BACKGROUND: Although the “ABC” behaviors—being abstinent or delaying sex, being faithful to one sexual partner, and consistently using condoms—are widely accepted as key to reducing the sexual transmission of HIV, considerable debate surrounds how best to deliver messages about them, and how they will be interpreted. Horizons and FHI/IMPACT collaborated on a study that examined how adults and youth in two communities in Kenya understand and perceive ABC terms and behaviors.

METHODS: Questionnaires, which included three open-ended questions on defining the ABCs, were administered to over 500 working adults and almost 1,400 in-school youth ages 13–19. Multiple focus group discussions were held with both groups.

RESEARCH: Both adults and in-school youth had heard of each of the ABC terms in the context of HIV prevention, but many were unable to define them correctly. Both groups best understood abstinence, while less than a quarter of respondents could correctly define being faithful, which was commonly confused with other concepts such as being loyal to a friend. Only 17 percent of farm workers and 13 percent of youth correctly defined consistent condom use, and a large proportion of youth offered negative opinions about the behavior instead of a definition. In fact, both groups had relatively negative opinions about condom use, while they perceived of abstinence and being faithful as positive behaviors. Focus group discussions highlighted many barriers to the ABC behaviors, including forced and transactional sex and a perceived lack of ability to control sexual behavior, particularly on the part of men. Respondents indicated that they received confusing and conflicting information on sexual behavior and condom use, including that condoms were ineffective or regularly burst. They cited radio as their main source of information about HIV yet preferred interpersonal and interactive methods of receiving ABC messages.

CONCLUSION: HIV prevention programs incorporating ABC messages should clarify with locally appropriate and clear terminology what is meant by each of the ABC behaviors. Negative perceptions about condoms should be addressed to successfully implement a balanced ABC approach. At the same time, existing support for the AB behaviors should be built upon. ABC-related messages should be combined with other complementary activities, such as gender-based violence and poverty reduction, to address contextual barriers to implementing the behaviors. Programs should make sure to include interactive and interpersonal activities. A behavior change intervention implemented by FHI that addresses many of these issues is currently ongoing in Naivasha.