December 2003

Studies in Brief
Washington, DC—"ABCs and Beyond" Meeting Focuses on Prevention Strategies

In the last few years, prevention of HIV transmission has become a hotly debated topic in both public health and political circles, and new research on prevention is reexamining old assumptions and developing potential new strategies.

To help focus and refine this global discussion, the Horizons Program sponsored a one-day meeting in April 2003 to develop research priorities for effective behavior change and risk reduction strategies, with an emphasis on what have been called the “ABC” behaviors (Abstinence or delaying sex, Being faithful or partner reduction, and Condom use). Representatives of more than 20 institutions and programs met to discuss prevention approaches and debate how best to promote prevention of sexual transmission. The agenda followed up on key issues and questions that emerged from an earlier USAID-sponsored meeting on prevention approaches (to learn more about that meeting, go to www.usaid.gov/pop_health/aids/TechAreas/prevention/abc.pdf)

After an overview of theoretical perspectives and key findings from studies by Horizons and other research organizations, the gathering discussed outstanding questions and themes for future operations research on prevention programming.

Participants agreed that programs designed to promote sexual risk reduction behaviors, including abstinence, partner reduction, and condom use, are crucial, yet there is a lack of clarity about the ABCs. For example, different programs define the ABC behaviors they promote in different ways. Being faithful/partner reduction—which participants agreed is the least well understood ABC message—can be defined as sex with only a marital partner over a lifetime, as sex with only one person at a time, or as reducing the number of secondary partners. Abstinence/delaying sex has been defined variously as abstaining until marriage, abstaining for a given period of time, or delaying sexual initiation until adulthood. While programs that address the ABC behaviors should include multiple combinations of messages, it’s still important for everyone to be clear about the various definitions used in different settings.

Another issue is distinguishing between the ABC behaviors as desired outcomes of HIV prevention programs and the best strategies to promote these behaviors. Participants felt that, to be effective, prevention programs need to address larger contextual issues, not just ABC behaviors themselves. For example, programs designed to develop the negotiation skills and self-esteem of young women will enhance their ability to avoid HIV infection, as would activities that focus on older men who have sexual relationships with these girls.

In Dakar, Senegal, the bottom half of this HIV prevention billboard highlights the ABC message: “Let’s Protect Ourselves: Abstinence, Faithfulness, Condoms.” Photo credit: Peggy D'Adamo/JHUCCP

“The discussion around this topic was especially fruitful,” said Dr. Julie Pulerwitz of Horizons/PATH, an organizer of the meeting. “Determining how best to promote HIV risk reduction for different audiences, while being sensitive to different life circumstances and cultures, is the crux of our work.”

ABC messages should also be tailored to the group that the program hopes to influence. For instance, while programs that aim to reduce the HIV risk of sex workers and their clients would likely focus on condom use, programs for youth who are not yet sexually active should focus more on delaying sexual initiation.

Youth were in fact highlighted during the meeting as a particularly vulnerable group that need to be reached with focused and comprehensive HIV risk reduction programs. Many of the participants emphasized the need to reach youth with HIV prevention messages so that they learn about risk reduction strategies before they become sexually active. This means that, in addition to the more common programs for 15- to 24-year-olds, appropriate programs need to be developed for youth 9 to 14 years old.

Participants proposed that one way to maximize impact and use resources most effectively is to coordinate the activities of different organizations and programs promoting ABC messages.

This strategy would enable groups with different approaches to concentrate on their strengths while acknowledging the value of other perspectives. Such collaboration could lead to more clarity in the messages presented via the varying institutions. For example, faith-based organizations (FBOs) could take the lead on promoting abstinence and partner reduction, while condom social marketing groups could focus on condom promotion.

During a more focused discussion about FBOs, participants agreed that their great reach and influence signifies their importance as partners in the struggle against HIV and AIDS. However, the activities and perspectives of FBOs vary tremendously. For instance, some groups favor a balance between condom use, abstinence, and monogamy messages, while others focus solely on abstinence and monogamy. Because limited research has been conducted on the nature and impact of faith-based initiatives on prevention, more studies on these approaches are needed.

Specific opportunities for research and program collaboration were raised frequently during the meeting, with the aim of encouraging each organization to focus on its strengths while working together toward similar outcomes. Horizons plans to pursue some of the research questions identified by experts at this meeting and to continue to partner with local organizations and engage local decision makers to ensure that the research is relevant both locally and globally. The research agenda that emerged from the discussions can also serve as a resource and guide for other organizations and researchers. For more information on this study, contact Dr. Pulerwitz at jpulerwitz@popcouncil.org. A report on this meeting is available at www.popcouncil.org/pdfs/horizons/abcmtgrp.pdf.

Alison Clarke

© 2003 The Population Council, Inc.

• Frontiers in Reproductive Health
• Population Council – HIV/AIDS
• Population Council – Safe Motherhood and Postpartum Care

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This page updated
19 November 2007