The 'ABC approach' to global HIV/Aids: good for women and girls

Donna M Hughes
11 August 2004

Since the late 1980s, I have focused on stopping the sexual trafficking of women and girls, and their exploitation and abuse in prostitution. This kind of work against the sexual victimisation of women and girls predated much of the growth of the Aids epidemic and of extensive medical knowledge about its causes. My understanding of the sex trade and its victims has been from the outset rooted in awareness of the harmful nature of sexual abuse and its injury to victims’ dignity, bodily integrity, and identity. After the Bangkok conference, openDemocracy writers debate whether United States policy on global HIV/Aids is self-interested or guided by universal values:

  • Bill Bowtell, “HIV/Aids: global policy after Bangkok” (July 2004)
  • Jeremiah Norris, “Misleading the poor isn’t a policy: a response to Bill Bowtell” (August 2004)
  • With the discovery of the Aids virus and its modes of transmission, women and girls in the sex trade were viewed as vectors of the virus. Prevention programmes targeted them in order to stop the spread of HIV to the general public. These programmes and the agencies that administered them paid little attention to the question of who infected the women and girls with HIV or to the circumstances of their lives in prostitution.

    To evaluate a new policy when it is proposed and enacted I ask two basic questions. First, is the policy good or bad for women and girls? Second, will it advance women and girls’ rights and status in society or will it limit their full emotional, intellectual, and spiritual development, either as individuals or as a group?

    In fifteen years of studying the sex trade, I have yet to find anything good about it for women and girls. Once they enter prostitution, they are consigned to an underclass. The longer they are in it, the more damage they incur, until eventually, their health, emotional resiliency, and hope for the future is destroyed. Aids is an assured death sentence to many in prostitution. To take only one example, a recent research project in South Africa revealed that two-thirds of women in prostitution in Durban are HIV-positive.

    In analysing the processes by which victims are recruited and exploited, I came to the conclusion that sex trafficking prevention programmes will not significantly reduce the supply of victims as long as there is a demand for victims. Men create a demand for victims when they purchase sex acts. Traffickers and pimps create a demand for victims when they profit from their sale and exploitation. Only by ending the demand can sex trafficking be effectively stopped.

    So, when I think about HIV/Aids policies, I consider whether they are good for women and girls, and I think about how they address the demand.

    The choice for men

    The official United States policy for Aids prevention is the “ABC approach” (Abstinence, Be faithful, otherwise use a Condom). How far does this serve a perspective that puts the interest, rights and potential of women and girls first?

    Let me start with condoms - the most effective, if not foolproof, method of preventing the transmission of HIV for sexually active people. In brothels, condoms are the logical first line of defense against the transmission of HIV. The problem I’ve identified with HIV/Aids prevention programmes is that they ignore the fact that many of the women and girls are trafficked into prostitution, meaning they are held in debt bondage and in conditions of literal slavery.

    In order to get the condoms to the women and girls, the aid workers have to establish friendly relations with the pimps and brothel-keepers, which means they can’t be advocates for those enslaved in the brothels. If they overlook enslavement, abuse, and exploitation, then condom campaigns are not good for women and girls. More women and girls will be prevented from contracting HIV and subsequently spreading it to the general public by campaigns for their liberation than by campaigns for condom distribution.

    At first, abstinence and “be faithful” seem irrelevant for policies relating to the sex trade. But when I thought about how men’s demand for commercial sex acts maintains the sex trade and its appetite for victims, I reconsidered this antediluvian term “abstinence”. Although “abstinence” isn’t in the feminist lexicon, feminists do frequently say that the lives of women and girls would be improved if men would more often just “keep it in their pants”.

    Although abstinence and fidelity may be beyond the choices of women and girls in prostitution, who are subjected to beatings and rapes if they refuse to engage in sex with men, they certainly are not beyond the choices that men could make. If men more often chose to “keep it in their pants” (i.e. be abstinent), there would be less demand for women and girls for prostitution. If men more often chose to be faithful, they would not contract HIV and transmit it to their monogamous wives, who are frequently identified as one of the fastest-growing HIV-positive subgroups. Therefore, I came to the conclusion that the ABC approach is good for women and girls.

    The benefit for women

    At the international conference on HIV/Aids in Bangkok in July 2004, a three-letter policy alternative to the ABC approach emerged: “CNN”, standing for Condoms, Needles, and Negotiation. The most that can be said for this approach is that it might, maybe, keep someone alive for another day. That’s critical for short-term crisis management, but nothing on which to base a global policy that aims to halt the spread of HIV.

    Yet some HIV/Aids prevention programmes for teenage girls do feature condoms and negotiation. Teenage girls are coached to negotiate condom use with older men, euphemistically called “sugar daddies”, who give them money and gifts. And condom use is advocated to girls engaged in “cross-generational sex”, a term taken right out of paedophile literature.

    The CNN approach offers no future for women and girls. Girls will be much better protected by accurately labeling these men’s behaviors as statutory rape and child sexual abuse. Girls should not be taught that they have to negotiate with perpetrators.

    The global sex trade is one of the greatest threats to women and girls’ well-being in the world today. The accompanying Aids epidemic has already killed many, and will continue to kill significant numbers of women and girls in prostitution. The ABC approach, particularly as it can be used to reduce men’s demand for commercial sex acts, offers more good outcomes for women and girls. It enables more women and girls to maintain their bodily integrity and not be sexually exploited. It offers more chances for women and girls to remain healthy and free to pursue their own lives. It better serves the rights and well-being of all women and girls in society.


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