文章基本信息

标题：Going Beyond “ABC” to Include “GEM”: Critical Reflections on Progress in the HIV/AIDS Epidemic
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作者：Shari L. Dworkin ; Anke A. Ehrhardt
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：1
页码：13-18
DOI：10.2105/AJPH.2005.074591
语种：English
出版社：American Public Health Association
摘要：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. MANY STUDIES HAVE sought to identify what factors accounted for substantial reductions in HIV seroprevalence in Uganda, Thailand, and other countries. A shared characteristic of these HIV/AIDS “success stories” is that these countries deployed specific combinations of “ABC” (abstinence, be faithful, condom use) strategies. 1 ^– 13 After much public discourse and research that emphasized the positive outcomes of ABC strategies, the Joint United Nations Programme on HIV/AIDS published its 2004 epidemic report. 14 The report revealed a new face of HIV/AIDS; nearly 50% of infected people worldwide were women, up from 35% in 1985. In nearly every region of the world, the number of women living with HIV/AIDS has risen, and, in most regions of the world, women and adolescent girls represent an increasing proportion of people living with HIV/AIDS. The Joint United Nations Programme on HIV/AIDS report also detailed that in several countries, 50% of new infections were occurring between spouses and that women were most often at risk from their main male partner. In the 1970s and 1980s, there was the “feminization of poverty,” a phrase used by researchers to convey that women disproportionately lived in poverty 15 ^– 17 ; similarly, we now have a “feminization of HIV/AIDS.” The evidence from these studies reinforces the necessity of placing comprehensive, long-term efforts that focus on gender relations in the forefront of the fight against HIV/AIDS. Given that the populations being affected by infection are shifting, it is more urgent than ever to press forward with approaches that are long term and gender specific and that attempt to fundamentally change the contexts in which risk occurs. In this article, we first provide a critical analysis of the limitations of ABC approaches. Next, to counter the limitations of ABC, we offer 3 additional prevention strategies that focus on gender, economics, and migration and will assist with the long-term minimization of HIV/AIDS risks. These 3 strategies provide the basis for a stronger central platform from which national efforts against HIV/AIDS can proceed to reduce transmission risks. These prevention strategies are better able to take the new face of the epidemic into account.