Abstinence-Only Sex Education Programs Not Effective at Preventing Spread of HIV in High-Income Countries, Study Says

Abstinence-only sex education programs are not effective at reducing the risk of HIV transmission in developed countries, according to a study published in the Aug. 4 issue of the British Medical Journal, the New York Times reports (Bakalar, New York Times, 8/14).

For the study, Kristen Underhill, a research officer at the University of Oxford, and colleagues searched 30 electronic databases that included information from January 1980 to February 2007. The search identified 13 abstinence-only education trials involving about 15,940 young people in the U.S. The programs aimed to prevent only HIV or both pregnancy and HIV. The trials assessed self-reported biological outcomes, such as HIV incidence and sexually transmitted infections. They also assessed self-reported behavioral outcomes, including the incidence or frequency of unprotected vaginal, anal or oral sex; incidence or frequency of any vaginal, anal or oral sex; number of partners; condom use; and sexual initiation (Underhill et al., BMJ, 8/4). Most of the programs were based in schools and directed at children in grades five through eight. One program targeted adults ages 18 to 21. There were various control groups, including those in modified programs and, in some cases, no programs at all, the Times reports.

Findings
The study found that abstinence-only programs had no significant effect in either decreasing or increasing risky behavior when compared with the control groups, the Times reports. Seven of the trials tracked STIs and found no significant short- or long-term benefit to abstinence-only sex education programs. None of the programs made any significant difference in preventing pregnancy, reducing unprotected sex or delaying sexual initiation, according to the study (New York Times, 8/14).

Conclusions
"Should the funding of abstinence-only interventions continue at its current levels, policymakers and practitioners might consider allocating more resources to methodologically rigorous evaluations with outcomes that directly indicate HIV risk," the authors wrote. The researchers also said that ongoing school-based and community-based trials will "help remedy some gaps in knowledge" about HIV prevention and that "additional trials may be necessary, particularly to assess interventions run by faith-based organizations" (BMJ, 8/4). Underhill said, "We hope our review encourages a closer look at the empirical research regarding HIV prevention programs," adding, "It appears that this evidence base is frequently neglected in debates over abstinence-based prevention" (New York Times, 8/14).

The study abstract is available online.