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The ABCs of HIV Prevention in Men: Associations With HIV Risk and Protective Behaviors

Steele, Matthew S MPH, PhD*; Bukusi, Elizabeth MBChB, MMed (ObGyn), MPH, PhD†‡; Cohen, Craig R MD, MPH§; Shell-Duncan, Bettina A PhD; Holmes, King K MD, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2006 - Volume 43 - Issue 5 - p 571-576
doi: 10.1097/01.qai.0000243098.72770.9b
Epidemiology and Social Science

Objective: To elucidate associations between beliefs in abstinence, fidelity, and condom use (the “ABCs” of preventing HIV and other sexually transmitted infections) and associated self-reported risk behaviors among Kenyan men.

Methods: We assessed associations of beliefs in the ABCs with sociodemographic characteristics and sexual risk behaviors in a respondent-driven sample of 500 men in Nairobi.

Results: Younger age, single marital status, and higher education were associated with beliefs in abstinence and condom use as “best” prevention methods; and older age and marriage were associated with belief in fidelity. Many of these and other associations persisted in multivariate models. Men citing abstinence or fidelity belief less often reported sex with a female sex worker (FSW) ever or recent concurrent partnerships less often. Belief in fidelity was negatively associated with reported use of condoms ever. Belief in condom use to prevent HIV was most common among those having recent concurrent partnerships.

Conclusions: Beliefs in abstinence, fidelity (“being faithful”), or condom use were associated, in plausible directions, with life stages and other demographic factors and with corresponding risk and preventive behaviors. Context-specific and selective educational promotion of individual ABC components rather than comprehensive education from an early age in a wide repertoire of prevention strategies ignores the evolution of sexual behaviors and the relative utility of different approaches throughout the life course.

From the *Program for Appropriate Technology in Health (PATH), Seattle, WA; †Kenya Medical Research Institute, Nairobi, Kenya; ‡Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; ‡Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; ‖Department of Anthropology, University of Washington, Seattle, WA; and ¶Department of Medicine, University of Washington, Seattle, WA.

Received for publication July 14, 2005; accepted July 27, 2006.

C. R. Cohen's current address is Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco, San Francisco, CA.

Supported in part by the Fogarty International Center International AIDS Research and Training Program (FIC T22TW00001), the University of Washington Center for AIDS Research (AI27757), and the National Institutes of Health (grant P30-AI-27757).

Reprints: King K. Holmes, MD, PhD, University of Washington Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.