April 2004
BMJ-British Medical Journal
HIV prevention schemes neglect partner reductionPartner reduction is crucial for balanced “ABC” approach to HIV prevention BMJ Volume 328, pp 891-4Without multiple sexual partnerships there would be no global AIDS pandemic, yet partner reduction is still overlooked in most HIV prevention programmes, argue researchers in this week's BMJ.
Interest has been growing in an "ABC" approach to HIV prevention in which A stands for abstinence or delay of sexual activity, B for be faithful, and C for condom use.
While most programmes to prevent HIV have focused on promoting abstinence or condom use, partner reduction has been the neglected component of this approach, write James Shelton and colleagues.
However, partner reduction has had an important role in countries that have cut HIV infections. For example, multiple partner behaviour dropped noticeably after a national campaign in Uganda to encourage people to practice fidelity.
The authors believe that it is imperative to begin including (and rigorously evaluating) messages about mutual fidelity and partner reduction in ongoing activities to change sexual behaviour.
"Rather than arguing over the merits of abstinence versus condoms, it is time for the international community to unite around a balanced, evidence based ABC approach," they conclude.
Authors of an accompanying commentary suggest that the ABC approach to changing sexual behaviour could be used to tackle all sexually transmitted infections. They believe that, although partner reduction is critical, encouraging young people to delay sexual intercourse should be the first step in programmes to prevent these infections.
Partner reduction is good epidemiology, not good ideology, adds David Wilson of the World Bank's Global HIV/AIDS Program, in an accompanying editorial. He believes that the key to HIV prevention lies in rapid, inexpensive, and locally led initiatives that rely on simple messages to promote changes in community norms, rather than mass media.
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