JHPIEGO TrainerNews™ |
Clinical Update: Contraceptive Pearl
(August 2002)
Programmatic approaches to male circumcision
Question: In light of the strong evidence of protection from HIV by male circumcision (MC), do you think health programs should be promoting MC? If so, how?
Answer: Currently, USAID has no plans to actively promote MC, but is developing observational and pilot feasibility studies to assess potential acceptability and operational issues involved in implementing MC services.
In my view, given the strong demand for MC among mature men that already appears to exist, and an existing infrastructure of providers (especially private sector), beyond pilot studies a reasonable approach might also include: promoting quality of care, establishing standards and guidelines and promoting public awareness of the advantages and disadvantages of MC.
ABC approach to behavior change
Question: I've heard people talking about an "ABC" approach to behavior change for AIDS prevention. What is that anyway?
Answer: It stands for: A - Abstain (or delay among youth); B - Be faithful (or reduce partners); and C - Condoms (especially correctly and consistently). Current evidence indicates that a balance of all three is optimal for the most impact. Despite earlier doubts about the feasibility of changing sexual behavior, it is now clear that many people (both youth as well as older people) will abstain or reduce partners in the face of a life-threatening epidemic. Reducing partners can be extremely important since epidemiologic models indicate that having multiple partners, especially concurrently, is critical to [the] spread of all STIs including HIV. Condoms appear especially effective programmatically in the context of reaching commercial sex workers and other people at greatest risk, but have a broader role as well. (Note: another component sometimes added is "D" for drugs, which refers both to intravenous drug use and recreational drugs such as alcohol that can increase the possibility of unsafe sex.)
The key concept is to support all the components in a balanced, supportive way. For example, promoting abstinence and fewer partners should not ignore the possibility that risky sex still might occur and thus the need for condoms. Likewise, condoms ought not be promoted in a manner that conveys the idea that use of condoms provides some kind of invincibility, and thus inadvertently [promotes] high-risk behavior.
References:
- VanLandingham M and Trujillo L. Recent changes in heterosexual attitudes, norms and behaviors among unmarried Thai men: A qualitative analysis. International Family Planning Perspectives, 2002; 28:6-15.
- Underwood C et al. Impact of the Heart Campaign: Findings from the youth surveys, 1999 & 2000. Johns Hopkins University and Zambia Central Board of Health. Lusaka November, 2000.
- United Nations Department of Economic and Social Affairs, Population Division. HIV/AIDS awareness and behavior. United Nations New York, 2002. (ST/SER.SER.A/209).
- Agha S. Declines in casual sex in Lusaka, Zambia: 1996-1999. AIDS, 2002;16:291-293.
- Green EC and Conde. Sexual partner reduction and HIV infection. Sexually Transmitted Infections, 1999;76:145.
- Hanenberg RS et al. Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet, 1994; 344:243-245.
These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID).