Abstinence, be faithful, use a condom

Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modifies the approach of abstinence-only sex education by including education about the value of partner reduction safe sex and birth control methods. Abstinence-only sex education is strictly to promote the sexual abstinence until marriage, and does not teach about safe sex or contraceptives. The abstinence-based sex education program is meant to stress abstinence and include information on safe sex practices. In general terms, this strategy of sex education is a compromise between abstinence-only education and comprehensive sex education. The ABC approach was developed in response to the growing epidemic of HIV/AIDS in Africa, and to prevent the spread of other sexually transmitted diseases . This approach has been credited by some with the falling numbers of those infected with AIDS in Uganda, Kenya and Zimbabwe, among others. From 1990 to 2001 the percentage of Ugandans living with AIDS fell from 15% to 5%. This fall is believed to result from the employment of the ABC approach, especially reduction in the number of sex partners, called "Zero-Grazing" in Uganda.

Abstinence-based sex education can include issues of human relationships, the basic biology of human reproduction, safe sex methods and contraceptives, HIV/AIDS information, and masturbation in place of sex. It recommends sexual abstinence outside marriage as an ideal, having only a single long-term sexual partner. The use of condoms and other safe sex practices is advocated only if it is not possible to remain with a single sexual partner. Advocating this ideal, whilst pragmatically dealing with the fact that abstinence only sex education is ineffective by itself, has made the ABC approach popular with many African governments and relief agencies.^[1]

The ABC approach has notably been used in African countries. Versions of this approach have been used for abstinence-only sex education in Uganda, among others.^[2] Its positive impact has been confirmed by a 2009 Stanford University survey.^[3]

Components

Abstinence, be faithful, use a Condom consists of three components:

• Abstinence: The ABC approach encourages young adults to delay "sexual debut" (age of first sexual intercourse), as used by Uganda, or to use abstinence until marriage, the most effective way to avoid HIV infection, as advocated as the ideal by Christianity and Islam. The program develops skills for practicing abstinence and encourages participants to adopt social norms that support abstinence.
• Be Faithful: In addition to abstinence, the ABC approach encourages participants to eliminate casual or other concurrent sex partners and to practice fidelity within their marriages and other sexual relationships. This reduces exposure to HIV. In Uganda between 1989–1995, President Museveni reported a 20% decline in casual sex partners, and an 11% decline in reported cases of HIV.
• Use a Condom: The final component to the ABC approach is "correct and consistent condom use." While understanding the benefits of abstinence, participants are instructed how to apply and use a condom. This is an example of risk reduction during cases when risk elimination is not practiced. Students are also taught that condoms do not protect against all forms of sexually transmitted diseases.{3}

Growth and popularity in the United States

Starting primarily in the 1980s and 1990s, the popularity of the "abstinence plus" sex education program grew into a common method of teaching students, in the United States, about sexuality. The program understood that it would not be possible to stop all teenagers from having sex, but still stressed that abstinence is the only guaranteed way of avoiding unwanted pregnancies and contraction of STDs.^[4] The most important message to teens from the program comes from Joycelyn Elders, President Clinton's first Surgeon General, that "if they have a baby there is an 80% likelihood they'll be poor, ignorant, and slaves for the rest of their lives."^[5] In 1997 the Department of Health and Human Services established a "Girl Power!" campaign focusing on girls ages 9–14 which encouraged abstinence as a form of empowerment.^[6] For those who would reject abstinence, though, or have early sex forced upon them, abstinence-only messages provided little to no hope to prevent pregnancy and spread of disease. To account for this, some states included information about contraceptives in their sex education programs along with encouragement for students to be abstinent. Of the states that, in 1995, required abstinence education, fourteen also included the use of contraception within the curriculum.^[7]

In September 1995, Hawaii passed the Abstinence-Based Education Policy. (Policy # 2110). It is meant to support abstinence and help develop skills to continue abstinence, help teens who have had sexual intercourse to abstain from further, and to provide teens with information on contraceptives and methods for preventing sexually transmitted diseases and pregnancy.^[8]

HIV/AIDS is one of the leading causes of deaths in the United States and 1 in 300 people are living with HIV/AIDS. Around one million people have HIV/AIDS in the United States. More than 524,000 people in the United States have died of HIV/AIDS. Around 40,000 people are infected each year.

Criticisms

The usefulness of the ABC approach is highly debated. The three elements are interpreted differently by different actors and critics argue that often abstinence and faithfulness are unduly promoted over condoms and other measures such as education, female empowerment and making available modern antiviral drugs.^[9] For example, the U.S. President's Emergency Plan for AIDS Relief under President George W Bush has been criticised for seeming to prioritize "A" and "B" over "C" within its funding criteria. "C" activities may only be directed at "high-risk" groups, and not to the general population.^[10] However, donor funding has always been allocated overwhelmingly to condoms, reflecting clear US and European policy priorities, including under George W Bush.

Criticism

Critics argue that in many countries women are frequently infected by their unfaithful husbands while being faithfully married, and thus women who follow the recommendations of ABC promoters face an increased risk of HIV infection.^[11] Condoms, needles, and negotiation is a proposed alternative approach as is SAVE (Safer practices, Available medication, Voluntary testing & counselling and Empowerment through education).^[12]

Critics furthermore allege that the strategy overlooks the epidemic's social, political, and economic causes and "vulnerable populations", e.g. sex workers and "those who lack the ability to negotiate safe sex" as well as risk groups such as homosexuals and intravenous drug users. However, most infections in Africa occur outside these vulnerable groups, and ABC was a US donor policy only for the "generalized" epidemics in Africa. Murphy et al. found that Uganda's ABC approach empowered women. "Remarkably, in the 2000–2001 Uganda DHS, 91 percent of women said they could refuse sex with their husbands if they knew their husbands had STIs, a somewhat higher percentage than in several other African countries" ^[13]

Critics also argue that using the word "abstinence," then teaching about safe sex and contraceptives, can be contradictory.^[14]

Commentators

Pope Benedict XVI has criticised some harm reduction policies with regards to HIV/AIDS, saying that "if the soul is lacking, if Africans do not help one another, the scourge [of HIV] cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem". Whilst this position has been widely denounced for misrepresenting and oversimplifying the role of condoms in preventing infections,^[15][16] there has been expert scientific opinion and evidence supporting it.^[17]

Archbishop Gabriel Charles Palmer-Buckle of Accra has stated that "the Catholic Church [offers] three methods to help solve this problem of AIDS in Africa: "A", abstain; "B", be faithful; "C", chastity, which is in consonance with traditional African values. Those Planned Parenthood people are only talking about condoms. By the way, they know full well that the condoms devoted to Africa are sub-standard."^[18] There are no reliable sources that condoms distributed in Africa are inferior to those elsewhere in the world.^[19]

A major proponent of the ABC approach, author and member of Presidential Advisory Council on HIV and Aids in 2003-2007, Harvard University's Edward C Green, stated “Advocates of the ABCs often use the term to mean a primary emphasis on abstinence/delay of sexual debut and faithfulness/partner reduction, with condom use being a secondary but necessary strategy for those who do not or cannot practice abstinence or fidelity." Furthermore, Green in his seminal book Rethinking AIDS Prevention (Praeger 2003) argued that the success in Uganda, where prevalence feel 21% to 6% between 1989-2003 was largely due to the "B" of the ABC approach, fidelity or reduction in multiple partners. This conclusion was validated and expanded to underscore the dangers of concurrent sexual partners by Helen Epstein, in The Invisible Cure ^[20]

References

External links

• USAID: The ABCs of HIV Prevention
• Avert.org: The ABC of HIV prevention