06 Aug 07

A study by Oxford University shows that educational programmes for young people, which solely promote abstinence as a way of preventing HIV infection, are not effective. Researchers concluded that abstinence-only programmes were no more effective than usual services or no treatment at all in preventing HIV infection. The study, published in this month's British Medical Journal, calls into question whether state and federal funding for such programmes in the United States could be better spent.

This is the largest review of abstinence-only programmes to be carried out in a high-income country. The researchers looked at 13 abstinence-only programme trials across the United States, involving nearly 16,000 young people aged between 10 and 21 years old. The findings were based on their self-reported biological and behavioural outcomes. They found that none of the abstinence-only programmes had a significantly helpful effect on the participants: on their age on losing their virginity; whether they had unprotected sex; condom use; number of sexual partners; incidence of sexually transmitted diseases; or incidence of pregnancy.

One trial did show a short-term benefit: when interviewed by researchers, participants reported that they were less likely to have had sex in the month following one abstinence-only programme. This finding was offset, however, by six other trials that showed the programmes had no effect on the participants' recent sex lives. Another trial showed that participants in abstinence-only programmes were significantly more likely to report pregnancy and sexually transmitted disease, compared to participants using the usual services. This finding was also countered by other studies, however, suggesting there were no significant effects.

Some researchers have suggested that abstinence-only programmes have a better chance of influencing behaviour in high-income countries. This hypothesis comes from the idea that high-income settings often have greater gender equality, possibly giving women more ability to refuse sex. While this review was unable to investigate different sub-groups based on socio-economic status within high-income countries, this latest research suggests that abstinence-only programmes are not generally effective in high-income settings. These results follow a previous review of abstinence-only programmes in developing countries, which has also shown no effect.

Lead author Kristen Underhill, from Oxford University's Department of Social Policy and Social Work, said: ' Our analysis suggests that abstinence-only programmes that aim to prevent HIV are not effective among US youth. It is difficult to tell how these results might extend to all other high-income countries, although abstinence-only programmes do appear to be less popular outside the US.

'This finding has key implications for policy and practice, especially in the US, where abstinence-only programmes receive both federal and state funding. There are recent signs that the US Congress may be re-considering some federal funds for abstinence-only education, and we hope that our review can make a contribution to this discussion.'

Co author Dr Paul Montgomery, from the Department of Social Policy and Social Work, said: 'The US Senate has agreed to extend funding of community based abstinence education (CBAE) to $141m, which in view of our evidence needs to be reconsidered. We would argue that contrary to the National Abstinence Education Association, who believe that August is the 'perfect' opportunity to encourage support for abstinence education, now is the time to reflect on the evidence.'

The research paper 'Sexual abstinence only programmes to prevent HIV in high-income countries: systematic review' by Kristen Underhill et al is published online at www.bmj.com