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Low fidelity

"Low fidelity" Continued...

Issue: "Red & blue all over," Sept. 23, 2006

"The easy response to that is that the 'B' message has to be given to the man," said Ray Martin, executive director of Christian Connections for International Health. "We would acknowledge that ABC by itself doesn't work for everyone, but just because it doesn't work for everyone, doesn't mean it doesn't work for some. People act as if male behavior is a given, and we don't buy that."

At a quiet display for faith-based groups at the conference, Martin distributed a just-published primer, "The ABC Approach to Preventing the Sexual Transmission of HIV: Common Questions and Answers." Interest in the booklet was high, he said, but he and other ABC proponents remained on the fringe, as Ngozi Iwere found.

Iwere is a longtime Nigerian activist and feminist who directs the Community Life Project in Lagos. The group works with multiple community and faith-based groups to help prevent AIDS.

After making presentations at the conference, Iwere complained, "We can see all the knocks that ABC is getting, and I got really worried at this conference that we're about to throw away the baby with the bath water. People have been saying that abstinence is not realistic, and for us in Africa and at the community level, we ask, 'Realistic for whom?'"

Later, Iwere told WORLD that Toronto displayed the worst criticism of ABC she has seen so far. "I left the conference not being sure what we were going to do for sexual prevention, beyond tools such as condoms and microbicides."

Microbicides are the new rage in prevention, but are still in the early stages of research. They are products-gels, creams, and long-release sponges, for example-with chemicals that can kill the AIDS virus when applied topically. Hailed as a breakthrough for women, who could conceivably use them without their sexual partners' knowledge, microbicides are still at least four years away from public use.

That leaves what to do today in limbo, and verbal sparring such as Davis had in Toronto. When he pointed out at one session that the United States is the largest government donor of condoms in the world, one panelist wasn't convinced and responded, "U.S. government funding does not translate into an increase in condom availability in some places. Whether it's true or not, I don't know."

Davis said data-based conclusions matter more than impressions. For two years, he has handled a PEPFAR-funded youth abstinence program in four countries-Ethiopia, Mozambique, Haiti, and Nigeria. Though relatively new to ABC, he has worked on other behavior- change projects since 1983. ABC's success is not measured in all or nothing, he said. In an abstinence program, not all youth will avoid sex until marriage. But even those who delay having sex and have fewer partners can help cut the virus' transmission rate.

"I did speak up on behalf of ABC," he told WORLD about the conference. "I did not plan to, but when I heard how they were maligning the strategy-and not using scientific data to do it-I felt like I had to." He took glares, thumbs-down gestures, and a few people mouthing "Boo!" at him. In this fight, facts never seem to be enough.

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