While HIV prevention witnesses a relentless argument pitting condoms against abstinence, the behaviour that really needs addressing – partner reduction – is largely ignored, according to the author of a Comment in this week's issue of The Lancet.
James Shelton (US Agency for International Development, Washington DC, USA) calls for an armistice in the polarised argument of condoms versus abstinence for HIV prevention and for a strong focus on partner limitation. Early evidence from Uganda is now bolstered by Kenya, where HIV incidence has been declining since the early-to-mid-1990s. Multiple partners among all men dropped substantially across the entire reproductive age range between 1993 and 2003. While these data are not proof, such a sea-change in behaviour would plausibly decisively reverse the epidemic, states Dr Shelton. He notes that South Africa has had no such reduction in HIV and no such decline in the number of partners as revealed in the survey of 2002 and 2005.
Dr Shelton concludes: "With a strong backdrop of partner limitation, condoms are a vital backstop for high-risk situations, including [HIV-]discordant couples. Abstinence efforts provide an opportunity to promote personal self-efficacy more broadly among young people, as well as fidelity and partner limitation once sexual activity commences…We need a harmonised HIV prevention strategy using all valid approaches, where partner limitation takes centre stage."
Contact: James D Shelton, Senior Medical Scientist, U.S. Agency for International Development, Bureau for Global Health, 1300 Pennsylvania Avenue NW, Washington DC 20523, USA. T) +1 202 712 0869 JShelton@USAID.GOV
Journal
The Lancet