Abstinence-only programmes 'not working'

Posted: 17 August 2007

A robust systematic review has found no evidence that sexual abstinence programmes reduce risky sexual behaviours, incidence of sexually transmitted infections, or pregnancy.

A team from Oxford University reviewed 13 US trials involving over 15,000 young people aged 10 to 21.

Seven of the trials tracked sexually transmitted infections, finding no significant short- or long-term benefit to abstinence-only programmes. None of the programmes made any significant difference in preventing pregnancy, reducing unprotected sex, or delaying sexual initiation.

Abstinence programmes are popular in the US and have supporters in the UK. A UK branch of the US Silver Ring Thing was set up four years ago to promote sexual abstinence among young people.

The latest study, published in the British Medical Journal, which included trials comparing young people attending abstinence-only programmes against those receiving no sex education, raises questions over whether they work in developed countries.

Funds from the US President's Emergency Plan for AIDS Relief (PEPFAR) can be used for abstinence-only programmes, but cannot be used for other safer sex strategies, needle exchange, or instructions for using condoms.

Researchers found none of the abstinence-only programmes had an 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.

This contrasted with programmes that promote the use of condoms which greatly reduce the risk of HIV, the BMJ reported.

Lead author Kristen Underhill said: "Our analysis suggests that abstinence-only programmes that aim to prevent HIV are not effective.

"This finding has key implications for policy and practice, especially in the USA, where abstinence-only programmes receive both federal and state funding."

Genevieve Clark, of the Terrence Higgins Trust, said: "Young people need to know that they can say no to sex, just as they need to know how to protect themselves from pregnancy or sexually transmitted infections if they decide that a sexual relationship is right for them.

"But abstinence-only programmes don't work because they provide no safety net for those young people who do have a sexual relationship - and research shows that many do."

A previous review of abstinence-only programmes in the developing world, presented at the 2006 international AIDS meeting, found little evidence that they were effective in changing sexual behaviour and preventing infection with HIV or other sexually transmitted diseases.