Abstinence and Delayed Sexual Debut
What We Know
Summaries of Research Articles
Gender Factors Associated with Sexual Abstinent Behavior of Rural South African High School Going Youth in KwaZulu-Natal, South Africa
Health Education Research (2009), Vol. 24 No. 3, pp. 450-460
Dlamini, S., et al.
The study of ninth grade students in rural South African high schools investigated the prevalence of sexual abstinence among rural KwaZula-Natal fourteen to twenty year old youth. The study analyzed gender perception about abstinence and motivating factors in abstaining from sex, and found that students who practiced abstinence were more likely to be younger females who also drank less alcohol. Girls who abstained from sex tended to believe that their friends and parents wanted them to abstain; that their friends also abstained from sex, and that abstinence helped them to mature emotionally. Abstaining girls tended to feel more confident than non-abstaining girls about saying no to sex when their partner pressured them. Abstinent boys expressed intentions to abstain from sex until marriage. The authors conclude that programs need to consider developing different abstinence activities for boys and girls. Programs that target and encourage females to abstain should focus on social influences, which include perceptions of friends and parents about abstinence from sex, parental support, and intervening early before the age of sexual initiation. For males, activities should include skills on resisting pressure to have sex and also changing and creating positive attitudes towards sexual abstinence.
Trends in HIV infection: Prevention-related attitudes and behaviors among secondary school students in western Uganda
Journal of Acquired Immune Deficiency Syndromes (2007), Vol. 44 No. 5, pp. 586-593
Kilian, A. H., et al.
The study tracked western Ugandan youths’ trends specific to HIV and AIDS prevention behaviors between 1995 and 2001. Data were collected annually from schools from three districts using a self-administered questionnaire. A cross-sectional sample of students from these schools was selected each year to obtain a generalized representation of youth in the area. For the study, fifteen students were randomly selected. It was found that ever use of condoms increased from the1995 to 1996 school year to the 2000 to 2001 school year (49 percent versus 73 percent). Abstinence increased more among males than females. During this period, females reported fewer partners compared to their male peers. These positive behavioral changes in regional youth could help explain this group’s reduction of HIV and AIDS prevalence.
Abstinence-only programs for HIV infection prevention in high-income countries
Cochrane Database System Review (2007), Vol. 4 No. 4, pp. 266-273
Underhill, K., Operario, D. & Montgomery, P.
This paper reviewed abstinence-only programs for HIV-prevention in high-income countries to assess their effectiveness. In the final analysis, thirty electronic databases were utilized in the review and evaluations that employed randomized and quasi-randomized methods. The researchers considered 20,070 records and 326 papers for inclusion in the final review; thirteen evaluations met all of the criteria. Self-reported data from abstinence-only program participants showed no affect on behavioral or biological outcomes such as sexual initiation or frequency of vaginal sex. The author’s concluded that abstinence-only programs show no evidence in decreasing HIV risk in participants.
Human rights, cultural, and scientific aspects of abstinence-only policies and programs
Sexuality Research & Social Policy (2008), Vol. 5 No. 3, pp. 1-70
Kirby, D.
This article reviews 56 studies that assessed the impact of abstinence-only education on adolescent sexual behavior in the United States. Eight studies assessed a total of nine abstinence programs, and 48 studies assessed comprehensive programs. Comprehensive programs included curricula addressing delay in sexual debut, and increase in use of condoms and contraceptives among youth. Study results indicate that most abstinence programs did not delay initiation of sex and only three of nine had any significant positive effects on any sexual behavior. In contrast, about two-thirds of comprehensive programs showed strong evidence that they positively affected young people’s sexual behavior, including both delaying initiation of sex and increasing condom and contraceptive use among vulnerable youth. The author suggests disseminating comprehensive sex and STI/HIV education programs rather than replicating abstinence-only programs.
An evaluation of the effectiveness of a peer sexual health intervention among secondary-school students in Zambia
AIDS Education and Prevention (2002), Vol. 14 No. 4, pp. 269–281
Agha, S.
This study, implemented by the Society for Family Health (SFH), explored changes in knowledge and normative beliefs about abstinence and condoms, and in personal HIV risk perception among Zambian secondary-school students. Trained peers conveyed factual information through didactic sessions; and modeled behavior through skits in a 105-minute class-based sexual health program. The peer-delivered approach helped students talk with trained peers about abstinence and condom use. After a follow-up assessment, students in the program group had greater knowledge and positive normative beliefs about abstinence and condoms. Additionally, students in program schools had higher personal perceived risk of getting HIV. Although the study did not measure actual behaviors, the program was effective in increasing knowledge, positive normative beliefs about abstinence and condoms, and personal risk perception.
Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data
The Lancet (2006), Vol. 368 No. 9549, pp. 1788-93
Cleland, J. & Ali, M. M.
