Partner reduction is crucial for balanced “ABC” approach to HIV prevention: Fig 2

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Epidemiological importance of partner reduction It seems obvious, but there would be no global AIDS pandemic were it not for multiple sexual partnerships. The rate of change of sexual partners—especially concurrent partners—is a crucial determinant in the spread of sexually transmitted infections,w3 including HIV.2 Moreover, HIV viral load and therefore infectiousness is dramatically higher during the early (acute) stage of HIV infection,3 so transmission would be particularly heightened by partner change among newly infected people. Transmission of HIV is also facilitated by the presence of other sexually transmitted infections, especially ulcerative ones.w4 Hence, increased risk of other sexually transmitted infections from multiple partnerships further magnifies the spread of HIV. ABC of sexual behaviour change A = abstinence or delay of sexual activity B = be faithful (including partner reduction and avoiding high risk partners) C = condom use, particularly for high risk sex References ↵ Green E . A plan as simple as ABC. New York Times 2003 Mar 1. ↵ Garnett GP . The basic reproduction rate of infection and the course of HIV epidemics. AIDS Patient Care STDs 1998; 12: 435–49. ↵ Pilcher CD, Tien HC, Eron JJ, Vernazza PL, Leu SY, Stewart PM, et al . Brief but efficient: acute HIV infection and the sexual transmission of HIV. AIDS (in press). ↵ Mills S, Benjarattanaporn P, Bennett A, Pattalug RN, Sundhagul D, Trongsawad P . HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups. AIDS 1997; 11(suppl 1):S43–51. ↵ Low-Beer D, Stoneburner RL . Behaviour and communication change in reducing HIV: is Uganda unique? African J AIDS Res 2003; 2: 9–21. www.hsph.harvard.edu/hcpds/PublicationsWeb/Low-Beer1.pdf (accessed 29 Jan 2004). ↵ Bessinger R, Akwara P, Halperin DT . Sexual behavior, HIV and fertility trends: a comparative analysis of six countries; phase I of the ABC study. Chapel Hill, NC: Measure Evaluation, 2003. www.cpc.unc.edu/measure/publications/special/ (accessed 29 Jan 2004). ↵ Hogle J, Green EC, Nantulya V, Stoneburner R, Stover J . What happened in Uganda? Declining HIV prevalence, behavior change, and the national response. Washington, DC: USAID, 2002. www.usaid.gov/pop_health/aids/Countries/africa/uganda_report.pdf (accessed 29 Jan 2003). ↵ Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, et al . HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS 2001; 15: 2171–9. ↵ Hearst N, Chen S . Condoms for AIDS prevention in the developing world: a review of the scientific literature. Geneva: UNAIDS, 2003. www.usp.br/nepaids/condom.pdf (accessed 29 Jan 2004). ↵ Robinson R, Mulder DW, Auvert B, Hayes RJ . Modelling the impact of alternative HIV intervention strategies in rural Uganda. AIDS 1995; 9: 1263–70. ↵ Rotello G . Sexual ecology: AIDS and the destiny of gay men. New York: Dutton, 1997. ↵ UNAIDS . Report on the global HIV/AIDS epidemic 2002. Geneva: WHO, 2002. www.unaids.org/Unaids/EN/Resources/Publications/Corporate+publications/Report+on+the+global+HIV_AIDS+epidemic+2002+.asp (accessed 30 Jan 2004). ↵ National Center for HIV/AIDS, Dermatology and STDs . Behavioral sentinel survey (BSS) V: sexual behavior among urban sentinel groups, Cambodia 2001. Phnom Penh: NCHADS, 2003. ↵ Fylkesnes K, Musonda RM, Sichone M, Ndhlovu Z, Tembo F, Monze M . Declining HIV prevalence and risk behaviors in Zambia: evidence from surveillance and population-based surveys. AIDS 2001; 15: 907–16. ↵ Agha S . Declines in casual sex in Lusaka, Zambia: 1996–1999. AIDS 2002; 16: 291–3. ↵ Mekonnen Y, Sanders E, Aklilu M, Tsegaye A, Rinke de Wit TF, Schaap A, et al . Evidence of changes in sexual behaviours among male factory workers in Ethiopia. AIDS 2003; 17: 223–31. ↵ Green EC, Conde A . Sexual partner reduction and HIV infection. Sex Trans Inf 2000; 76: 145. ↵ VanLandingham M, Trujillo L . Recent changes in heterosexual attitudes, norms and behaviors among unmarried Thai men: a qualitative analysis. Int Fam Plann Perspect 2002; 28: 6–15. ↵ Halperin DT, Padian NS, Palefsy J, Shiboski SC . High level of HIV-1 infection associated with anal intercourse: A neglected risk factor in heterosexual AIDS prevention. International AIDS Conference, Barcelona, July 2002. www.aids2002.com/Program/Viewasp?id=/TCMS_Content/Abstract/200206290751215051.xml (accessed 29 Jan 2004). ↵ Bailey RC, Plummer FA, Moses S . Male circumcision and HIV prevention: current knowledge and future research directions. Lancet Inf Dis 2001; 1: 223–31.