For close to 25 years the typical HIV prevention method was the ABC s.exual behaviour change strategy: Abstain, be Faithful, and use Condoms. Today, this plan has all but faded into the background, with only condoms remaining on the tick-list of ‘to do’s’. The evidence was clear: New infections continued to rise gradually year in year out, irrespective of ABC.
Re-focusing upon the Facts and Rules of Transmission – One of the failings from the old HIV prevention ABC approach was to create the exceptions the rule, and to focus upon these exceptions to handle preventing HIV transmission inside the general population: Multiple partners, infidelity, high frequency of intercourse, and early age of commencement of s.exual activity, to mention a few assumptions.
Research in the past decade stated that people are not (generally) overly se.xually active: Studies by Durex show that the typical South African is literally average with regards to se.xual activity, when compared with all of those other world. The identical was found for age first se.xual activity. Additionally, it proved that multiple partners – although a high risk for HIV transmission – is not really as widespread as previously thought, and cannot explain rapid increases in overall HIV transmission within a community. The ‘AB’ (abstain and be faithful) strategy failed because individuals were (generally, excluding high specific risk group) already pretty conservative in this regard.
Condoms, although a logical solution, was without the impact which was expected. In the beginning, the reason behind this failure was blamed on absence of education and availability. However, if these were corrected not much changed, except for youth and workers. Other individuals resisted condoms for relationship reasons (trust issues; evidence of love and commitment) and because it really prevented having babies. The desire to possess babies beats the chance of death, for many people. Count the number of pregnant peer educators in the event you question the mismatch between the ABC message and what folks are very doing.
Focusing upon the overall rules, not the exceptions – There always continues to be – and always will be – people, behaviours, resources and circumstances which are beyond the plethora of precisely what is considered average or normal. These would require target-specific methods. However, for your great most of people and circumstances, the A2B4CT approach is quite straightforward and within the current government health guidelines and protocols. It’s time to get caught up, refocus, and spend our energies and resources using a higher-level of Homepage efficiency and impact.
The A2B4CT (A-BB-CCCC-T) Approach – Fortunately, a completely different prevention strategy has emerged within the last couple of years, which include eight various ways which we term – for lacking a much better acronym – the A2B4CT approach: Antiretrovirals (with emphasis upon access and adherence); Breastfeeding (Exclusive, with ART for PMTCT); Barriers (condoms, microbicides); Circumcision (voluntary male medical circumcision); Co-infection prevention/reduction (TB, STIs; fungal, bacterial and parasite infections; Couples counseling (including multiple partners); Community viral load reduction; Testing (HIV).
The A2B5CT approach is situated upon biology, not morality. You don’t need to modify your personal beliefs: Instead, you need to understand the way it works, and use it. The character in the required behaviour changes can also be different, and they are linked to economics, gender equity, and mental medical issues, including motivation towards an improved future, communication within relationships, stress and depression, and substance use (especially alcohol).
The outcomes from the A2B4CT approach are dramatic. A selection of results illustrates the impact of these prevention methods:
For couples where one person has HIV and it is taking ARVs, and also the other is HIV-negative, the probability of transmitting HIV for the uninfected partner is near to zero (99.9%) right after the treated partner achieves an undetectable viral load (and where the individual is adherent for the ART);
With all the new PMTCT (Protection against Mother-to-Child Transmission) protocols – when applied as intended – mother-to-child transmission rates are reduced from 20 to 25% levels to close to 1%. It is a 95% reduction in transmission;
Voluntary Male Medical Circumcision (VMMC) reduces the probability of a male becoming infected with HIV by about 50%, and the possibilities of him later infecting his regular partner by about 50% (WHO).
Condoms have re-emerged as a good prevention method, although with a different emphasis and application in the new A2B5C approach. For instance, being a short-term protective measure while a couple of waits for that infected partner’s viral load to decrease to safer levels, in order that conception of babies can occur without risk of transmission from a single partner to a different. Microbicides are now being developed as another type of barrier against HIV transmission.
New opportunities require new understanding – The new A2B4CT relies upon HIV prevention research biology: The nature of HIV and exactly how the viral load is key to understanding chance of transmission. Three biological terms have to be thoroughly understood: Viral Load (VL), co-infections, and Langerhans Cells. When these ogvmdy terms are understood and logically applied, a wide range of prevention methods become obvious, including individual, couples, and community interventions. Knowing the general length of HIV viral load is important in developing effective prevention strategies. Many medical experts state that the viral load is much more essential that the CD4 count in determining the medical and wellbeing of a person.