"Abstinence-Plus" Programs Can Reduce Risky Sexual Behaviors in Youth

There is no evidence that programs promoting safer sex measures along with sexual abstinence lead to more sexually transmitted infections (STI), according to a new review of studies comprising nearly 40,000 young people.

Some supporters of abstinence-only programs have suggested that the safer-sex component of abstinence-plus programs might increase the incidence of STI.

However, those who enroll in these “abstinence-plus” programs are less likely to engage in risky behaviors such as unprotected sex, at least for a few months after the program.

The review is the first to focus on the role of such programs in HIV prevention in high-income countries such as the United States. The results suggest, “Abstinence-plus interventions do not significantly exacerbate sexual behaviors and might reduce risk for HIV transmission,” among participants, said co-author author Don Operario, Ph.D., of Oxford University in England.

The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Unlike abstinence-only programs, which offer abstinence as the only way to reduce the risk of sexual infection, abstinence-plus programs offer a “pyramid” of choices, suggesting that abstinence is the safest choice, followed by safe sex practices.

In part, the reviewers decided to look at abstinence-plus programs because they are “politically important” and “have important and promising implications for improving the health of young people,” particularly in the United States where the programs are popular and widespread, Operario said.

In a 2006 U.S. survey, 82 percent of participants said they would prefer programs that included some discussion of safe sex practices along with abstinence information.

"Abstinence-only programs, while a priority of the federal government, are supported by neither a majority of the public nor the scientific community," said Amy Bleakley, Ph.D., a public health researcher at the University of Pennsylvania who led the survey group.

Operario and colleagues examined 39 studies that included 37,724 participants. The majority of the programs took place in schools and community centers.

Most of the studies seemed to have some effect on self-reported risky sexual behaviors, lowering rates of unprotected sex, early sexual activity and sex with casual partners, among other risks.

Still, none of the studies included medical tests for sexual transmitted infections, including HIV or pregnancy, “which reflects a limitation of current research in this area,” said Operario.