Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Shari L Dworkin, Dec 01, 2014
  • Source
    • "Reasons brought forward to explain these modest results are related to limitations in the content, implementation and delivery of educational programmes, to disabling environments and the complex cultural embeddedness of sexual behaviours, as well as to methodological problems in the studies conducted (kippax 2003; Michielsen et al. 2010; Vanwesenbeeck 2011). Overall, the field has been criticised for wrongfully breathing 'pan-optimism' (lesko 2010) and for the incorrect underlying assumption that individual decision-making is the key site of risk minimisation and progress towards sexual health (Bromnick and Swinburn 2003; Dworkin and Ehrhardt 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Today, more than half of the world population is under the age of 25 years and one in four is under age 18. The urgency of expanding access to Comprehensive Sexuality Education (CSE) notably for children and young people in Africa and Asia is greater than ever before. However, many challenges to the implementation and delivery of CSE in resource poor settings have been identified in the literature. CSE’s effectiveness could be strongly improved if these challenges were better met. This paper aims to contribute to those much-needed improvements by sharing lessons learned from a decade of implementation of one particular CSE programme, The World Starts With Me, among various populations in 11 low income countries in Africa and Asia. The aims, content, reach and effectiveness of the programme are described. Next, the challenges for implementation and delivery at student, teacher, school and context level are discussed with reference to the wider knowledge base in this area. Finally, suggestions are provided for ways forward including the increased sensitivity of programmes for normative and practical barriers to sexual health, further advancement towards gender transformativity, a far-reaching expansion of comprehensive forms of teacher training and coaching, and a serious stepping-up of multilevel ‘whole school’ approaches.
    Full-text · Article · Nov 2015 · Sex Education
  • Source
    • "), 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). "

    Full-text · Dataset · Nov 2012
    • "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) "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Jul 2012 · Indian Journal of Community Medicine
Show more