The Lancet Student

Learning our ABCs

This blog was submitted by mtkoobatian on 14th March 2012.
Tagged with HIV/AIDS, Africa, Prevention


A disease epidemic gives new meaning to the term “all options on the table” when searching for an effective solution.

 Historically, quarantine has been the worst case scenario when dealing with impossible circumstances regarding public health. Leper colonies were common during the middle ages. Dating back as far as 1663, colonial America began quarantine law to fight a smallpox epidemic.  Even in modern times federal orders of quarantine have been served; the most notable example was the case regarding Andrew Speaker, an Atlanta attorney who was diagnosed with a drug resistant strain of tuberculosis which marked the first time in nearly half a century that quarantine was used to control a potential outbreak.

 Unfortunately in some cases even exercising extremes such as quarantine will do little good; the most cited case being HIV which has been stated as the worse epidemic in history second only to the “Black Death”. Annually, HIV/AIDS claims 1.5 million lives a year. In a situation such as this the most effective method of slowing down the epidemic hinges on a targeted well-funded approach constructed by health experts and government officials.  One of these initiatives is commonly known as ABC; Abstinence, Be-Faithful & Correct use of condoms. For many this approach is extremely progressive because unlike abstinence-only education, this approach also advocates sex education including how to have safe sex and the use of birth control methods. The greatest vocal critic of this approach has historically been the Catholic Church. Pope Benedict XVI historically proclaimed “if the soul is lacking, if Africans do not help one another, the scourge [of HIV] cannot be resolved by distributing condoms; quite the contrary, we risk worsening the problem”. Archbishop Gabriel Charles Palmer-Buckle of Accra has also weighed in on the issue stating "the Catholic Church [offers] three methods to help solve this problem of AIDS in Africa: "A", abstain; "B", be faithful; "C", chastity, which is in consonance with traditional African values. Those Planned Parenthood people are only talking about condoms. By the way, they know full well that the condoms devoted to Africa are sub-standard."

A thorough study reporting the outcomes of countries adopting the ABC approach has been published in Annals of Internal Medicine entitled “The President’s Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes (PEPFAR)” . In summary it states that countries which adopted an ABC approach with funding from the PEPFAR initiative have 10.5% fewer deaths due to HIV compared to control countries (from 2004-2007). Trends dating before 2003 were not significant. Uganda which receives funding from PEPFAR is a particularly interesting case because of its precipitous drop off from 15% infection (in the 1990’s) to 5% in 2001.

In a personal discussion with a Rwandan genocide survivor who was also a Priest confirmed with me that the ABC approach has worked, continues to work and is gaining popularity in Rwanda due to its success in Uganda.  However controversial an approach such as ABC may be it can now be safely said that the ABC approach has a positive impact. From a medical perspective it is also encouraging to see that there are African countries which have taken the lead and risk adopting progressive policies such as ABC and are now reaping the benefits. The ABC approach is a fantastic example of what can occur when public health policy, proper funding and education are combined and serves as a powerful and inspirational example for those interested in pursuing public and international health.  

Maxwell Koobatian is a PhD student at the SUNY Buffalo Medical School. His research interests include the development of artificial blood vessels and their translation into medical practice. He graduated with a B.S in chemistry from UC Merced, and has been published in the journals Langmuir and Philosophical Transactions of the Royal Society Part A. Maxwell is currently a contributing writer for the SUNY Buffalo school newspaper “The Spectrum”.