Teaching condom use as a backup to abstinence helps prevent HIV
18 September 2007
Teaching adolescents to use condoms when abstinence fails is a reasonable strategy for preventing HIV, according to a new research study in PLoS Medicine by an Oxford University team.
The same team recently published findings in the British Medical Journal that abstinence-only programmes – teaching that no sex is the best and only way to prevent HIV – do not appear to reduce risk. The findings called into question the US government’s policy of funding abstinence-only programmes.
New findings from a systematic review of many individual studies on abstinence-based programs which also teach condom use (so-called ‘abstinence-plus’ strategies) show that many of these programmes do appear to have some effect.
The ‘abstinence-only’ approach, favoured in recent years by US government-sponsored programmes, reflects the notion that teaching adolescents anything about safer sex (including condom use) might confuse them and encourage risky activity. The results from this study suggest otherwise.
Kristen Underhill, Don Operario and Paul Montgomery in Oxford University’s Centre for Evidence-Based Intervention screened over 20,000 research reports to identify 39 studies of abstinence-plus programs including more than 37,000 North American youth, typically in schools, community facilities, and healthcare settings.
They found that 23 of the 39 reports showed a beneficial effect on at least one sexual behaviour reported by the participating adolescents, including increased abstinence, more condom use, and less unprotected sex.
No report found that participants who were taught “abstinence plus” increased their risk by starting to have sex at an earlier age, or by decreasing their condom use when they did have sex.
The study also found limited evidence that some abstinence-plus programmes can reduce pregnancy rates among teens.
The findings suggest that abstinence-plus approaches do not undermine programme messages encouraging abstinence, nor does the abstinence component undermine programme messages encouraging safer sex.
Co-author Dr Paul Montgomery from Oxford University’s Centre for Evidence Based Intervention said: 'The US Senate has recently agreed to put another $141m into community-based abstinence education, and that funding is only available to abstinence-only programmes, which in view of our evidence is completely the wrong way to go.’
In a commentary accompanying the research article, HIV prevention researchers Shari L Dworkin and John Santelli point out that abstinence-plus programs have been excluded from US funding allocated for abstinence-based programs. They note that US government promotion of abstinence-only programs has created disarray in efforts to prevent HIV in developing countries.
For more information contact Kristen Underhill or Paul Montgomery, 01865 280325, kristen.underhill@socres.ox.ac.uk