The global projections for HIV/AIDS are alarming. Particularly in Africa, populations are being devastated. With the promise of a vaccination in the near future dim and the cost of drugs prohibitive for many Africans, atmospheres of hopelessness and helplessness are prevalent throughout this continent.
But a recent report in the highly regarded research journal Science offers hope. Uganda has demonstrated significant effectiveness in reducing HIV/AIDS in comparison with surrounding countries. In Uganda, as is the case in most African countries, HIV occurs because of consensual sexual intercourse.
Uganda has experienced a 70 percent reduction in HIV/AIDS since the early 1990s. Countries with similar epidemics such as Kenya, Zambia and Malawi did not have similar successes despite substantial condom use and the promotion of biomedical approaches. Researchers Stoneburner and Low-Beer began their investigation to determine which factors contributed to Uganda's success.
The researchers' findings indicate that reduction in the number of sexual partners and abstinence among unmarried, sexually inexperienced youths, rather than condom use, were the important factors in Uganda's success. In other words, abstinence from sexual relationships prior to marriage and monogamy after marriage were the factors that primarily contributed to the reduction in HIV/AIDS. Such public health messages communicated via social networks appear to have directly influenced the outcome.
Although there needs to be a better understanding of the social elements which elicited the Ugandan response, what is clear is that the government communicated the following message: AIDS is fatal and requires a population response based on zero "grazing" (unfaithfulness to one's partner). It is interesting that condoms were a minor component of the original strategy.
The authors concluded, "Our findings indicate that substantial HIV reductions in Uganda resulted from public-health interventions that triggered a social process of risk avoidance manifested by a radical change in sexual behaviors. The outcome was equivalent to a highly effective vaccine."
As HIV/AIDS continues to emerge and re-emerge as a major health problem, with resistant strains reported regularly, and with promises of a vaccine distant, perhaps it is time for a shift in strategic thinking on health policy and HIV/AIDS. Public health interventions which are characterized by messages of abstinence and monogamy may be as effective as a highly effective vaccine, and should not be dismissed as unrealistic or as moralizing. The approach appears to have saved tens of thousands of lives in Uganda. Perhaps it's time to consider this approach in other countries, including the United States.
A. Dean Byrd is with the Department of Family and Preventative Medicine at the University of Utah School of Medicine.