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. Last Updated: 07/27/2016

AIDS Is Not as Simple as ABC

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The HIV/AIDS epidemic in Eastern Europe and Central Asia has often been overlooked by the West. Major Western donors interested in the East mostly focus on political and economic transition, while those who are concerned about HIV/AIDS mostly look south to sub-Saharan Africa, where the epidemic has reached a much more visible stage. If the epidemic in Eastern Europe and Central Asia continues to be largely ignored, however, this region will eventually face a similar disaster.

The United States cannot be accused of ignoring the HIV/AIDS epidemic in this region. The U.S. government has been making its presence felt with AIDS-related development assistance, notably in Ukraine and Central Asian countries, for the past decade. U.S. diplomats and politicians have also raised the profile of HIV/AIDS in discussions with their Russian counterparts. Yet there is a risk that certain approaches trumpeted by U.S. politicians and aid agencies will undermine the hard work of preventing HIV already under way in this region.

The core of the current U.S. approach is the so-called "ABC" strategy, based primarily on the experience of Uganda. "A" stands for abstinence, "B" for "Be faithful," and "C" for condoms. Abstinence, according to this theory, should take precedence for people who are not in a relationship. Those who are in a relationship should remain faithful to their partners. And if the first two strategies fail for any reason, one should use condoms to prevent the transmission of HIV.

The message delivered by the ABC approach is that the best way to avoid HIV is to refrain from sexual activity. But HIV prevention programs that focus on absolutes, such as total abstinence, allowing for no choices or mistakes, are likely to end in failure.

The absurdity of such an absolutist approach becomes clear when you apply it, for example, to automobile safety. It is common knowledge that wearing a seat belt does not guarantee that the wearer will emerge from an accident unharmed. Seat belts merely reduce the chances of serious injury or death. The only way to rule out injury in an accident entirely is not to get in the car in the first place. Worse, if drivers and passengers are told repeatedly that seat belts are not 100 percent effective, they may question the wisdom of wearing them at all, leading inevitably to an increase in injuries and deaths.

We encounter a similar problem when encouraging people to use condoms. Advocates of the ABC approach exaggerate the failure rate of condoms in order to scare young people into abstinence. Should these young people decide to engage in sexual activity anyway, they may well opt to do so without protection, figuring that since condoms are not 100 percent effective they run the risk of infection whether they wear one or not.

This is not to say that encouraging abstinence should play no role in an HIV/AIDS prevention strategy. Abstinence, or delaying first intercourse, can play an important role in controlling the epidemic. Yet it should not be encouraged in such a way that it discourages the use of condoms. Any HIV/AIDS prevention message must focus on the fact that people have choices in life and they should be given frank and accurate information to help them make the right choices to protect themselves from HIV.

The ABC formula is a simplistic device that may work well for politicians and op-ed pages, but does not work as well when faced with more complex challenges on the ground. Instead of catchy but misleading acronyms and abbreviations, we should promote the integrated and multi-sectoral approach that those of us involved in the global fight against AIDS have been pushing for years. This approach requires the cooperation of policymakers, health care workers, teachers and schools, businessmen, people living with HIV/AIDS, and everyone else in the community to discuss openly HIV/AIDS, its methods of transmission, and how to reduce stigma and discrimination as well as how to promote better medical care for those with HIV/AIDS.

In Eastern Europe and Central Asia, we encounter other damaging aspects of the United States' absolutist approach, particularly its shunning of comprehensive approaches that target injecting drug users and sex workers.

Many people from this region broadly share the conservative values of many Americans and naturally shy away from such frank public discussions. The United States also struggled in the early days of its own HIV/AIDS epidemic, which was largely related to taboo social groups such as gay men and intravenous drug users. The United States still struggles with these issues to some extent. Yet one of the greatest contributions that the United States can make in Eastern Europe, Central Asia and the world is to share its experience of largely overcoming these taboos and making the HIV/AIDS epidemic a manageable and fairly predictable, if permanent, part of American life.

David Veazey is a senior adviser and Rian van de Braak is the executive director of the Dutch NGO AIDS Foundation East-West, a Moscow-based charity fighting the AIDS epidemic in Eastern Europe, Central Asia and Mongolia. They contributed this comment to The Moscow Times on the occasion of World AIDS Day.