whether the approach can bring any more positive results or needs to be revised.

The report says that some proponents of C label Abstinence and fidelity (Being faithful) as impractical or even impossible, while advocates of A&B have advanced issues of immorality and inefficiencies of the condom as a barrier method.

“Promoters of AB de-campaigning C as being an option for the immoral. They claim that the condom is not very effective as a barrier method, alleging the existence of holes big enough to allow the passage of HIV. The promoters of C on the other hand, allege that high level political leaders are de-campaigning the condom due to donor influence, particularly in order to access US Government PEPFAR funding with A&B conditionality,” says the report.

Consequently, the debate has resulted in competing and conflicting messages that confuse both the stakeholders and the target audience, leaving many puzzled about the government’s stand on ABC.

New Approach proposed

There are those who believe that the ABC should be replaced with a new method called SAVE- an acronym for Safer practices, Available medications, Voluntary counseling and testing and Empowerment through education.

According to the London-based nonprofit group, Christian Aid which has adopted the SAVE approach, the ABC approach “is not well suited to the complexities of human life” and “fuels stigma and precludes safer sexual practices” by placing people in one of the three categories.

Christian Aid said in a release recently said that Being Faithful to one sexual partner does not automatically protect a person against HIV transmission as one partner may be faithful while another partner is not faithful; meaning the one who is faithful in a relationship is not protected.

They said contrary to the AB or C debate, Condom users are not necessarily people who do not wish to abstain or be faithful, but some people are forced to have sexual relations and use condoms. For long, the example of disadvantaged girls and women who are forced to have sex to get money from rich men has been cited.

Under the SAVE method, “safer practices” include ensuring HIV-negative blood for transfusions, using methods to prevent HIV transmission during sexual intercourse, ensuring the availability of clean needles and adopting medical safety procedures.

This is also reflected in the UTTA report, which re-examines the strength and weaknesses of ABC as a single approach and those of its individual components.

The report notes that despite achievements, the ABC model has not been understood and consistently promoted as one model. “ABC has been looked at in ascending or descending order rather than synergistically,” the report notes.

This is the point well elaborated by proponents of SAVE approach. They point at inadequate targeting of ABC interventions to different population groups for instance the deaf and the blind who have difficulties in accessing information while others fail to act on the messages due to environments they are in, for example married women who cannot insist on condom use if they discover their husbands are having extra-marital affairs.

The AIDS think tank says that the single ABC components largely focus on individual responsibility vis-à-vis social responsibility. Many in the anti HIV/AIDS movement say that by focusing on individuals, the ABC strategy ignores environments, which greatly contribute to personal/individual actions.

Abstinence

Abstinence is defined as the choice or decision to refrain, avoid, decline, shun, deny oneself, renounce, or keep from something in this case sex.

Whereas abstinence is commended for bringing the prevalence down in age group 15-20 years, which also corresponded with delayed sexual debut from 14 to 18 years, it has been found wanting among girls in an environment where boys are encouraged to be sexually aggressive and girls socialized to be submissive. Abstinence is also criticised because it is not an option for women who are in difficult situations and have no choice for instance in instances of rape and child sexual abuse.

Being Faithful

It is defined as having strong belief, confidence in, or conviction, which translates into loyalty, dependability, devotion, fidelity and trustworthiness in case of one’s spouse. Being faithful is rated highly in causing the decline of prevalence in Uganda from 30% in the early 1990s to 6% by the year 2001, also leading to the decline of habits of multiple sexual partners.

The decline in casual sex is said to have registered a 60% decline over the last 20 years. “Despite the positive attributes, the strategy looks at the existing relationship without considering the environment in which the relationship started especially among young people,” the UTTA report says.

Being faithful has been criticized for assuming normative definitions of relationships usually in terms of religion or cultural norms, without for example considering that one party may decide to engage in another sexual relationship and thus put the faithful partner at risk of HIV infection.

Condom use

Most adverts in Uganda have been saying “if you can’t abstain or remain faithful, then use a condom”. Condoms are being de-campaigned as a reward for the promiscuous largely because they have been promoted as a method for those who cannot abstain or stick to one partner, while some people including President Yoweri Museveni allege that some local sex styles are “too elaborate and do not favor condom use”.

Anti condom campaigners also point to the fact that mostly available condoms on market are for males and therefore controlled by males leaving women in no position to enforce protection. Others point to a lot of misconceptions on condoms, quality and supply factors.

Factors like disparities in free condom distribution across the country, the unforeseen shortage of condoms due to quality problems with some types of condoms.

In fact, President Museveni insists that Uganda’s success in reducing HIV/AIDS prevalence levels is much a result of abstinence and be faithful campaign than it is of condom use.

Many organizations led by Human Rights Watch (HRW) and local NGOs argue that Uganda’s past success cannot be wholly attributed to behavioral change factors of abstinence and faithfulness. They have been warning that a shift to abstinence and faithfulness only programs promoted by the US Presidential Emergency Plan for Aids Relief under President George Bush might scale countries like Uganda keen on this to further infections.

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