The ABC's: Is it Helping Women in the Fight Against HIV/AIDS?

There are many battles African women are facing today, ranging from limited political rights to raising a family in poverty, but the greatest and most threatening battle facing these women may be against HIV/AIDS. The "AIDS epidemic," a term of which many are familiar with, has increasingly become a disease disproportionately affecting women, where in Zimbabwe twenty-one percent of women are living with HIV as opposed to fifteen percent of men. This trend is occurring not only in Zimbabwe, but throughout many other Sub-Saharan countries as well. (Swaziland and South Africa are among the other significant examples. In Swaziland, thirty-one percent of women are HIV-positive compared to twenty percent of men. And in South Africa, young women account for ninety percent of new HIV infections, according to the UNAIDS 2007 AIDS epidemic update.)

In effort to quell this epidemic among both men and women, and reduce new infection rates, several countries and organizations have stuck by the "ABC's," a slogan that has been long considered a cardinal rule in the fight against HIV. The ABC's stand for:

Abstain
Be faithful
Correct and consistent use of condoms

The ABC campaign has been considered a success since what is believed to be its first debut in the late 1990's in Botswana. (The picture to the right shows a billboard in Botswana promoting the ABC's.) Not long after, the slogan was used by other organizations and initiatives such as PEPFAR and UNAIDS, and has been credited with reducing HIV/AIDS in Uganda. According to the Guttmacher Report on Public Policy, when many Ugandan's began practicing A, B, and C at the same time, the infection rate declined from fifteen percent in 1991 to 5 percent in 2001. Young people in Uganda were waiting longer to have sex, more people were practicing monogamy, and condom use increased. The report also states that the ABC's are succeeding in Zambia. But how well do the ABC's really work in reducing the prevalence of HIV throughout Sub-Saharan Africa? And how well does it help protect women from the virus? As I see it, not very well.

The most significant problem with the ABC campaign is that it only skims the top of the social causes behind the spread of HIV. It is true that abstaining from sex, being monogamous, and using condoms will reduce infection rates, but what is the reality that these practices will be followed? For African women, following the ABC's may not be an option; they may be forced or expected to engage in into sexual relations at a young age, and may not have control over the faithfulness of their partner or whether condoms are used. Essentially, the ABC's do not take into account cultural or social norms and gender inequality.

In 2006, the Centers for Disease Control and Prevention (CDC) found that in Africa, forty-two percent of women between the ages of 15-24 had been married before the age of 18. The CDC also concluded that because poverty is prevalent in Africa, women are married at a young age to older men who can afford to pay her dowry. The husband, who has likely had multiple sex partners in part because of his age, may be infected with HIV and pass it on to his young wife who is expected to engage in sexual activity for pleasure and to become pregnant. Since being fertile and producing children is an important part of many African cultures, many young wives, such as those pictured below with their children, may increase their sexual activity in order to produce offspring. Consequently, the "abstinence" element of the ABC's may work for singles, but does not apply to married individuals.

The ABC program may also fail when women who are faithful to their husbands or partners cannot be certain of their husband or partner's fidelity. Both the CDC and The Duke Global Health Institute have concluded that men are continuing to have multiple sexual relationships, explaining why there are increasing reports of HIV among monogamous women. Social norms may affect this as the CDC stated that men in Africa are expected to have more partners and be more sexually experienced, and furthermore that wives, who are often dependent on their husbands, are in no position to demand his fidelity. No matter how faithful a woman is, if she has an unfaithful partner the ABC's will not protect her.

Additionally, because women in Africa are often dependent on men, (due largely to lack of education, financial security and equal rights), they do not have the ability to demand the use of condoms. Women may fear refusal, embarrassment or violence, and are expected to be passive and submissive in regards to sex. Even if a woman does feel empowered to request that a condom is used, African women often lack access to health education or products such as condoms, making it harder for them to enforce such requests. As a result, the "condom" component of the ABC's may not help women protect themselves against HIV, and consequently the ABC's fail again by missing the deeper social, cultural and gender standards in Africa.

Though the ABC strategy does some good, it will not fully succeed until it addresses gender difference and discrimination. Since women represent the majority of people infected with HIV in Africa, women need an updated campaign that gets to the root causes of the spread of HIV by focusing on protecting them. Out with the old ABC's and in with a new strategy to promote gender equality in the battle against HIV/AIDS.