Health programs that exclusively encourage people to abstain from sex do not seem to affect the risk of HIV infections in developed countries, according to a report in the British Medical Journal. This also calls into question the continued use of public money to fund abstinence-only programs in the United States.
Proponents of abstinence-only programs claim that sexual abstinence is the only means of preventing HIV infections, while not promoting safer sex behaviors. Its effectiveness in high-income settings remain unclear. At present, 33% of HIV prevention funds from the US President’s Emergency Plan for AIDS Relief (PEPFAR) are used for abstinence-only programs, limiting the funding available for other safer sex strategies such as condom usage.
A pre-existing review has already examined the program’s effectiveness in developing countries. This prompted researches at the University of Oxford to review 13 trials involving over 15,000 American youths to assess the effects of abstinence only programs in high-income countries. Such programs are aimed to prevent HIV infections, especially in pregnancy.
The researchers measured self-reported biological and behavioral outcomes. Study shows that the program has no beneficial effect on the incidence of unprotected sex, number of partners, condom use, sexual initiation, incidence of pregnancy, or incidence of sexually transmitted infection. The results also suggest that abstinence only programs did not increase primary abstinence, or prevention from sex, or secondary abstinence, or decreased incidence and frequency of recent sex.
Despite some study limitations, these conclusions are consistent with previous reviews that claim no evident effect of abstinence only programs in either developing countries or in the United States. The authors of the said research call for more rigorous evaluations of the programs in the future. They point out that the US Senate has agreed to extend funding of community-based abstinence education (CBAE) to $141 million that, according to the evidence presented in the study, needs to be reconsidered.
In contrast, researchers state in an accompanying editorial that programs promoting the use of condoms greatly reduce the risk of acquiring HIV, especially when these programs are culturally-tailored behavioral interventions targeting people at higher risk of HIV infection.
In view to this, they suggest that priority should be given to culturally sensitive, sex specific, behavioral interventions that target African-Americans, and Hispanic patients in clinics for sexually-transmitted infections, men who have sex with men, and adolescents being treated for drug misuse who are the highest risk of acquiring HIV.
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