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PSI's Position on the ABCs
Services International (PSI)
April 28, 2005
all the ABCs — Abstinence, Be faithful and Correct and Consistent
Condom Use — as effective
poster campaign from PSI/Malawi targets youth with a pro-abstinence
The bottom of each poster reads, "Abstinence is the best
way to prevent HIV/AIDS, STIs and unwanted pregnancy."
for protecting against sexually-transmitted infections and unintended
pregnancies and seeks to promote them in realistic ways. PSI staff
understands that different responses are required for different
situations and designs programs that are based on evidence and local
reality. PSI has been promoting the ABCs since 1988, when it implemented
a mass media campaign promoting abstinence, fidelity and correct
and consistent condom use among adolescents and young adults in
the Democratic Republic of the Congo. A 1991 evaluation of this
campaign showed that it increased "acceptance and reported practice
of abstinence and mutual fidelity" and "knowledge, acceptance and
reported use of condoms."
Everyone agrees that if a teenager avoids sexual activity, it is
unlikely that either pregnancy or HIV infection will result. That
is, perfect abstinence is likely to be 100% effective, depending
on how abstinence is defined. The problem is achieving perfect abstinence.
PSI promotes abstinence when it's likely to happen, particularly
among young adolescents who are not yet sexually active. However,
the American Psychological Association found recently that 60% of
college students who had taken virginity pledges during their middle
and high school years had broken their vow to remain abstinent until
marriage. Furthermore, abstinence until marriage is unrealistic
in many cultures where the difference between the median age at
first sex and median age at first marriage among women is two or
more years. Data from national Demographic and Health Surveys show
this is often the case. Some young people may be convinced to return
to abstinence after having become sexually active, the so-called
"secondary abstinence," but realistic options must be provided for
the majority who will not, including information on and access to
PSI programs also promote perfect fidelity (that is, mutual fidelity
with a non-infected partner) as another highly effective method,
especially for stable and married couples. It is important to emphasize,
however, that this strategy works only if both partners are faithful
and uninfected. Some women practice mutual fidelity but their husbands
do not. In this context, fidelity is ineffective. Also, people understand
fidelity in different ways. For example, "serial monogamy" - where
a person is faithful to one person at a time but keeps changing
partners - has been cited by Zambian youth as a type of fidelity.
Obviously, this is not what most fidelity proponents have in mind.
We live in an imperfect world in which people, for many reasons,
do not or can not practice perfect abstinence or mutual fidelity.
These people, if they are sexually active, must use condoms to protect
themselves and their partners. Condoms, like seat belts and bicycle
helmets, are not 100% effective, but most reasonable people believe
them to be about 90% effective when used consistently and correctly.
Most problems with condoms are the result of inconsistent and incorrect
when used consistently and correctly, are highly effective in preventing
transmission of HIV, the virus that causes AIDS, according to the
U.S. Centers for Disease Control and Prevention. In addition, correct
and consistent use of latex condoms can reduce the risk of other
sexually-transmitted diseases such as gonorrhea, chlamydia and trichomoniasis.
Genital ulcer diseases and human papillomavirus (HPV) infections
can occur in genital areas that are not covered or protected by
a latex condom. They can also occur in areas that are not covered
or protected. Latex condoms, when used consistently and correctly,
can reduce the risk of genital herpes, syphilis, chancroid and HPV
infection, only when the infected areas are covered or protected
by the condom. In addition, the use of latex condoms has been associated
with a reduction in risk of HPV-associated diseases, such as cervical
and communication campaigns are based on the belief that young adults
and other vulnerable target groups deserve to have all the facts
as their circumstances change and they move from one phase of their
lives to another. For example, a 16-year-old virgin girl who does
not need a condom today should still have information on that risk
reduction strategy as it may well protect her from HIV infection
when she is 19. Similarly, a sexually active 25-year-old man engaged
to be married needs to know the benefits of mutual fidelity so that
he can protect his prospective bride and himself from future illness
It is not a
question of Abstinence vs. Condoms as is often the case. All three
elements must be promoted together to provide maximum protection
to those at risk. Each of these strategies — abstinence, fidelity
and condoms — are often applied imperfectly, but the answer is not
to throw out any of these strategies but to ensure that people at
risk have access to quality information on all three strategies
and, in the case of condoms, to product so that people come as close
as possible to achieving perfect application of their chosen strategy.
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