Abstinence only sex programmes - a waste of government money?

The latest research confirms and supports earlier work which has stated that programmes which exclusively advocate abstinence from sex in order to stop risky sexual behaviour or help in the prevention of unwanted pregnancy, are ineffective.

The researchers from Oxford University in the UK found abstinence only sex programmes had no negative or positive impact on the rates of sex infections or unprotected sex and did not appear to affect the risk of HIV infection in high income countries.

The Oxford team reviewed 13 U.S. trials involving over 15,000 people aged 10 to 21 and their conclusions question the continued use of public money to fund abstinence only programmes especially in the United States.

Abstinence only programmes encourage sexual abstinence as the exclusive means of preventing HIV infection, without promoting safer sex behaviours, but their effectiveness in high income settings has been unclear.

Abstinence-only programmes are very popular in the U.S. and also have their supporters in the UK, but such programmes fail say experts because they provide no safety net for young people who do have a sexual relationship, which many do.

A third of President Bush's HIV budget for AIDS Relief (PEPFAR) is given to abstinence only programmes which severely limits the funding available for other safer sex strategies.

The study, which included trials comparing young people attending abstinence-only programmes to those receiving no sex education, raises questions over whether they work in developed countries.

The researchers found that none of the abstinence-only programmes had any impact on the age at which individuals lost their virginity, whether they had unprotected sex, the number of sexual partners, the rates of sexually transmitted diseases or the number of pregnancies.

An earlier review had already examined programme effectiveness in low income countries, which led the University of Oxford researchers to review 13 trials involving over 15,000 U.S. youths in order to assess the effects of abstinence only programmes in high income countries.

The programmes aimed to prevent HIV infection or HIV and pregnancy and measured self reported biological and behavioural outcomes such as sexually transmitted infection, pregnancy, frequency of unprotected sex, number of partners, and sexual initiation.

It was found that when compared with various controls, no programme had a beneficial effect on the incidence of unprotected vaginal sex, the number of partners, condom use, sexual initiation, incidence of pregnancy, or incidence of sexually transmitted infection.

In contrast to abstinence only programmes, programmes that promote the use of condoms greatly reduce the risk of acquiring HIV, especially when such programmes are culturally tailored behavioural interventions which target people at the highest risk of HIV infection.

The researchers suggest that in the U.S. priority should be given to culturally sensitive, sex specific, behavioural interventions that target Black and Hispanic patients in clinics for sexually transmitted infections, men who have sex with men, and adolescents being treated for drug misuse who are at highest risk of acquiring HIV.

Lead author Kristen Underhill says compared to programmes that promote the use of condoms, which greatly reduce the risk of HIV, abstinence-only programmes that aim to prevent HIV are not effective.

Underhill says the finding has key implications for policy and practice, especially in the U.S., where abstinence-only programmes receive both federal and state funding.

The research is published in the British Medical Journal.

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