ABC and beyond: Reflections on the C

An increasing number of countries including Rwanda, Uganda, Kenya, Zimbabwe and Ethiopia, have experienced national or sub-national declines in HIV prevalence, associated with the widespread adoption of “A,” “B,” and “C” prevention behaviors according to a United Nations General Assembly Special Session (UNGASS) progress report of 2007. The U.S. Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), supports the ABC approach because it can be used to target the sources of the most new infections in a given population. Fundamental to this approach is the recognition that different settings will also feature different barriers to the adoption of ABC behaviors. Prevention programs must therefore be developed in collaboration with the communities they serve and must, in addition to promoting individual behavior change, address the social norms, environmental factors, and policies that contribute to new HIV infections. Between the year 1994 to 2005 Rwanda succeeded in denting the tide of HIV/AIDS through what we now summarize a the “ABC strategy” which refers to A for Abstinence, B for Being faithful in marriage, and C for Condoms use( especially for those with risky sexual life styles). A and B were the loudest message but there was also a quiet condom message. This is the now baptized ABC approach which is credited for turning back the tide of news infections. In many senses it succeeded because it made people responsible for their personal choices challenging them to fundamental behavioral change. The President underlined the fact that HIV/AIDS, like many pandemics on the African continent, is a disease linked to poverty and ignorance and also had his personal view “I strongly believe that instead of focusing on the ABC strategy alone, we should now give equal support and attention to E, which stands for Education,” he said. As I reflect back on the ABC strategy and how to improve it especially for the youth, I believe the C should stand for Change of Communities. We shouldn’t underestimated the role of safe community zones around which the young people can explore the normal development of relationship and get support to live out their commitment to delay engaging in sexual activity. We should remember that in the early 80’s and 90’s because the internet had not saturated the minds of the youth with liberal lifestyle’s the HIV rates were low compared to today. The spread of pornography has also been a source of negative socialisation; especially for the youth, as they rely more and more on outside influences in their sexual behavior and not traditional family units. It is a dangerous world out there for the young people wishing to delay their start in sexual activity. The recent data on HIV/AIDS prevalence from the national Demographic Health Survey 2005 was concerned with the growing number of young women infected with the epidemic; with HIV/AIDS prevalence rates among women aged 15-24 years five times the rate of men of the same age group. In Rwanda, the percentage of young people aged 15-24 who had sex before the age of 15 is said to be at 13% among males and just 4 percent with the females, as indicated by the UN report. The number of people living with HIV/AIDS has reduced from 191,437 in 2006 to184,859 in 2007, a United Nations General Assembly Special Session progress report said. It says that despite the decrease, the percentage of young women infected with HIV remains high and has continued to increase. The numbers stand at 3.7 percent among the 15-19 age group, and 2.5 percent (20-24). 2005 statistics were 0.6 percent and 2.5 percent respectively. This may not seem like a lot but it represents thousands of lives. Elders should not fail or give up, continue to challenge the young people to make tough but responsible choices to abstain, and also do something to eliminate or control the many forms that promote illicit sexual behavior. The community leaders and activist should focus on providing young people with safe zones such as youth centers, where they can play, grow and learn from each other in non- sexualized environments. Ankunda Artherine a Peer Educator working with Care International lauded the government of Rwanda for controlling the community; “We do not have local FM stations which compete with each other in how sexually provocative their programs can be, we do not have highly pornography news paper publications polluting our community”, she said. Time has come for us to deal face to face with the reality that AIDS is a state of emergency, Dr. Peter Piot of UNAIDS said, “AIDS/ HIV is an extra-ordinary tragedy that calls for extra or binary response.” We should ensure that there are alternative community centers which provide safe zones for young people to grow in a life style of abstinence among peers. The media has to be involved in programs that promote safe sex, by providing information on the importance of the ABC principle. Radio, television and news paper owners should take up this challenge as they disseminate information on issues related to the HIV/AIDS. Finally time has come for the community to celebrate the heroic achievement of its young people who chose to abstain from sexual activity as a protective measure to HIV/ AIDS. we should reward them by providing incentives to those who are abstaining. AB works and can work even better when we have C standing for Change in Community that supports a life-style of abstinence for the Youth. This is not to say that we should eliminate having condoms for the sexually active. Rather I am saying that we put our young people at great risk if we do not do something about changing the environmental context in which life and death decisions are made. This should really be a basic as ABC. Contact:byawakaj@yahoo.com