Promoting abstinence, fidelity for HIV prevention is ineffective, Stanford study finds

http://www.eurekalert.org/pub_releases/2016-05/sumc-paf042716.php

Public Release: 2-May-2016
Promoting abstinence, fidelity for HIV prevention is ineffective, Stanford study finds
Stanford University Medical Center

The U.S. government has invested $1.4 billion in HIV prevention programs that promote sexual abstinence and marital fidelity, but there is no evidence that these programs have been effective at changing sexual behavior and reducing HIV risk, according to a new Stanford University School of Medicine study.

Since 2004, the U.S. President's Emergency Fund for AIDS Relief, known as PEPFAR, has supported local initiatives that encourage men and women to limit their number of sexual partners and delay their first sexual experience and, in the process, help to reduce the number of teen pregnancies. However, in a study of nearly 500,000 individuals in 22 countries, the researchers could not find any evidence that these initiatives had an impact on changing individual behavior.

Although PEPFAR has been gradually reducing its support for abstinence and fidelity programs, the researchers suggest that the remaining $50 million or so in annual funding for such programs could have greater health benefits if spent on effective HIV prevention methods.

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"Overall we were not able to detect any population-level benefit from this program," said Nathan Lo, a Stanford MD/PhD student and lead author of the study. "We did not detect any effect of PEPFAR funding on the number of sexual partners or upon the age of sexual intercourse. And we did not detect any effect on the proportion of teen pregnancy.

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Senior author Eran Bendavid, MD, said the ineffective use of these funds has a human cost because it diverts money away from other valuable, risk-reduction efforts, such as male circumcision and methods to prevent transmission from mothers to their children.

"Spending money and having no effect is a pretty costly thing because the money could be used elsewhere to save lives," said Bendavid, an assistant professor of medicine at Stanford.

PEPFAR was launched in 2004 by President George W. Bush with a five-year, $15 million investment in global AIDS treatment and prevention in 15 countries. The program has had some demonstrated success: A 2012 study by Bendavid showed that it had reduced mortality rates and saved 740,000 lives in nine of the targeted countries between 2004 and 2008.

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The one factor that the researchers found to be clearly related to sexual behavior, particularly in women, was education level. Women with at least a primary school education had much lower rates of high-risk sexual behavior than those with no formal education, they found.

"One would expect that women who are educated have more agency and the means to know what behaviors are high-risk," Bendavid said. "We found a pretty strong association."

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