Abstinence-only programs for HIV infection prevention in high-income countries

University of Oxford, Oxford, England, United Kingdom
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2007; 2008(4):CD005421. DOI: 10.1002/14651858.CD005421.pub2
Source: PubMed


Abstinence-only interventions promote sexual abstinence as the only means of preventing sexual acquisition of HIV; they do not promote safer-sex strategies (e.g., condom use). Although abstinence-only programs are widespread, there has been no internationally focused review of their effectiveness for HIV prevention in high-income countries.
To assess the effects of abstinence-only programs for HIV prevention in high-income countries.
We searched 30 electronic databases (e.g., CENTRAL, PubMed, EMBASE, AIDSLINE, PsycINFO) ending February 2007. Cross-referencing, handsearching, and contacting experts yielded additional citations through April 2007.
We included randomized and quasi-randomized controlled trials evaluating abstinence-only interventions in high-income countries (defined by the World Bank). Interventions were any efforts to encourage sexual abstinence for HIV prevention; programs that also promoted safer-sex strategies were excluded. Results were biological and behavioral outcomes.
Three reviewers independently appraised 20,070 records and 326 full-text papers for inclusion and methodological quality; 13 evaluations were included. Due to heterogeneity and data unavailability, we presented the results of individual studies instead of conducting a meta-analysis.
Studies involved 15,940 United States youth; participants were ethnically diverse. Seven programs were school-based, two were community-based, and one was delivered in family homes. Median final follow-up occurred 17 months after baseline. Results showed no indications that abstinence-only programs can reduce HIV risk as indicated by self-reported biological and behavioral outcomes. Compared to various controls, the evaluated programs consistently did not affect incidence of unprotected vaginal sex, frequency of vaginal sex, number of partners, sexual initiation, or condom use. One study found a significantly protective effect for incidence of recent vaginal sex (n=839), but this was limited to short-term follow-up, countered by measurement error, and offset by six studies with non-significant results (n=2615). One study found significantly harmful effects for STI incidence (n=2711), pregnancy incidence (n=1548), and frequency of vaginal sex (n=338); these effects were also offset by studies with non-significant findings. Methodological strengths included large samples, efforts to improve self-report, and analyses controlling for baseline values. Weaknesses included underutilization of relevant outcomes, underreporting of key data, self-report bias, and analyses neglecting attrition and clustered randomization.
Evidence does not indicate that abstinence-only interventions effectively decrease or exacerbate HIV risk among participants in high-income countries; trials suggest that the programs are ineffective, but generalizability may be limited to US youth. Should funding continue, additional resources could support rigorous evaluations with behavioral or biological outcomes. More trials comparing abstinence-only and abstinence-plus interventions are needed.

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    • "We could not conduct any subgroup analyses for the relative effectiveness of integrated and non-integrated delivery strategies in our review since all the studies were delivered in non-integrated manner. Existing systematic reviews on community-based HIV/AIDS prevention and control programs are limited in their scope as they either evaluate the effectiveness of a single intervention, or interventions targeted at a specific population group [38-43]. "
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    ABSTRACT: In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.
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    • "Unfortunately, the current Sexual Offences Act [6] may inhibit such comprehensive services and may serve as a barrier to adolescent help-seeking. Abstinence-only education has been shown to be ineffective in delaying sexual debut, reducing sexual risk behaviour, or reducing the risk of HIV infection, whereas comprehensive sex education programmes have shown an increased likelihood in delaying sexual initiation and reduced likelihood of teen pregnancy [46-49]. Awareness or knowledge alone is unlikely to result in behaviour change [1]; therefore, a comprehensive sex education programme should include sexual decision-making and negotiation skills and opportunities for adolescents to critically examine and challenge social scripts and peer pressures related to the whole spectrum of sexual behavior as well as the multiple motivations related to having sex or not having sex. "
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    Full-text · Article · Jul 2013 · BMC International Health and Human Rights
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    • "As a result, funding for a particular type of intervention comes in waves, driving several providers into that direction, irrespective of original priorities. For example, the "Abstinence, Be faithful, use a Condom" (ABC) campaign has gained a lot of popularity, esteem and funding in recent years, even though abstinence has not proven to be an effective means of HIV prevention [75]. "
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