The Fidelity Fix

The New York Times > Magazine: "hy is it so hard to loosen the grip of AIDS on southern Africa? H.I.V.-prevention programs in that part of the world have been under way for years -- there have been campaigns to raise awareness about AIDS and to promote the use of condoms; clinics have been established to conduct H.I.V. testing and to treat sexually transmitted diseases that may accelerate the spread of H.I.V.; more recently, schoolchildren have been taught the benefits of abstinence -- and yet the virus continues to spread. About a third of all sexually active adults in Botswana and South Africa carry H.I.V., a rate nearly 10 times higher than almost anywhere in the world outside Africa. These prevention efforts have been sensible -- abstaining from sex or using condoms consistently do prevent H.I.V. infection -- but their effects have been disappointing.

There is another way to reduce the spread of H.I.V. -- one that is increasingly recognized by public-health experts but that has been relegated, thus far, to an afterthought: fidelity -- either in marriage or in a committed relationship. As experts come to understand more about the African AIDS epidemic, it seems clear that regular sexual contact with more than one person is the key human behavior that enables the rapid spread of H.I.V. Since 2002, international organizations have promoted an approach called ''A.B.C.,'' which stands for abstain, be faithful, use condoms."