Promoting Abstinence and Fidelity
Since 2004, the U.S. President’s Emergency Fund for AIDS Relief, known as PEPFAR, has supported local initiatives that encourage men and women to limit their number of sexual partners and delay their first sexual experience.
The PEPFAR program has had some demonstrated success: A 2012 study by Bendavid showed that it had reduced mortality rates and saved 740,000 lives in nine of the targeted countries between 2004 and 2008.
...But Stanford Says People Are Still Having Sex
Despite the fact that the US government has invested $1.4 billion in HIV prevention programs that promote sexual abstinence and marital fidelity, there is no evidence that these programs have been effective at changing sexual behavior.
Measuring the Program
To measure the program’s effectiveness, Nathan Lo, a Stanford MD/PhD student and lead author of the study, and his colleagues used data that examined individual and household statistics related to population, health, HIV, and nutrition. T
Essentially No Difference in Sexual Partners
Among the 345,000 women studied, they found essentially no difference in the number of sexual partners among those living in PEPFAR-supported countries compared with those living in areas not reached by PEPFAR programs.
No Difference in Teenage Pregnancy Rates
The researchers examined teenage pregnancy rates among a total of 27,000 women in both PEPFAR-funded and nonfunded countries and found no difference in rates between the two.
Changing Sexual Behavior Not Easy
Senior author Eran Bendavid, MD, commented in a prepared statement that in any setting, it is difficult to change sexual behavior. For instance, a 2012 federal Centers for Disease Control analysis of US-based abstinence programs found they had little impact in altering high-risk sexual practices in this country. “Changing sexual behavior is not an easy thing,” Bendavid said. “These are very personal decisions. 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. Behavioral change is much more complicated than that.”
Using the Money Elsewhere?
Although PEPFAR has been gradually reducing its support for abstinence and fidelity programs, the researchers suggest that the remaining $50 million or so in annual funding for such programs could have greater health benefits if spent on effective HIV prevention methods.
Such as Preventing Mother-to-Child Transmission
Dr Bendavid said the ineffective use of these funds has a human cost because it diverts money away from other valuable, risk-reduction efforts, such as male circumcision and methods to prevent transmission from mothers to their children.
The US government has invested $1.4 billion in HIV prevention programs that promote sexual abstinence and marital fidelity, but there is no evidence that these programs have been effective at changing sexual behavior and reducing HIV risk, according to a study from Stanford Medicine.
- N. C. Lo, A. Lowe, E. Bendavid. Abstinence Funding Was Not Associated With Reductions In HIV Risk Behavior In Sub-Saharan Africa. Health Affairs, 2016; 35 (5): 856 DOI: 10.1377/hlthaff.2015.082