BACKGROUND: In South Africa HIV prevention programs have tended to emphasize the “C” component (condom use) of the ABC strategy. As a result South African youth have had little exposure to formal “A” (abstinence) and “B” (be faithful) messages. As part of a larger study focused on youth, Horizons collected qualitative data to learn how in-school, young adolescents from a semi-rural area define the ABC terms and behaviors as well as to explore perceptions, beliefs, cultural practices, and norms around these issues.

METHODS: Six focus group discussions were conducted with in-school youth aged 11–15. The focus groups were stratified by sex; each group consisted of approximately 8 boys or 8 girls, for a total of 48 in-school youth participants. Focus groups were conducted in isiZulu by a team of trained facilitators.

RESULTS: Participating youth did not recognize the ABC strategy in the context of HIV prevention. Students struggled to define abstinence and being faithful—while none could provide exact definitions of abstinence, respondents in two of the six groups were able to give some variation of the correct definition. No respondents could correctly define the term “be faithful." Of the three components, in-school youth were most familiar with “C,” condom use. Almost all in-school youth could discuss condom use, but they could not define consistent condom use.

Youth were familiar with the behaviors associated with abstinence (e.g., not having sex), but they did not associate this behavior with the term “abstinence.” Few participants could correctly describe behaviors associated with the term “be faithful” in the HIV prevention context.

Generally, once the facilitator explained the term and defined the behavior, youth agreed that “A” and “B” are acceptable behaviors but that they are not always practical or feasible. Youth cite financial issues, sexual coercion, and peer pressure as reasons why youth have a difficult time engaging in “A” and “B.”

CONCLUSIONS: Data suggest that the youth had been exposed to “C” messages, but that exposure to AB messages was limited. They have limited understanding of, and comfort discussing, both the AB terms and behaviors. These findings highlight that program managers should not assume that their target audiences, particularly youth, have a clear understanding of all the components of an ABC strategy and that they can intuitively link ABC terms with actual preventive behaviors. Therefore, ABC messages, particularly those focused on AB in this setting, need to be clearly communicated in the context of HIV prevention.