The "ABC" method of HIV prevention is failing too many women, say groups including the United Nations agency set up to fight AIDS (search).

The groups say that programs relying on abstinence, being faithful, and condom use — the so-called ABC method of prevention — don’t serve the realities of women in poor countries where the epidemic is the worst. They called for international donors and countries like the U.S. to adopt an "ABC plus" policy devoting more money to stopping unequal economic and social treatment of women and girls.

“These programs are not being implemented in a social vacuum,” says Peter Piot, MD, executive director of UNAIDS. “The simple truth is that empowering women and girls to protect themselves from HIV and AIDS is the key to turning the tide.”

Light Shines on Women for World AIDS Day

Piot’s agency released figures last week showing a sharp rise in HIV infection rates among women. They make up 49 percent of the estimated 39 million people now infected worldwide, up from 41 percent in 1998. In sub-Saharan Africa, the area hardest hit by AIDS, 57 percent of victims are now women.

The figures prompted health groups including UNAIDS to turn a spotlight on women for today’s annual observance of World AIDS day. But groups Wednesday went further, saying that the ABC policy — which by law governs billions in U.S. AIDS donations — is falling short.

“Focusing solely on personal behavior and risk does not go far enough,” says Geeta Rao Gupta, PhD, president of the International Center for Research on Women.

Abstinence is not an option for most young married women at risk of contracting HIV from promiscuous husbands, Piot says. “Being faithful depends on both partners, and imposing fidelity on your partner has its limitations.”

Economic Security as Prevention

The groups call on international donors to boost funding for HIV prevention education but also to invest in general post-primary schooling for girls as a way to encourage later marriage and reduce economic dependence on men.

That dependence can force women to accept the sexual demands of unfaithful husbands or to resort to dangerous prostitution for a source of money, Gupta says. Her group also recommends bolstering ABC programs with efforts to increase women’s ownership of assets such as land and houses.

“Economic insecurity and dependency make it more likely that women will sell or exchange sex for money, goods, or favors and less likely that they will be able to negotiate safer sex with a partner,” Gupta says.

In an editorial Wednesday,The Washington Post criticized UNAIDS for its recent focus on women, saying that programs in poor nations should continue to target specific populations at highest risk for catching and spreading HIV, including sex workers, truck drivers, and men who have sex with men.

“A sex worker, for instance, can infect hundreds of people in the course of a month; targeting a prevention message at that worker is vastly more effective than targeting it at a faithful teenage bride, however awful her predicament,” the paper writes.

Richard Feachem, executive director of the Global Fund to Fight AIDS (search), Tuberculosis, and Malaria, tells WebMD that the fund hopes to expand funding to women’s organizations and others focusing on preventing infections in women and girls.

But expanding other education or property rights in an effort to reduce women’s overall vulnerability would probably have to be left to others, he suggests.

Gupta says President George Bush’s Emergency Plan for AIDS Relief — set to send some $2.6 billion to overseas ABC programs this year — should link its donations to other U.S. programs promoting economic development, education, and employment for women.

By Todd Zwillich, reviewed by Michael W. Smith, MD

SOURCES: AIDS Epidemic Update 2004, UNAIDS and World Health Organization, Nov. 23, 2004. Peter Piot, MD, executive director, UNAIDS. Geeta Rao Gupta, PhD, president, International Center for Research on Women. Richard Feachem, executive director, Global Fund to Fight AIDS, Tuberculosis, and Malaria.