Strategies for HIV/AIDS
Strategies for HIV/AIDS Prevention in Kenya
Kenyan, U.S. AIDS officials explain a multifaceted plan for disease prevention
Prevention of mother-to-child transmission of AIDS is part of the Kenyan strategy. (USAID photo)
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 epidemic.
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 health.
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 countries.
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.
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.)
(Distributed by the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)