Reframing ABC prevention: the value of ethnographic research in creating culturally relevant HIV programs in Belize

Abstract

Since its emergence in 1983, public health professionals have been working to effectively prevent the transmission of HIV. The ABC method or prevention, referring to promotion of abstinence, condoms and being faithful, has been employed extensively throughout sub-Saharan Africa. Contrastingly, the Belizean epidemic has received very little attention from ABC researchers. Although some research exists looking into the determinants of sexual HIV transmission in Belize, very little is understood about the cultural norms that perpetuate these factors. In order to make recommendations for the efficient implementation of ABC programs in Belize, case studies from Botswana, Zaire and Uganda will be used to review past experiences of ABC in Africa, and identify the cultural challenges faced in their implementation. Case studies found that programs that relied heavily on abstinence and condom promotion did not work well in these contexts due to opposing views of sexuality, while balanced programs that emphasized being faithful were more successful within these cultures. Ethnographic research is needed to fill knowledge gaps regarding Belizean sexuality. Namely, future research should seek to understand the male view of sexuality in particular, as well as differences in generational views of sex. Public health workers should also aim to create programs that engage the community in order to build trust, as well as understand the role of community leaders and celebrities in influencing local views of sex. These insights provide future researchers a starting point for building effective ABC programs that work within the given culture rather than against it.