TY - JOUR
T1 - Reducing the overall HIV-burden in South Africa
T2 - Is reviving ABC an appropriate fit for a complex, adaptive epidemiological HIV landscape?
AU - Burman, Christopher J.
AU - Aphane, Marota
AU - Delobelle, Peter
PY - 2015/1/2
Y1 - 2015/1/2
N2 - This article questions the recommendations to revive ABC (abstain, be faithful, condomise) as a mechanism to educate people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, descriptive prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of dynamic prevention at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the descriptive prevention parameters can facilitate. The parameters of the descriptive prevention paradigm, that maintain-and partially reinforce-the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the descriptive paradigm, and ABC, represents an historically dislocated form of prevention-with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.
AB - This article questions the recommendations to revive ABC (abstain, be faithful, condomise) as a mechanism to educate people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, descriptive prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of dynamic prevention at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the descriptive prevention parameters can facilitate. The parameters of the descriptive prevention paradigm, that maintain-and partially reinforce-the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the descriptive paradigm, and ABC, represents an historically dislocated form of prevention-with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.
KW - anticipatory HIV literacy
KW - complex adaptive epidemiological landscape
KW - descriptive prevention
KW - dynamic prevention
KW - pattern management
UR - http://www.scopus.com/inward/record.url?scp=84929154494&partnerID=8YFLogxK
U2 - 10.2989/16085906.2015.1016988
DO - 10.2989/16085906.2015.1016988
M3 - Article
C2 - 25920980
AN - SCOPUS:84929154494
VL - 14
SP - 13
EP - 28
JO - African Journal of AIDS Research
JF - African Journal of AIDS Research
SN - 1608-5906
IS - 1
ER -