Abstinence-only programs do not reduce HIV risk

In high income countries, programs that encourage abstinence from sex as the only method of preventing HIV infection are not effective in achieving this goal, findings from a review of trial data suggest.

As reported in this week's issue of the British Medical Journal, Dr. Kristen Underhill and colleagues, from the University of Oxford in the UK, searched 30 electronic databases to identify studies that examined the effectiveness of abstinence-only programs as a means of preventing HIV infection. Data from 13 trials, containing nearly 16,000 U.S. youth, were included in their analysis.

Compared with no program, safer sex programs, and various other control programs, the abstinence-only programs did not seem to reduce HIV risk. Specifically, abstinence-only programs did not influence the rate of unprotected vaginal sex, the number of sexual partners, condom use, or initiation of sexual activity.

In one trial, there was evidence that abstinence-only programs may have had an adverse effect. Compared with a comparison group of young people who did not participate in an HIV prevention program, abstinence-only programs were associated with a rise in sexually transmitted infections and pregnancy. Still, the authors note that other trials did not show a significant link between abstinence-only programs and these outcomes.

In another trial, there was a suggestion that abstinence-only programs may reduce levels of vaginal sex, but the follow-up period was relatively short.

"In contrast to abstinence only programs, programs that promote the use of condoms greatly reduce the risk of acquiring HIV, especially when such programs are culturally tailored behavioral interventions targeting people at highest risk of HIV infection," Dr. Stephen E. Hawes, from the University of Washington in Seattle, and colleagues note in a relate editorial.

SOURCE: British Medical Journal, August 4, 2007.