For close to twenty five years the conventional HIV prevention method was the ABC s.exual behaviour change strategy: Abstain, be Faithful, and utilize Condoms. Today, this strategy 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 after year, regardless of ABC.
Re-focusing upon the Facts and Rules of Transmission – Among the failings in the old hiv dating ABC approach was to make the exceptions the rule, and also to focus upon these exceptions to handle preventing HIV transmission within 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 said that people are not (in general) overly se.xually active: Studies by Durex show that the average South African is average with regards to se.xual activity, in comparison to the rest of the world. Exactly the same was found for the age of first se.xual activity. In addition, it proved that multiple partners – although a high risk for HIV transmission – is not as widespread as previously thought, and cannot explain rapid increases in overall HIV transmission in a community. The ‘AB’ (abstain and be faithful) strategy failed because people were (in general, excluding high specific risk group) already pretty conservative in this regard.
Condoms, although a logical solution, was without the impact that was expected. In the beginning, the explanation for this failure was blamed on absence of education and availability. However when these were corrected not much changed, with the exception of youth and workers. Other people resisted condoms for relationship reasons (trust issues; evidence of love and commitment) and because it really prevented having babies. The drive to have babies beats the risk of death, for many individuals. Count the number of pregnant peer educators if you question the mismatch between the ABC message and what people are actually doing.
Focusing upon the typical rules, not the exceptions – There always has been – and constantly will be – people, behaviours, resources and circumstances that are beyond the plethora of what exactly is considered average or normal. These would require target-specific methods. However, for your great greater part of people and circumstances, the A2B4CT approach is quite straightforward and in the current government health guidelines and protocols. It’s time to catch up, refocus, and spend our energies and resources having a higher-level of visit efficiency and impact.
The A2B4CT (A-BB-CCCC-T) Approach – Fortunately, a totally different prevention strategy has emerged in the last couple of years, which include eight different methods which we term – for the absence of 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 must understand the way it works, and use it. The nature in the required behaviour changes is additionally different, and therefore are connected to economics, gender equity, and mental health issues, including motivation towards an improved future, communication within relationships, stress and depression, and substance use (especially alcohol).
The results of the A2B4CT approach are dramatic. A variety of results illustrates the impact of such prevention methods:
For couples where one individual has HIV and is also taking ARVs, and the other is HIV-negative, the probability of transmitting HIV towards the uninfected partner is near to zero (99.9%) right after the treated partner achieves an undetectable viral load (and where the person is adherent to the ART);
Using 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% decrease in transmission;
Voluntary Male Medical Circumcision (VMMC) reduces the likelihood of a male becoming contaminated with HIV by about 50%, and the probability of him later infecting his regular partner by about 50% (WHO).
Condoms have re-emerged as an effective prevention method, although having a different emphasis and application in the new A2B5C approach. As an example, being a short-term protective measure while a few waits for that infected partner’s viral load to decrease to safer levels, to ensure that conception of babies can take place without chance of transmission from one partner to a different. Microbicides are developed as another type of barrier against HIV transmission.
New opportunities require new understanding – The brand new A2B4CT is based upon my response biology: The nature of HIV and exactly how the viral load is vital to understanding risk of transmission. Three biological terms must 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 a lot more important that the CD4 count in determining the medical and wellbeing of any person.