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PSI's Position on the ABCs
Population Services International (PSI)
April 28, 2005

PSI promotes all the ABCs Abstinence, Be faithful and Correct and Consistent Condom Use as effective

This poster campaign from PSI/Malawi targets youth with a pro-abstinence message.

"Abstinence is the best way to prevent HIV/AIDS, STIs and unwanted pregnancy."

This poster campaign from PSI/Malawi targets youth with a pro-abstinence message.

The bottom of each poster reads, "Abstinence is the best way to prevent HIV/AIDS, STIs and unwanted pregnancy."

strategies 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 condoms.

Be Faithful:
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 use.

Latex condoms, 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 cancer.

PSI's education 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 and death.

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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