The first behavioral interventions designed to stem the spread of HIV were tested over 25 years ago, within just a few years of the first reported cases of AIDS. Interventions grounded in sound theories of behavior change have since been demonstrated effective at reducing high-risk injection and sexual practices in nearly every population with known risks for HIV/AIDS. Yet the epidemic continues thus it has forced everybody to think of a practicable behavioral interventions.

1. Dr.Sujnanendra Mishra MD (O&G) The ABC’s of AIDS Prevention

2. HIV prevention Traditionally, prevention is described as being at three levels: -----primary, ------secondary and ---------tertiary.

3. Primary HIV prevention refers to activity focused on preventing uninfected people becoming infected. Secondary HIV prevention aimed at enabling people with HIV to stay well (e.g. testing to allow people to know their status; welfare rights advice; lifestyle behaviour ; anti–discriminatory lobbying). Tertiary HIV prevention aims to minimise the effects of ill–health experienced by someone who is symptomatic with HIV disease (e.g. the prophylactic use of drugs and complementary therapies )

4. Two approaches to disease prevention 1. Risk avoidance (abstinence or delay of age of first sex; mutual monogamy. Not injecting drugs, or stopping if already started). 2. Risk- reduction or “remedies” interventions (condoms, treating STIs with drugs, providing clean needles) Some refer to the latter as “Primary Prevention” or “Primary Behavior Change”

5. Risk avoidance & risk reduction BLOOD Approaches Sex Injection Transfusion Pregnancy RISK AVOIDANCE Abstinence, mutual monogamy safe and appropriate use of injections reducing unnecessary transfusions Routine HIV antibody screening interventions RISK REDUCTION Condoms, STI Rx Sterile syringes quality blood for transfusions Short-course monotherapy Zidovudine ,Nevirapine to mothers and babies Elective Caesarean delivery and breastmilk replacement

7. PRIMARY PREVENTION Prevention of New Infections • A = abstinence, i.e., delaying sexual debut • B = be faithful, i.e., avoid, or reduce multiple (concurrent) sexual partners • C = condoms, i.e., consistent*condom use if one (or one’s partner) has multiple concurrent sexual partners (assuming one does not increase multiple partnering with the use of condoms) * Consistent condom use is only 80% (or less) protective; inconsistent use has minimal or no protection.

9. ABC Strategy A Avoid exposure A bstinence Mutual faithfulness B Reduce exposure B e faithful (Partner reduction) C Block exposure efficiency C ondom use And D for Drugs, for treating STDs, another prevention method

10. Abstinence for youth. Abstinence until marriage for those who have not yet initiated sexual activity . “ Secondary abstinence” for unmarried youth who have already engaged in intercourse.

13. Poster from Uganda’s AIDS Control Programme in the late1980s B = be faithful “… another loves another.. It’s a circle of love…” Look, listen and decide, Ray Phiri

15. What supports faithfulness • Love, respect and communication important • Being married can help set the expectation • Religion helps set some rules--- – Faithfulness, --respect, --do not commit adultery. • Sexual satisfaction, harmonious households, education/fear of diseases as reasons for being faithful.

17. Faithful relationships seen as ideal in terms of romantic expectations and HIV prevention, yet many recognize that the application of “B” is complex and they are not sure how to negotiate this in their relationships. “B” is particularly difficult if relationships are unequal .

25. Many assume that “ABC misses the point” Nancy Padian, presentation to NIH, 2005 Message Reality Abstain from sex Rape & forced sex Be faithful Infection by partners Wear a condom Coercion & financial dependency Defense of women! for whom ABCs do not apply

26. Realistic Approach *Consistent condom use is only 80% (or less) protective; inconsistent use has minimal or no protection. D delaying sexual debut R reduce multiple (concurrent) sexual partners C Consistent and correct condom use *

27. STUDY BASED EFFECTIVE Approach A Abstinence, i.e., delaying sexual debut . B be faithful, i.e., avoid, or reduce multiple (concurrent) sexual partners . C consistent and correct use of CONDOM c CIRCUMCISION c CONTRACEPTION

28. Has ABC been superceded by SAVE? ANERELA+ (the African Network of Religious Leaders Living with or personally affected by HIV and AIDS) has developed a new model for a comprehensive HIV response, called SAVE . • S afer practices • A vailable medications • V oluntary counseling and testing (VCT) • E mpowerment through education Translation: condoms, pills, testing and “empowerment” (Notice removal of A&B)