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David Patient-Neil Orr's blog

The New A-3B-4C-T of HIV Prevention and The Failure of the ABC Approach David Patient and Neil Orr- South Africa

The New A-3B-4C-T of HIV Prevention Neil M. Orr (MA) & David R. Patient (MHT) South Africa 2014 June 03

The Failure of the ABC Approach For close to 25 years the standard HIV prevention strategy was the ABC sexual behaviour change strategy: Abstain, be Faithful, and use Condoms. Today, This ‘old’ strategy has all but faded into the background, with only condoms remaining on the tick-list of ‘to do’s’. The evidence was clear: New infections continued to rise steadily year after year, regardless of ABC. The 2012 South African Department of Health Antenatal Study confirms this.

Re-focusing upon the Facts and Rules of Transmission One of the failings of the old ABC approach was to make the exceptions the rule, and to focus upon these exceptions to deal with preventing HIV transmission in the general population: Multiple partners, infidelity, high frequency of sex, and early age of commencement of sexual activity, to name a few assumptions.

Research during the past decade revealed that people are not (by and large) overly sexually active: The average South African is literally average in terms of sexual activity, compared to the rest of the world. The same was found for the age of first sexual activity. It also turned out that multiple partners – although a high risk for HIV transmission – is not as widespread as previously thought, and cannot explain rapid increases in overall HIV transmission within a community. The ‘AB’ (abstain and be faithful) strategy failed because people were (by and large) already pretty conservative in this regard.

Condoms, although a logical and ideal solution, did not have the impact that was expected. At first, the reason for this failure was blamed on lack of education and availability. However when these were corrected not much changed, except for youth and sex workers (recreational sex).

HIV/AIDS - One step forward, two steps back - South Africa

To: The Health Communication Social Network within The Communication Initiative

From: David Patient and Neil Orr - South Africa

On the 1st April, 2014, The South African (SA) National HIV Prevalence, Incidence and Behaviour Survey, 2012 was released.

Not only has the incidence of HIV increased in SA since the last survey; the rate at which prevalence is increasing is also going up. So clearly, when it comes to our prevention programs, they are simply not least that is what the evidence suggests.

As part of ‘the way forward’ in the report, one of the key recommendations is to revive and strengthen the long standing ABC message (Abstain; Be Faithful; Condomize), messaging based in morality, with a strong focus on monogamy, that is confusing, morality based and ignores the science of transmission.

It is time to move from a prevention approach to a risk reduction approach. The model we are suggesting, A-3B-4C-T offers up a much wider menu of options and is based around viral load management and the science of transmission. For too long, HIV infection has been seen as the disease of the promiscuous, yet when you understand the science of transmission, this argument fall flat and is largely, baseless. However the long-term damage this kind of morality based messaging or belief has caused more harm than good (read: stigma). The amount of sexual partners you have is irrelevant. Your or their viral load is highly relevant when it comes to transmission. The ABC focuses on Sex while the A-3B-4C-T focuses on viral load, viral spiking, treating of all secondary infections and the science of HIV transmission. The A-3B-4C-T model offers 28 risk reduction strategies, with all but one, as recommendations by our very own Department of Health. Yet they are still taking the moral high ground and focusing on the morality based messaging of ABC.

Health Communication