1. English audio file (mp3 format, 42.4 MB)

Focusing on the ABC initiative, community youth leaders and scientists discussed the efficacy of abstinence and condom-use in the prevention of HIV and AIDS.  The panelists presented effective grassroots youth-led programs and scientific research and international case law for and against the use of condoms, abstinence prevention and HIV and AIDS awareness.

Sami Shawer, (Global Youth Partners), discussed the challenges of promoting HIV and AIDS awareness programs for Egyptian youth through peer training.  Shawer emphasized the success, “we are youth, but we are not too young to teach our peers.”

Jonathan Cohen, (Open Society Institute), addressed the human rights violations taking place in Uganda under the ABC program.  The presentation documented changes in sexual education materials including Ugandan government promotion of abstinence and the censorship of educational materials. The report included the following facts:

• Mrs. Janet Kataha Museveni, First Lady of Uganda offered a scholarship to girls who could prove their virginity upon graduation from secondary school. 
• Ugandan billboard slogans state, “Condoms 80% effective.  Abstinence 100% effective.”
• Testimony from Ugandan teachers stated that they were no longer allowed to teach their students how to use condoms and were instead told to encourage abstinence, marriage and fidelity.

Julie Pulerwitz, (Horizons Program), presented a study that demonstrated that both youth and adults were unclear on the definitions of “ABC.”  Study respondents perceived condoms as “immoral, ineffective and as a system that spread disease.” 

She found that:

• There is a high level of awareness of HIV and AIDS among youth and adults.
• The majority had both heard of “ABC” in context of AIDS.
• There was a low clarity of what “ABC” means.
• For abstinence, half of youth and 40% of adults were clear that this is what the “A” represents.
• For the letter “B”, 35% of youth and adults understood the meaning of being faithful and the majority confused fidelity with being kind and trusting your partner to be faithful.
• For the letter “C”, instead of defining a condom, youth gave mostly negative opinions about the ineffectiveness of this kind of prevention.  It was widely thought that condoms were immoral to use, that they broke easily and that they spread disease.

John B. Jemmott (University of Pennsylvania) presented his findings on youth prevention based on a 2 year follow up after sex education and condom-use training.  Jemmott found a negligible variation between abstinence and condom programs on the instance of early sexual debut.   

Nicoleta Manescu, (Romanian Angel Appeal) gave a presentation on the challenges in diagnosis disclosure to HIV positive teenagers.  Manescu found many HIV positive youth in Romania whose status has been kept from them by their parents due to fears of stigma and discrimination.                  

Themes:

• Youth versus Adult Leadership – some adults are uncomfortable working with youth as partners.
• Condoms are a necessary option for youth in all countries. 
• Complete information on the efficacy of condoms should be included in sex education and HIV prevention.

Quotes: 

In Uganda, “Sexually-educative materials were replaced by more ethical and moral behavior – denying youth the reality of the sexual education and knowledge about AIDS and condom use,” Jonathan Cohen.

“Many youth were told that condoms have small holes that virus can go through,” Julie Pulerwitz.

Kenyan young men believe, “the way girls dress makes it difficult to abstain,” Julie Pulerwitz.

Recommendations:

• ABCs should be clearly defined, consistent and not contradictory.
• Leadership initiatives must leverage positive views toward A and B in promotion of C.
• Youth prevention programs should barriers and include complimentary activities that enable individuals to implement ABC behaviors.
• Youth sexual education programs must be improved and offered at all levels of education.

MOAX0501  GYP Egypt: Youth-driven advocacy-based success story (Shawer S)

Importance of leadership role of youth.  Trust of adults in youth were underscored.  Need for investment in youth and advocacy programs was highlighted.  Key to empowerment of youth is access to information.

MOAX0502 Using human rights standards to assess HIV-prevention programmes for childern and youth: A case study of Uganda (Cohen J)

Based on a standard human rights analysis of a Human Rights Watch report on the expansion of an Abstinence program in Uganda.  Shifts in Uganda's response in the early 90's from ABC to AB following receipt of PEPFAR funding.  Not just droppoing condom promotion but more conservative approaches to communicating about reproductive health issues.  Empowerment of FBOs in influencing the content of school-based programs was highlighted and restrictions of the rights of young people to information.

