Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

15 August 2011

Tricky Terminology in HIV Prevention: "Abstinence" and "Being Faithful"

In the HIV/AIDS prevention world, terminology can be a tricky thing. Over time, certain words have taken on different implications and nuances across various communities.

Take “abstinence” and “being faithful” – two conventional HIV-prevention methods that have been the subject of a long-running debate in the public health community. These terms were at the forefront of discussion once again last month, sparked off by NAM’s new HIV prevention resource where they were at the top of the non-alphabetical list of HIV-prevention methods. NAM swiftly clarified that the order was the same as in previous printed editions, with newer sections being added in later. An organizational representative emphasized that NAM has tried to capture the pros, cons, and complexities of each prevention method and that the organization stays away from editorializing.

The debate, however, continues. Many see “abstinence” and “being faithful” as loaded with sexual morality, inextricably tangled up with conservative ideas of virtue and marriage, and reinforcing social taboos against pre-marital sex and polygamous relationships. On the other hand, in many patriarchal cultures, postponing sexual activity can actually be seen as empowering for women who are often pressurized into early sex. Similarly, remaining unmarried is not a realistic choicefor women in many countries – in such a context, reducing unsafe sex with multiple, concurrent partners would be an important aspect of HIV prevention.

A great step would be promoting the usage of alternative terms that focus on behavior rather than “values”. For instance, why not replace “being faithful” with a more neutral phrase, one that brings open, honest non-monogamous relationships within its ambit? Unfortunately, “monogamy” seems to have supporters and detractors in equally large numbers, and the same goes for “mutual fidelity”. While some see these options as objective behavioral descriptors, others perceive them as morally loaded phrases. It seems almost impossible to come up with a term that works for everyone – this is perhaps inevitable considering the widespread geographic and cultural differences within the HIV prevention community!

Of course, many people in the HIV prevention field question the very effectiveness of both these measures, making the debate even more heated. Abstinence is commonly perceived as a “failed” method, and being faithful/monogamy/mutual fidelity seems like a non-option when being married is often an independent HIV risk factor for women in many communities (conversely,others point out that the latter takes place precisely because the women’s husbands may have multiple,concurrent relationships).

The majority point of view, however, seems to be that no single option is equally valid for every person, community, or country. Offering these conventional prevention methods as part of a bouquet is valuable: they can work for people who are ready, prepared, and happy to use them consistently (like any other prevention option).

Coming soon: another “Tricky Terminology” post on the important distinction between “oral PrEP” and “microbicides” in HIV prevention discourse.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

1 comment:

  1. It's unhelpful to present any list of prevention strategies without comparing the evidence for their effectiveness AND the social and cultural factors that can make their application contextually appropriate or not.

    I actually have some time for the "ABC" formulation, though, taken as a single strategy. The conservatives saw it as positioning condom use as a last resort, after their two favourite strategies.

    But men in its target audience most likely processed it as a decision "tree", ordered by decreasing difficulty. Abstinence - yeah right! Be faithful - well, I try... Condoms - okay, THAT I can manage.