Published: 6th May 2005
Dr. Trevor Stammers, Senior Tutor in General Practice at St. George’s Hospital Medical School and a leading expert in sexually transmitted infections (STIs), has dramatically challenged the government’s approach to the rapid spread of STI’s in the UK by looking at the way abstinence is working in reducing levels of infection in Uganda.
Writing in the latest edition of the Postgraduate Medical Journal Dr Stammers said: 'Uganda's 'ABC' strategy (Abstinence, Being Faithful, Condom-use) programme has led to dramatic decreases in HIV infection rates for over a decade. No country in the world has seen its HIV incidence fall through condom promotion alone. Changes in primary sexual behaviour are always present when HIV rates decline. Safer-sex is first about partner choice and then condom use, but both are important. There are valid criticisms of the ABC approach but its critics and proponents alike should work together if the Ugandan success is to be maintained and replicated in other countries.'
Few experts now dispute the overwhelming evidence from Uganda that has demonstrated both the extent and duration of the reduction of HIV infection. HIV prevalence in Uganda declined from 21.1% to 9.7% from 1991-1998 across 15 antenatal clinics, with the greatest declines amongst the younger age groups. In 21-yr-old army recruits, the decline was from 18.5% to 4% (1991-2002) and among blood donors, HIV prevalence fell from 24% to 7% (1989-1998). While there was some geographical variation, HIV prevalence fell in both urban and rural areas and in both men and women.
There also continues to be a decline in the incidence of HIV in Uganda with a 37% drop in HIV-1 incidence between the years 1995-99 compared with 1990-94 in a recently reported study. As incidence is a better measure of the future trends of the disease than prevalence, it seems likely that Ugandan HIV rates will continue to decline at least for the next few years. Little wonder then, that leading researchers of the ABC methodology claim, 'The Ugandan success is equivalent to a vaccine of 80% effectiveness. Its replication will require changes in global HIV/AIDS intervention policies and their evaluation.'
Dr Stammers concluded: 'What the ABC success surely teaches is that a range of options is now needed in the UK to help teenagers to defer sexual intercourse until they are in a secure, committed and loving relationship; to encourage faithfulness and partner reduction among the sexually active - and to promote condom use among those who engage in higher risk sex.
'The current warfare should end between those who would deny all use of condoms on religious grounds and those who decry abstinence because it cuts across their ideology of a teenager’s right to sex.
'The Chief Medical Officer maintains that there is no evidence that education programmes aimed at delaying first intercourse ('abstinence education') are effective. This research demonstrates that he is quite wrong to hold this view; it is high time the Department of Health’s STI reduction policies should be evidence-based, as opposed to simply recycling unhelpful statements that show little more than a kneejerk ideological opposition to abstinence education.
'It will take much than a liberal strewing about of condoms to reverse the tide of sexually transmitted infections currently engulfing young people in Britain'.
Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
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