Expensive Worldwide Abstinence Program Did Not Prevent HIV

Abstinence and marriage fidelity programs costing 1.4 billion have not been effective when it comes to preventing HIV on a global scale, Stanford study says.

June 6, 2016

Worldwide abstinence and fidelity programs funded by the US government at a cost of $1.4 billion have failed to prevent HIV. 

The President’s Emergency Fund for AIDS Relief (PEPFAR), a worldwide initiative to rid the world of HIV and AIDS, was implemented by then US president George W. Bush in 2003. A third of its funds were required to focus on abstinence-based programs that promote abstaining from sex until marriage, limiting sexual partners and remaining monogamous. This portion of PEPFAR, which some critics said was added to appease religious conservatives, is referred to as ABC, or “Abstinence, Be faithful, Condoms.”

The ABC program has largely focused on public messaging such as billboards like one in Uganda that displays a photo of a young woman with the message, “She’s keeping herself for marriage, how about you?” beside a smiling face. PEPFAR supports AIDS prevention initiatives in Africa, India, Ukraine, Dominican Republic and Southeast Asia.

According to the Stanford University School of Medicine, such billboards have been ineffective in changing sexual behaviors or preventing teen pregnancy.

“Overall we were not able to detect any population-level benefit from this program,” Nathan Lo, a graduate student in Stanford’s School of Medicine and lead author of the study, said in a statement. “We did not detect any effect of PEPFAR funding on the number of sexual partners or upon the age of sexual intercourse. And we did not detect any effect on the proportion of teen pregnancy.”

HIV, the virus that causes AIDS, attacks cells that fight off infections in the body. HIV can be transmitted through sexual contact, blood transfusion and infected needles. If left untreated, a person with HIV eventually gets AIDS within 10 years, according to US Department of Health & Human Services (HHS). The survival rate for untreated AIDS is usually up to three years.

Worldwide, about 37 million people, almost three million of them children, are living with AIDS, according to the HHS. Most of these are in poorer countries, particularly in Sub-Saharan Africa.

In this study, Lo and team analyzed data from the Demographic and Health Surveys Program, a US-funded program that has gathered data on world health and population trends since 1984. This study covered data from 500,000 people–345,000 of them women–under the age of 30 in 22 Sub-Saharan African countries from 1998 to 2013. Of these, 14 of the countries were PEPFAR sites.

When comparing data from before and after PEPFAR began, the scientists found no decrease in the number of sexual partners among women and most men in  countries with or without the program. When it came to delaying first sexual experiences, the difference between PEPFAR and non-PEPFAR countries was less than four months. There were also no differences in the rate of teenage pregnancy.

These statistics also build upon previous studies in the US that have found no difference in the rate of teen pregnancy and sexually transmitted disease among those exposed to abstinence programs as compared to the general population, according to study senior author Dr. Eran Bendavid, an infectious diseases physician and Assistant Professor of Medicine at Stanford.

“When individuals make decisions about sex, they are not typically thinking about the billboard they may have seen or the guy who came by the village and said they should wait until marriage,” Dr. Bendavid said in the press release. “Behavioral change is much more complicated than that.”

So what does work in changing sexual behavior? One factor could be education level among women, the researchers said. Those with more education engaged in less risky behavior, according to the study.

PEPFAR’s one-third ABC requirement was removed in 2008, when the amount spent on abstinence programs was $250 million. By 2013 that number had dropped to $45 million.

“Spending money and having no effect is a pretty costly thing because the money could be used elsewhere to save lives,” Dr. Bendavid said in the release.

This study was presented February 26 at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington.

The study was funded by the Doris Duke Charitable Foundation and Stanford’s Center on the Demography and Economics of Health and Aging.

No conflicts of interest were declared.




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