Africa Gives 'ABC' Mixed Grades

Former president Bill Clinton listens as Microsoft's Bill Gates speaks in their conversation session at the 16th International AIDS Conference in Toronto. (By Frank Gunn -- Associated Press)

"People who were exposed to the program had greater knowledge but were no more likely to be practicing ABCs," said Margarett K. Davis, director of the "BOTUSA" collaboration between the two countries.

There was a somewhat different result in a study of young Nigerians, ages 15 to 24, most unmarried, living in the city and working in semiskilled jobs.

People in specific neighborhoods were counseled with an ABC message as part of a seven-year project funded by the U.S. Agency for International Development and its British counterpart. Those people's attitudes and behaviors were measured before and 18 months after the intervention, and compared with those of people who were not counseled.

The uncounseled group showed no increase in condom use -- it stayed about 55 percent. In the counseled group, however, condom use by women in their last nonmarital sexual encounter rose from 54 percent to 69 percent. For men, it rose from 64 percent to 75 percent.

Stigmatizing attitudes appeared to be less common among the counseled group. More of them, for instance, said they would be willing to buy food from someone with HIV compared with those who had not gotten the prevention messages. But those were about the only differences.

"We did not see a reduction in the number of partners," said Godpower Omoregie, the researcher from Abuja who presented the findings.

A survey of 1,400 Kenyan teenagers found a fair amount of confusion about ABC's messages. About 15 percent of the girls and slightly less than half the boys had had intercourse.

Half of the teenagers could correctly define abstinence and explain why it was important. Only 23 percent could explain what being faithful meant and why it was important. Some thought it meant being honest, and some thought it meant having faith in the fidelity of one's partner. Only 13 percent could correctly explain the importance of a condom in preventing HIV infection. About half spontaneously offered negative opinions about condoms, saying they were unreliable, immoral and, in some cases, were designed to let HIV be transmitted.

"This group, at least, had very negative views about condoms," Julie Pulerwitz, who helped conduct the study for the Population Council of Washington, told the delegates.

Some critics of ABC say that some counselors use the strategy as a way to discredit condoms, not simply describe their use. The source of these youths' opinions, however, was not known.

In the Philadelphia study, 662 black students in grades six and seven were randomly assigned to get one of several sex-education messages. One emphasized abstinence only. (At the time, 23 percent had already had intercourse at least once.)

Two years later, 48 percent of the group that got abstinence-only messages had had intercourse at least once, compared with 61 percent of those who had gotten a "comprehensive" message that mentioned condoms, among other things.

John B. Jemmott III, a psychologist at the University of Pennsylvania, said those initiating sex in the abstinence-only group were just as likely to know about condoms, and to use them, as those who got the full ABC message. This curriculum for young students is being adopted for use in Kenya as part of a CDC-sponsored program, he said.