Abstinence and faithfulness programmes not effective
Nearly $US1.3 billion has been spent on the promotion of abstinence and faithfulness programmes by the US President’s Emergency Plan for AIDS Relief (PEPFAR) in sub-Saharan Africa, with no significant impact on sexual behaviour, or reduction in HIV incidence. These disappointing results came from an analysis of sexual health data from 14 different countries where PEPFAR programmes are implemented, and were presented at last week’s Conference on Retroviruses and Opportunistic Infections (CROI 2015).
A research team from Stanford University School of Medicines measured the impact PEPFAR programmes focusing on abstinence and faithfulness by comparing trends in sexual behaviour derived from national demographics and health surveys in 22 countries in sub-Saharan Africa. Researchers compared trends in the number of sexual partners for both men and women, the age of first sex for both men and women, and teenage pregnancy among 14 PEPFAR programme countries and eight non-PEPFAR funded countries. By looking at trends in behaviour prior to the introduction of PEPFAR funding and after PEPFAR funding, researchers were able to analyse whether year-on-year changes were out of the ordinary, and whether shifts in behaviour either followed the long-term trend or deviated from it. The researchers found no significant change in the number of sexual partners for both men and women, the age of first sex for both men and women and the proportion of teenage pregnancies.
Funding abstinence and faithfulness programmes were believed to reduce the number of sexual partners and delay sexual debut, thus having a substantial impact on the HIV epidemic. PEPFAR therefore earmarked one-third of its funding to be spent on programmes promoting abstinence from sexual relations, delaying sexual activity and faithfulness to one partner in 2004. The current evaluation of the effectiveness of these programmes implies that the funding of these programs was not effective. Funding for PEPFAR abstinence and faithfulness programmes peaked at US$ 200 million in 2008, but has since declined to US$50 million in 2013, as money has been directed to other programmes with stronger evidence.