USIS Washington File - August 16, 2006
The following op-ed, co-authored by Dr. Ibrahim Mohammed,
director of Kenya's National AIDS/STI [sexually transmitted
infecitions] Control Program, and Dr. Mark Dybul, U.S. Global
AIDS Coordinator of the President's Emergency Plan for AIDS
Relief, appeared in the Toronto Star August 16, 2006. There are
no republication restrictions.
The ABCs of Kenya's War on AIDS
By Dr. Ibrahim Mohammed and Dr. Mark Dybul
The challenges of HIV/AIDS prevention in the developing world are
daunting. To turn back the rising tide of infection, we need a
public health approach that respects the people we serve so they
can make their own decisions.
The HIV/AIDS strategy of the government of Kenya emphasizes an
evidence-based approach rooted in "ABC: " Abstain, Be faithful,
and the Correct and Consistent use of Condoms. Americans, through
President George W. Bush's Emergency Plan for AIDS Relief,
support Kenya's prevention strategy.
In much of Africa, HIV/AIDS is a generalized epidemic affecting
all age groups and segments of society.
A comprehensive approach is needed to combat a generalized
The evidence is clear -- in such an epidemic, all three
components of ABC are essential to combat HIV/AIDS. In
concentrated epidemics -- Thailand and Brazil, for example --more
targeted approaches can be effective.
The Kenyan health ministry estimates that HIV prevalence has
dropped markedly from 1998 to 2003. While the causes are complex,
the data point to:
* Increased male faithfulness - among men aged 20 to 24, the
percentage who reported more than one sexual partner dropped from
more than 35 per cent to 18 per cent.
* Delayed sexual debut, with median age for first sex among women
rising from 16.7 years of age to 17.8.
* High levels of both primary and secondary abstinence (people
who were sexually active who have abstained for at least one
year) in teenagers of both sexes.
* Increased condom use among women who engage in risky activity.
Similarly, a study published this year in the journal Science
reported sharp declines in HIV prevalence in eastern Zimbabwe,
associated with striking changes in sexual behaviour.
As Dr. Peter Piot, head of the Joint United Nations Program on
HIV/AIDS, remarked, "[T]he declines in HIV rates have been due to
changes in behavior, including increased use of condoms, people
delaying the first time they have sexual intercourse, and people
having fewer sexual partners."
In other words, the ABC behaviors.
As data from these and other nations such as Ethiopia, Uganda,
Zambia, Malawi and South Africa demonstrate, ABC is good public
It also respects local culture - ABC was developed in Africa, not
in North America - and respects the people whom we serve.
To focus programs on only one component of ABC would be dangerous
and patronizing, reflecting an assumption that intelligent people
who care about themselves and their families cannot make
decisions for themselves.
ABC provides hard data so people can decide how to protect
themselves: the only 100 per cent effective way to avoid HIV is
to abstain or to be faithful to a single, HIV-negative partner,
while correct and consistent use of condoms reduces risk by
approximately 90 per cent.
With that knowledge, if one chooses risky behavior, condoms must
be made available to that person.
Kenyan policy promotes the common sense, public health approach
of ABC, which the U.S. government supports throughout the world.
In generalized epidemics, however, other interventions, in
addition to ABC, are needed.
The Kenyan strategy recognizes this by promoting programs to
minimize gender inequality, which often makes it difficult for
women to negotiate A, B or C.
Kenya is also increasing HIV counseling and testing to ensure
that HIV-negative couples maintain fidelity and that
HIV-discordant couples [one positive and one negative partner]
receive counseling and condoms.
Beyond sexual transmission, Kenya is focusing on prevention of
mother-to-child transmission, blood safety, safe medical
injections and other key issues.
The U.S. government supports this comprehensive approach to
prevention in generalized epidemics in Kenya and many other
Treating people with respect by providing them with HIV
prevention education and services is good public health. It
fosters the democratic value of personal responsibility that
leads to healthy behaviors.
The governments of Kenya and the United States, together with our
partners in civil society, will remain committed to providing
people with the information and tools they need to protect
themselves from HIV infection.
As Kenya is demonstrating, only a comprehensive, public health
approach will turn the tide against HIV/AIDS.
For more information, please visit the U.S. Global AIDS
Coordinator's Web site, or contact the Coordinator's office by
phone (202) 663-2802 or e-mail PughKA@state.gov.
President George W. Bush's Emergency Plan for AIDS Relief is the
largest commitment ever by a single nation toward an
international health initiative -- a five-year, $15 billion,
multifaceted approach to combating the disease in more than 120
countries around the world.
(Dr. Ibrahim Mohammed is director of Kenya's National AIDS/STI
Control Program. Dr. Mark Dybul is U.S. Global AIDS Coordinator
of the President's Emergency Plan for AIDS Relief.)