The doctrine of ABC has long been used as shorthand by many HIV non-governmental organisations as the foundation of comprehensive HIV prevention programmes. The ‘ABC’ stands for ‘Abstinence; Be faithful; and use Condoms.’ ABC has been presented as: abstain; if you can’t abstain, then be faithful; and if you can’t be faithful, then use a condom.
Recently, in a conference of Christian Aid (CA) HIV partners from around the world, CA became aware of problems implicit in the ABC approach. Some of the messages given to mitigate the spread of HIV have had the unfortunate consequence of adding to the stigma surrounding it; ABC is one such message.
ABC as a theory is not well suited to the complexities of human life. If you or your partner have been tested positive for HIV and still have unprotected sexual intercourse, then this puts the other person at risk of HIV infection. While abstinence may be appropriate at some stages of life, faithfulness is for many people the preferred choice, but unfortunately is not a guarantee against infection. According to these definitions, the use of a condom automatically puts a person in the category of one who can not be faithful or does not want to abstain. This fuels stigma and precludes safer sexual practices.
CA partner ANERELA+ (the African Network of Religious Leaders Living with or personally affected by HIV and AIDS) has developed a new model for a comprehensive HIV response, called SAVE.
Voluntary counselling and testing (VCT)
Empowerment through education.
In discussions with our partners from around the world, CA has decided to adopt SAVE as the basis for a comprehensive approach to HIV. HIV is a virus, not a moral issue. The response to HIV should therefore be based on public health measures and human rights principles.
HIV prevention can never be effective without a care component. The SAVE model combines prevention and care components, as well as providing messages to counter stigma
S refers to safer practices covering all the different modes of HIV transmission. For example: safe blood for blood transfusion; barrier methods for penetrative sexual intercourse; sterile needles and syringes for injecting; safer methods for scarification; and adoption of universal medical precautions.
A refers to available medications. Antiretroviral (ARV) therapy is by no means the only medical intervention needed by people living with HIV or AIDS (PLHA). Long before it may be necessary, or desirable, for a person to commence ARV therapy, some HIV associated infections will have to be treated. Treating these infections results in better quality of life, better health and longer term survival. Every person needs good nutrition and clean water, and this is doubly true for PLHA.
V refers to voluntary counselling and testing. Individuals who know their HIV status are in a better position to protect themselves from infection; and if they are HIV-positive, from infecting another. Someone who is HIV-positive can be provided with information and support to enable them to live positively. People who are ignorant of their HIV status, or who are not cared for, can be sources of new HIV infections.
E refers to empowerment through education. It is not possible to make informed decisions about any aspect of HIV or sexual behaviour without access to all the relevant facts. Inaccurate information and ignorance are two of the greatest factors driving HIV- and AIDS-related stigma and discrimination. Correct, non-judgmental information needs to be disseminated to all, inside and outside churches. This will assist people to live positively – whatever their HIV status – and to break down barriers which HIV has created between people and within communities. Education also includes information on good nutrition, stress management, and the need for physical exercise.