Today’s most commonly cited acronym for HIV prevention – “ABC” – falls severely short of describing the global effort needed to reduce HIV transmission. First, the ABCs mix up different prevention strategies. “A” (for abstinence) and “B” (for be faithful) are behaviors. “C” (for condoms) is a commodity. The implication of this string of concepts is that anyone can achieve protection if he or she chooses one or more options from the short menu. “A” is an important and preferred choice for many individuals, particularly many young people, and delaying sexual debut is an effective strategy in reducing infection rates. But abstinence it is not realistic for much of humanity, and “A”-focused programming should not be delivered without other interventions, though it often is. “B” is not protective unless a couple knows the infection status of both partners, and both honor their commitment. For millions of women whose husbands are not monogamous, B is insufficient since the female partner may be ignorant of her risk or powerless to insist upon protection.
Absent from the ABCs is an acknowledgement of the limitations of self determination in this epidemic and the powerful impact of social factors like stigma, the unequal social status of women and girls, poverty, laws criminalizing drug use, and anti-gay bias. If HIV prevention comprises only the ABCs, the social reality of millions of women means they will simply not be able to choose A or C, and B will bring little protection – and perhaps even greater risk. The “alphbet soup” approach overlooks interventions needed to protect people in risk-filled environments such as prisons or refugee camps.
The ABCs infantilize prevention, oversimplifying what should be an ongoing, strategic approach to reducing incidence. True, the simplicity of the ABC slogan has probably helped some people better appreciate that they can take basic steps to protect themselves from HIV infection. But that advantage must be weighed against the dangerously misleading messages the ABCs send to both individuals and to policy makers. “ABC” gives the incorrect impression that all HIV transmission is sexual and that effective prevention is simply a matter of changing the individual choices of millions of people with a few, tried and true interventions. Reciting the “ABCs”invites distracting and useless arguments, such as whether abstinence is better than partner reduction or both are better than condom use.