MOAX0503  Kenyan youth understanding of ABC for HIV prevention (Pulerwitz J)

Clarity and confusion and barriers and facilitators were explored in a survey conducted in school going youth and adults.  While most had heard of ABC there was a limited understanding of "B" and "C".  This was influenced by gender and sense of fatalism.  Need for a more balanced approach to HV risk reduction was highlighted as was the importance of sources of information and perceptions of quality and trust in person providing information.

MOAX0504  Efficacy of an abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents

Intervention based on 15 years history of developing and implementing behavioural interventions.  Importance of a different mix of interventions for different target groups. 

HIV: Heavy toll on young people through sexual transmission.  Abstinence - decrease in frequency of sexual activity or delay in sexual debut.  Limited data available on the latter.  Majority of research to date has focused on increase in condom use in the context of safer sex practices.  PHAT (Promoting health among teens).  RCT: Abstinence only / safer sex / Abstinence plus safer sex / Health promotion

10 Groups, 662 African American adolescents in Philadelphia; mean age 12 years.  23% ever had sex at baseline, 84.4% retention rate at 6 months follow up.  Abstinence only arm - least likely to have sex delay in sexual debut, no effect on condom use.

MOAX0505  Challenges in diagnosis disclosure to HIV positive teenagers (Manescu N)

Infants with HIV acquired nosocomially now teenagers.  Some are sexually active. Challenge of parents disclosing the children's HIV status to them.  Children infected in 87/88 - majority of parents have not disclosed children's HIV status to them. Establishment of a multidisciplinary team to assist parents with disclosure and challenges faced highlighted.  Being a teenager is tough, being a HIV positive teenager is tougher.  Surviving infection acquired at birth or nosocomially poses most complex challenge for parents and children.

Youth and HIV: What's Sex Got to Do With It?

By Suzanne Fournier, Youth Rapporteur

The components of the ABC method of HIV prevention and the policy’s impact on the behaviour and perceptions of global youth were put under a microscope this afternoon.  Researchers presented evidence of the “phasing out” of prevention programmes promoting condoms and the alarming negative perception of condoms among youth.

1. Using human rights standards to assess HIV-prevention programs for children and youth: a case study of Uganda
Presented by Jonathan Cohen, Open Society Institute, Law and Health Project

An investigation by Human Rights Watch into Uganda’s HIV prevention policies following their implementation of the ABC approach found a disturbing shift toward “abstinence-only” messages and away from the promotion of condom use and safer sex.   These results support widespread criticism that the ABC approach is really an “AB” approach.

2. How well do Kenyan youth understand ABC messages for HIV prevention?

Presented by Julie Pulerwitz, Horizons Program/PATH, Washington DC, USA

This research highlighted the gap between delivery of the ABC message and the resulting perceptions of youth. A survey of 1400 in-school Kenyan youth found that abstinence and being faithful were perceived as positive behaviours and condom use as negative.  The negative perceptions of condoms included that they were “ineffective”, that they “break easily”, “transmit HIV”, and are “immoral”.

3. Efficacy of an abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents

Presented by John B. Jemmott III, University of Pennsylvania, Annenberg School, Center for Health Behavior and Communication, Philadelphia, USA

662 young African American adolescents were randomized into four HIV/STD risk reduction strategies; an abstinence-only intervention, a safer-sex intervention, a comprehensive safer-sex and abstinence intervention, or a health-promotion control intervention.  In a 24-month follow up period, no method was showed to be superior in delaying first sexual contact, and none resulted in a negative impact on condom use.

The highlight of the session was the criticism of PEPFAR by Jonathan Cohen of the Law & Health Initiative as he discussed the results of the Human Rights Watch study on changes in Uganda’s HIV/AIDS prevention approach.  The study found that since the adoption of the ABC strategy, it appears that condom promotion is being “phased out” through the removal of images of youth wearing condoms from educational materials in schools, and the presence of billboards promoting abstinence among women.

Presenter John B. Jemmott III of the United States admitted that he still does not know how to get people to practise abstinence and that more research on this method of prevention is needed.  A question from the audience captured the essence of the divide between advocates for abstinence and those who also believe in safer-sex strategies.  The audience member sought to clarify that PEPFAR policy is not against promoting condoms among all youth, only for youth under the age of 15.  Perhaps this audience member is unaware that people under 15 are having sex.