Do not let sleeping docs lie

Of course, this misinformation cannot go unchecked. I have written an email and sent it to the Star yesterday.

With regards to the mail from Dr K.Y. Chong (ABC Method to prevent AIDS, 11 Oct), I agree with him that the ruling is indeed groundbreaking.

The good doctor seems to imply that abstinence is the best option and condoms are third best. However, it should be noted there is no best method; it is a combination of methods, which works.

Abstinence in itself does not decrease the infection of HIV. What if someone who have abstained till marriage, have unprotected sex with his/her partner for the first time? Proof of abstinence can’t be verified with certainty.

There is no one glove thats fit all. For people who cannot abstain or be faithful, for whatever reasons, condom is the best option.

The abstinence component of Uganda's strategy focused on efforts to delay first intercourse among young people. As a result of these interventions, surveys indicate that the average age of sexual initiation among females rose from 16.5 years in 1988 to 17.3 in 2000. Among men, the age increased from 17.6 years in 1995 (the first year for which data are available) to 18.3 in 2000.

Contrary to some media reports, Uganda is not an example of an "abstinence-only" prevention program. Rather, the decline of HIV/AIDS prevalence rates in Uganda offers testimony to the triumph of the multi-pronged ABC approach.

In fact, the “Be faithful” aspect of Uganda's ABC campaign is believed to be the most significant contributor to the overall decline in HIV infection, and has been particularly successful in reducing the incidence of casual sex. (Generally defined, casual sex refers to those having more than one sexual partner in a 12-month period.)

The whole point I am getting at is that HIV/AIDS program should be a combination of approaches, and not just emphasis on one. The "ABCs," was a great success in Uganda, because they recognize the varied needs and behaviors of individuals and offer them options.

Any intervention that stresses either condoms-only or abstinence-only misses the mark, and is unlikely to significantly slow this deadly pandemic.

As for Botswana and Swaziland, these countries do not emphasis condoms only; public education & awareness, education for young people and prevention of mother to child transmission (MTCT) are other methods used. HIV prevalence is still high is definitely not due to lack of effort, but of the stigma of HIV/AIDS, health infrastructure, political will, resources, etc.

For example, Botswana has become the first African country to aim to provide antiretroviral therapy to its citizens on a national scale. It is believed by many that if any country in Africa is going to succeed in implementing such a comprehensive HIV/AIDS care and treatment programme, then it is Botswana. But its ambitious antiretroviral drug programme, MASA, has not yet been as successful as first hoped. Of the 300,000 HIV-infected people, 110,000 were estimated to meet the criteria to qualify for treatment. The government aimed to enrol 19,000 people in the first year, but only 3,500 were actually enrolled. By June 2004, this had risen to around 18,000.

This disappointing outcome has highlighted a number of issues related to providing antiretroviral therapy. These include the education and training of health care workers and the strength of the infrastructure. If other countries with fewer resources by head of population are to follow the example of Botswana, there are still many lessons to be learned. A considerable emphasis needs to be placed not only on the availability of antiretroviral drugs, but the availability of health care professionals and an adequate infrastructure.

All the points above are taken from Population Action International and Human Rights Watch website. A simple Google search of “Uganda AIDS prevention program” will yield the relevant links.

Derek Lee