No one can argue that a surefire way to prevent HIV infection is simply to avoid having sex. However, most people know—public health experts included—that preaching a life of abstinence isn’t realistic.
And yet, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) , the U.S. has invested some $1.4 billion worldwide on programs aimed to promote sexual abstinence and fidelity since 2004.
A study published May 2 in Health Affairs provides ample evidence that these programs are not effective for changing sexual behavior or reducing rates of HIV transmission and unwanted pregnancies. This study is based on data for 500,000 people in 22 different countries, some with PEPFAR abstinence programs in place between 1998 and 2013, and others without. All of the study participants were younger than age 30.
Led by researchers from the Stanford University School of Medicine, the paper looked at a number of measurements to determine how successful these programs actually were. These include the number of sexual partners reported by individuals over a 12-month period, the age at which they reported first having sex, and teen pregnancy rates.
After examining data on 345,000 women, they found there was no difference in the number of sexual partners women had who lived in PEPFAR-supported countries had versus those living in countries where these programs don’t exist. The researchers arrived at the same conclusion for the 132,000 men included in the study.
Next, they looked at data on the age of first sexual intercourse among 178,000 women and more than 71,000 men. They found only a slight difference in ages of the women who lived in countries with PEPFAR programs versus those who did not. Women who did not receive abstinence education tended to have sex just a few months before those who had access to these programs. There was no difference in the age of first sexual intercourse for men in these programs versus those who weren’t. There was also no difference in rates of teenage pregnancy in countries with PEPFAR programs versus those without.
“Changing sexual behavior is not an easy thing,” Dr. Eran Bendavid, senior writer on the study, said in a press statement. “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.”
However, the researchers did observe one notable correlation: Women with at least a primary school education were less likely to practice high-risk sexual behaviors compared to those without any education.
PEPFAR was launched in 2004 by President George W. Bush with an investment of $15 million over five years. A study conducted in 2012 suggested these program were responsible for saving lives of 740,000 people in approximately five years. However, those estimates were based on the entire PEPFAR program, not just the component that covered abstinence education.
The requirement that one-third of program’s funds be spent on abstinence education has been controversial. Some critics say focusing on abstinence would lead to a deficiency in the availability of information that could potentially save lives, such as education on how to practice safe sex and maintain one’s reproductive and maternal health.
When President Barack Obama took office he did away with the one-third requirement, though some money was still reserved for these programs. Funding for abstinence education decreased from $260 million in 2008 to $45 million in 2013.
Based on their findings, the authors of the study argue that the funding still dedicated to abstinence education programs would be more effectively applied to education on other critical sexual health topics that would save more lives and greatly reduce rates of unwanted pregnancies.