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ABC D isaster
Joke van Kampen
World AIDS Day
2005, along with the usual conferences, speeches and rallies around
the globe, finally brought the voices to life that point at the
failing and devastating effects of the ABC approach to HIV/AIDS
prevention. The EU (in a statement1)
and the UN (report of the Task Force on Women and Girls and HIV/AIDS
in Southern Africa 2), testimonies,
articles, and interviews, all simultaneously seem to pay attention
to at least the limitations and often the adverse effects of the
ABC (Abstain, Be faithful, use a Condom) approach.
has, at least for the time being, the power of the purse and has
by now a coca cola like coverage in Africa. It is also highly standardised
- you see the same manuals, slightly adjusted to local circumstances,
over and over again, spreading from South Africa north to the borders
of the Arab world.
Since the introduction
of ABC there has been scepticism, but almost of an apologetic sort.
What could be heard was that abstinence is "of course" the ideal
but since the reality is different, the messages should be targeting
sexually active people. All couples being faithful is "of course"
what we all would like to see, but since the reality is different,
we need to talk a lot about condoms. Over the years, the A and B
of the ABC tend to get a lot more emphasis than the C (clearly reflected
in the materials and manuals where condoms feature on the last one
or two pages of the teachers' guide). Something else also happened
in the process: a whole generation of teachers, counsellors, and
others involved in educating young people, who themselves enjoyed
an at that time unprecedented sexual freedom in their adolescent
years, are preaching abstinence without even confronting their own
history, desires and practices within what they preach.
of the content of AB is simple: the messages cannot be implemented
by substantial parts of the population, they are not geared at real
life. Abstinence is not an option for many (poor) women and being
faithful does not protect against HIV/AIDS infection. The "be faithful"
message is especially disturbing. According to research, serial
monogamy is what many young people in Africa see as desirable in
terms of relationships. But being faithful only makes sense with
regards to HIV/AIDS if you stay faithful to your first sexual partner
for the rest of your life, being his/her first and only sexual partner
as well, after having been tested and proven to both be negative.
Few people in Africa or elsewhere will spontaneously mention that
model as their ideal and even fewer will live accordingly. In a
recent survey among 15-24 year olds in Malawi, 80% of the respondents
say they are not at risk of contracting HIV/AIDS, some of them because
they are not having sex at the moment, but a substantial part say
they are not at risk because they are faithful to their sexual partner.
Being faithful is constantly mentioned in a context of HIV/AIDS
prevention and even if the information given is correct, the ABC
approach often connects being faithful to being protected against
Many of the
well intending ABC materials do pay attention to condoms, but somehow
they manage to draw a picture of using condoms as a very exotic
not to say alien habit, only fit for those who lack the self control
and values to stay safe within A and B. And man, a lot can go wrong
with condoms according to these manuals. Probably that is why they
never reveal where you can get them. Or teach girls how to negotiate
the use of condoms (they are endlessly lectured on how to say "no"
and communicators in Africa and elsewhere, precisely because ABC
has the power of the purse, agreed and implemented the ABC approach.
But from a communication point of view there is a lot more wrong
with ABC than the content of the messages alone. It is ineffective
from a communication perspective. And ABC can lead to effects that
would be comical if only the consequences were less tragic.
ABC yells one-liner
slogans at people pretending to tackle very complicated, deeply
personal and highly sensitive issues in a way that is almost offensive.
If the ABC approach is anything, it is loud and omnipresent. I belong
to none of the many target groups for HIV/AIDS prevention communication
and I live in backwater Blantyre (Malawi), but I have been monitoring
for a week and it turns out that on an average day (reading the
newspapers, listening to the radio, going to work, walking in town,
going to a bar, watching some TV), I receive at least ten HIV/AIDS
messages. Or, to be more precise, I receive nine fear-inducing,
sex-discouraging messages, and one condom promotion message (billboards
from a South Africa based condom factory read: "Studded for more
By trying to
take into account gender issues or the different positions of men
and women with regards to HIV/AIDS, ABC education is revitalising
double moral standards. Unlike South Africa, where virginity (and
virginity tests) all of a sudden are portrayed as part and parcel
of African authentic culture, virginity is not a common concept
in Malawi. More than half of the girls in a recent survey had never
heard of it.3 The ABC approach will
change that one too. In a sort of strange side effect of the abstinence
mantra, manuals on sex education linger on virginity for pages.
While virginity might seem a desirable state of being to some people,
it is as useful in HIV/AIDS prevention as advising people to stay
inside in order to reduce traffic accidents. Full blown double standards
go unchallenged in the virginity discourse, since virgins are, we
all know this, female.
