Going beyond “ABC” to include “GEM”: critical reflections on progress in the HIV/AIDS epidemic

HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY 10032, USA.
American Journal of Public Health (Impact Factor: 4.55). 02/2007; 97(1):13-8. DOI: 10.2105/AJPH.2005.074591
Source: PubMed


A considerable number of studies have sought to identify what factors accounted for substantial reductions in HIV seroprevalence after several countries deployed "ABC" (abstinence, be faithful, condom use) strategies. After much public discourse and research on ABC success stories, the Joint United Nations Programme on HIV/AIDS 2004 epidemic report indicated that nearly 50% of infected people worldwide were women, up from 35% in 1985. In light of the feminization of HIV/AIDS, we critically assess the limitations of ABC strategies. We provide 3 additional prevention strategies that focus on gender relations, economics, and migration (GEM) and can speak to the new face of the epidemic. Pressing beyond ABC, GEM strategies provide the basis for a stronger central platform from which national efforts against HIV/AIDS can proceed to reduce transmission risks.

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Available from: Shari L Dworkin, Dec 01, 2014
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    • "), there is a dire need to institute universal, comprehensive HIV-prevention strategies to avert new HIV infections. But HIV-prevention efforts in southern Africa, in particular, have been less than successful (Dworkin & Erhardt, 2007). "
    • "Gangakhedlkar et al. showed high prevalence of HIV infection among females in general population, who were previously considered as a low-risk group in India.(6) Recent surveillance data indicate that HIV epidemic is increasingly feminizing in India like in many other African countries.(7–9) Most Indian females acquire HIV from their husbands as 90% of infected women reported to be married and monogamous.(10–12) "
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    ABSTRACT: Clinico-epidemiological profile of the Human immunodeficiency virus (HIV) epidemic in India is varied and depends on multitude of factors including geographic location. We analyzed the characteristics of HIV-infected patients attending our Immunodeficiency Clinic to determine any changes in their profile over five years. A retrospective observational study. The study sample included all patients with HIV infection from January 1, 2003 to December 31, 2007. Diagnosis of HIV was made according to National AIDS Control Organization guidelines. Of 3 067 HIV-infected patients, 1 887 (61.5%) were male and 1 180 (38.5%) were female patients. Mean age of patients was 35.1 ± 9.0 years. Majority (91.8%) of patients were in the age group of 15 to 49 years. Progressively increasing proportion of female patients was noted from year 2004 onward. Median CD4 count at presentation in year 2003 was 197/μl (Interquartile range [IQR] = 82.5-373) while in year 2007 it was 186.5/μl (IQR = 86.3-336.8). Mean CD4 count of male patients was 203.7 ± 169.4/μl, significantly lower as compared with female patients, which was 284.8 ± 223.3/μl (P value ≤0.05). Every year, substantial proportions of patients presenting to clinic had CD4 count<200/μl indicating advanced disease. Predominant route of transmission was heterosexual in 2 507 (81.7%) patients. Tuberculosis and oropharyngeal candidiasis were the most common opportunistic infections (OIs). Cryptococcal meningitis was the most common central nervous infection. Our patients had comparatively lower median CD4 counts at the time of presentation with various OIs. Patients had advanced stage of HIV infection at the time of presentation throughout five years. Females presented earlier during the course of HIV infection. There is need for early screening and increasing awareness in healthcare providers to make a diagnosis of HIV much sooner.
    Indian Journal of Community Medicine 07/2012; 37(3):158-64. DOI:10.4103/0970-0218.99914
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    • "In southern Africa two critical structural drivers of HIV for young people are gender inequalities [16,20] and livelihood insecurity [11,21,22], and specifically how these two factors intersect [8,19,23]. Interventions are increasingly seeking to modify these structural factors as a pathway towards HIV prevention [17,19,24]. "
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    ABSTRACT: Young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities. We searched key academic data bases to identify interventions that simultaneously sought to strengthen people's livelihoods and transform gender relationships that had been evaluated in southern and eastern Africa. Our initial search identified 468 articles. We manually reviewed these and identified nine interventions that met our criteria for inclusion. We clustered the nine interventions into three groups: microfinance and gender empowerment interventions; supporting greater participation of women and girls in primary and secondary education; and gender empowerment and financial literacy interventions. We summarise the strengths and limitations of these interventions, with a particular focus on what lessons may be learnt for young people (18-24). Our review identified three major lessons for structural interventions that sought to transform gender relationships and strengthen livelihoods: 1) interventions have a narrow conceptualisation of livelihoods, 2) there is limited involvement of men and boys in such interventions, 3) studies have typically been done in stable populations. We discuss what this means for future interventions that target young people through these methods.
    Journal of the International AIDS Society 06/2012; 15 Suppl 1(3Suppl 1):1-10. DOI:10.7448/IAS.15.3.17362 · 5.09 Impact Factor
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