Programs to encourage sexual abstinence, which American conservatives see as a keystone of efforts to prevent HIV infection, fail just as much in the United States as they do in developing countries, a new study says.
Researchers reporting in Saturday's British Medical Journal (BMJ) say an overview of 13 published investigations into abstinence programs, conducted among nearly 16 000 American youngsters, found no evidence that the schemes work.
The study covered research into the performance of so-called "abstinence only" programs.
These are schemes that encourage teenagers to delay their sexual debut and not have multiple partners after they begin sexual activity.
There is no promotion of condoms or other methods of safer sex or contraception.
In contrast, "abstinence plus" programs are those that promote abstinence but also safer sex.
Abstinence programs have no effect on sexual activity
"No [abstinence only] program affected incidence of unprotected vaginal sex, number of partners, condom use or sexual initiation," says the paper, written by a trio of researchers at the University of Oxford's Centre for Evidence-based Intervention, England.
Indeed, one of the 13 trials found evidence that youngsters who had been encouraged to be abstinent had a higher rate of sexually-transmitted infections, intercourse and unwanted pregnancy than their counterparts.
This finding was not borne out by data from the 12 other trials, though.
The authors admit that their review had limitations. It did not address oral or anal sex or same-sex behaviour, and the data in the 13 trials was self-reported, which is prone to bias. Nor did any trial specifically assess incidence of the human immunodeficiency virus (HIV).
HIV not reduced by programs
Despite these weaknesses, they say, the clear picture is that abstinence-only programs in the United States have made no headway on reducing HIV risk compared with safe-sex programs - or even no programs at all.
Previous reviews about abstinence-only programs in developing countries have come to the same conclusion.
A third of funds go towards ineffective programs
At present, 33% of funds that are allocated for HIV prevention under President George W. Bush's campaign to fight AIDS in Africa and the Caribbean are used for abstinence-only programs.
In addition, the US House of Representatives has approved funding of US$141 million in fiscal 2008 for "Community-Based Abstinence Education", or CBAE, to US youth. Funding in 2007 was US$109 million.
CBAE programmes encourage abstinence from sexual activity outside marriage and describe it as the only certain way to avoid unwanted pregnancies and sexually transmitted diseases.
Abstinence programs incense many AIDS campaigners, who contend that these initiatives do not work, are often driven by political or religious agendas and drain money from more effective HIV prevention schemes. - (SAPA)
Teens not buying abstinence