The same double
standards are resulting in hilarious communication hazards. One
of the many NGOs here that were circulating messages on the occasion
of World AIDS Day published two posters here. One portraying women
in a village, pouring maize, the other portraying men drinking beer
and playing trick track (ok, let's not split hairs here). The theme
of World Aids Day being Keeping the Promise, the women on the poster
say: "I promise to be mutually faithful", the men promise "to reduce
the number of my sexual partners". Apart from the fact that it is
hard to imagine how an individual can promise to be mutual, note
that these promises, when kept, will lead to infection indeed.
these days reinforced by ABC communication, heavily blind common
sense. A 1997 Democratic Health Survey of Nicaragua states, without
raising an eyebrow, that 55% of the boys between 15 and 19 are sexually
active, while only 3% of girls in the same age group are.4
Must be very busy, those 3%. Though there has not been a DHS survey
in Malawi for some time, figures for Southern African countries
are similar. Along the same lines, in the public discourse it is
widely assumed and constantly communicated that men are having multiple
sexual partners while women get infected by being faithful to unfaithful
husbands. Might very well be, but with whom are these men having
sex? Must be with unmarried women who are all abstaining from sex
One might argue
that all this lying about the reality of people's sexual life is
rather innocent and of all times, but especially in the light of
HIV/AIDS prevention it is a serious obstacle. We are in dire need
of reliable information on what people do and don't, what they feel
and think. Without that information we will not be able to develop
prevention messages that can and will be implemented in real life.
Instead of learning how to communicate meaningfully, honestly and
openly about sexuality, ABC role-models, teaches and engrains shame,
lying and useless values.
The art of separating
the discourse from the reality has risen to high heights, both because
the ABC messages have little to do with real life and because ABC
communication in itself is full of hidden and not so hidden moral
messages on what sexuality should be (and not on what sexuality
actually is). Recent research shows once again that Malawians are
well informed on HIV/AIDS. Young people know about AIDS, they even
can reproduce words like abstinence and being faithful and they
do not change behaviour. 84% of 15-24 year olds are sexually active,
54% of men did not use a condom in their last sexual encounter,
73% of the women did not use a condom in their last sexual encounter.
70% of youths did not use a condom at sexual debut. Although using
the words abstinence and being faithful, many of them indicate they
are involved in occasional sex. 3 Clearly
the messages received by these young people are being filed somewhere,
they are being able to repeat them and to fit into the discourse,
it just does not occur to them to actually practice what they are
saying. But maybe that should not surprise us, knowing that teachers
deliver the ABC messages to them in a context where sexual abuse
by the very same teachers is widespread.
Not all of the
distorted discourse on sexuality can be assigned to the effects
of ABC of course, but ABC does nothing to clear the air, to encourage
open and frank discussion on the issues. Instead, it imposes rules
on people that many people have no intention or possibility to obey.
AIDS is in Africa
to stay, even if the epidemic stems tomorrow, AIDS will be a fact
of life for generations to come. Since this became obvious, stigma
and discrimination of people living with HIV/AIDS is getting placed
higher on the agenda. Fighting the virus within an ABC context almost
inevitably means condemning sexuality or at least a lot of sexuality
(everything before, after or outside marriage, to be precise). By
suggesting that faithful people cannot contract HIV/AIDS, the conclusion
that a person infected must be a person with bad sexual practices
and morals is almost logical. To say the least, ABC does nothing
to fight stigma and discrimination. If you look at communication
coming from organisations trying to improve the quality of life
of people living with HIV/AIDS which are using ABC in their prevention
efforts (the case with the vast majority of the many faith-based
organisations active in this field), you can see how difficult it
is to reconcile the messages. It goes like this: to get HIV/AIDS
you have to be a very bad person but once you have it you deserve
all the care and support you need. In addition, efforts to "justify"
the safeguarding of human rights of people living with HIV/AIDS
produce a constant stream of testimonies of two top models of "innocent"
HIV/AIDS survivors featuring on the one hand the raped girl and
on the other, the faithful wife.
In an advertisement
for a contest, young Malawians were asked to write songs with the
chorus starting: "A real woman waits..." (you could also write a
song on "A real man waits..." but that did not seem to inspire anyone,
no entrees received). Somehow I am sure the winning song will not
read "A real woman waits 'till the condom is in place".
Joke van Kampen
AIDS Day - EU Statement on HIV Prevention for an AIDS Free Generation
[PDF], November 24 2005.
the Future Together: Report of the United Nations Secretary-General's
Task Force on Women, Girls and HIV/AIDS in Southern Africa [PDF],
- Malawi. Baseline Report on Behaviour Issues, Mozambique and
Malawi, May 2005, presented at the Gender Workshop, 6 December
2005. For GOAL Ireland's work in Malawi, click
Action International. Condoms
Count: Report on Meeting the Need in the Era of HIV/AIDS [PDF],
2002, page 11.
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