Reclaiming the ABCs – The Creation and Evolution of the ABC Approach

Karen Hardee, Jay Gribble, Stephanie Weber, Tim Manchester, Martha Wood

During the 2003 State of the Union Address, U.S. President George W. Bush announced his vision for the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year Emergency Plan designed to provide $15 billion to address HIV/AIDS prevention, treatment and care, most heavily concentrated in 15 focus countries. The strategy for preventing seven million new infections focuses on sexual transmission and draws on the “ABC” (Abstain, Be Faithful, use Condoms) approach, with strong emphasis on abstinence for youth and fidelity in marriage (accompanied by testing). Consistent use of condoms is promoted for those most at risk for transmission of HIV (OGAC, 2005).

This report demonstrates that the building blocks of the ABC approach have existed for many years and were implemented in independent ways in various countries. Programs aiming to prevent the sexual transmission of HIV2 quickly promoted these three behaviors in different combinations and using different messages, as will be illustrated in this report.

This report was developed through review of the early literature on HIV/AIDS policies and programs in non-industrialized countries and of media material promoting prevention of heterosexual transmission of HIV in those countries. Material from the early days of the epidemic was difficult to obtain. Most materials were long ago archived or are in personal files in “basements” as some respondents indicated. While the report focuses on the experiences of three countries, it also examines the early responses of international organizations to HIV in many other developing countries. Additional data were obtained using a snowball sampling technique through which the authors contacted people who had worked in HIV/AIDS programs in the 1980s and early 1990s to learn more about historic HIV/AIDS prevention strategies. The pool of respondents is not intended to be exhaustive, but the respondents provide important voices of those working in the developing world at the beginning of the epidemic.


Table of Contents

Introduction & Methodology
International Organizations Respond to HIV-AIDS
USAID Responds to HIV/AIDS
The Philippines, Dr. Flavier, and International Use of “ABC”
ABC Definitions Over Time
ABC/AIDS Timeline
Tanzania and the Fleet of Hope
Various Definitions of ABC
Policy Recommendations


  • Gary Slutkin, MD, Professor of International Health and Epidemiology at University of Illinois at Chicago School of Public Health, was Medical Epidemiologist responsible for Central and East Africa in WHO/GPA from 1987-1990 and Chief, Intervention Development and Support from 1991-1994. He worked on the Uganda National AIDS Control Plan in 1998, and led all support activities in Uganda from 1987 to 1994.
  • This paper focuses on prevention programs addressing heterosexual transmission of HIV, the dominant mode of transmission in Africa and most of the developing world.
  • The HIV prevention programs of industrialized nations in the early years of the epidemic tended to be directed toward so-called high-risk populations (gay men and injection drug users); the experiences of countries such as Thailand, which did not base its early prevention strategy on an ABC approach, are also not included.