In this secondary analysis of public-access data in 18 African countries, the authors examined abstinence, contraceptive use, and condom use between 1993 and 2001 among young single African women. The analysis found little change in the percentage of women reporting to be virgins. However, the percentage of sexually experienced women reporting no sexual intercourse in the previous three months (secondary abstinence) increased significantly in seven of the countries, and the median percentage of women reporting secondary abstinence increased for all countries (43.8 percent to 49.2 percent). Condom use for contraception increased in thirteen countries, and the median percentage of women using condoms for pregnancy prevention rose from 5.3 percent to 18.8 percent. In summary, the reported increase in condom use was greater than the increase in abstinence, though an increase in secondary abstinence could have signified a change in sexual partner selection. The authors noted that the period of data analysis pre-dated the wide-scale implementation of abstinence messages. They also underscored the variation in the prevalence of virginity, and noted that diversity of societal attitudes toward abstinence would affect the acceptance of such messages.
Sexual Behavior, HIV and Fertility Trends: A Comparative Analysis of Six Countries: Phase I of the ABC Study
USAID-funded MEASURE Evaluation Project (2003),
Bessinger, R., Akwara, P. & Halperin, D.
Data from Demographic and Health Surveys (DHS) were used to compare abstinence, being faithful, and condom use (ABC) behaviors in three countries where HIV prevalence declined during the 1990s: Uganda, Zambia, and Thailand, with three countries where HIV prevalence did not decline in the 1990s: Cameroon, Kenya, Zimbabwe. In countries with declines in HIV prevalence, there were increases in all ABC behaviors. The same pattern of behavior change was not evident in the three countries that did not experience declines in HIV prevalence; instead, condom use was observed to increase; though little increase in abstinence or partner reduction was reported. In Uganda, the country with the earliest and greatest reduction in HIV prevalence, declines in non-regular and multiple sexual partnerships were greatest between the late 1980s and the mid 1990s, when the rate of new infections (HIV incidence) most likely began to drop. Throughout this decade in Uganda, levels of premarital sex also declined, along with an increase in the average age at sexual debut. Increases in condom use with non-regular partners occurred throughout the 1990s, although levels of condom use were not substantial until the middle of the decade. While the trends in ABC behaviors within these countries are consistent with trends in HIV prevalence, they were not sufficient to fully explain differences in HIV prevalence between countries.
Reports and Briefs
"Abstinence and Delayed Sexual Initiation for Youth.", USAID (2004).
Programs that include comprehensive messages can teach skills for practicing abstinence as well as provide information for sexually active youth about condoms and reducing the number of partners.
"Abstinence and Delayed Sexual Initiation.", Family Health International/YouthNet (2003).
Promoting abstinence is an important strategy that can help delay sexual activity, but complementary messages are needed for those youth who are sexually active. This document discusses abstinence programming from a variety of countries including, but not limited to Jamaica, Uganda and Zambia.
"Abstinence: An Option for Adolescents.", Family Health International (2002).
This document explains the importance of abstinence as one of many options for adolescents in Uganda. According to the authors abstinence offers adolescents, in particular, a number of advantages such as protection against pregnancy and sexually transmitted infections. However, in practice, abstaining from sex tends to be less effective than many contraceptive methods because complete abstinence requires strong motivation, self-control, and commitment.
"Youth Survey Provides Wealth of Data on Behavior to Inform Intervention Strategies.", Family Health International/YouthNet (2006).
The Youth Behavior Survey was conducted in 2004 in the Iringa region of Tanzania. Its goal was to gain a fuller understanding of the youth’s HIV knowledge, attitudes and behaviors to guide prevention programs. One of the main results of the survey was that fear of HIV/AIDS and other sexually transmitted infections was the strongest motivator to remain abstinent.
"Condom Use and Abstinence among Unmarried Young People in Zimbabwe: Which Strategy, Who’s Agenda?", Population Council (2003).
This paper compares the views about abstinence and condom use expressed by young people in Zimbabwe in contrast to abstinence-only messages promoted by policymakers, traditional, and Christian leaders and condom promotion messages from private sector and nongovernmental organizations. Evidence from focus-group discussions indicates that adolescents sometimes conceal condom use in deference to adult preferences. Clear and open policies regarding condom use and abstinence should be promoted as complementary alternatives.
No Time to Lose: Getting More from HIV Prevention
Committee on HIV Prevention Strategies in the United States, Institute of Medicine, Washington, DC
National Academy Press (2001), Vol. xi-xii, pp. 118-20.
In this report, the Institute of Medicine, a medical expert body to the US Federal government, reviewed abstinence-only activities in the US and concluded that there was no scientific basis to support funding of these programs. The committee recommended using care when considering adaptation of US abstinence-only activities to other settings. The report highlights scientific studies showing that comprehensive sex and HIV education programs, along with condom availability, can be effective in reducing unprotected sexual intercourse and frequency of sex.
Government Support for Abstinence-Only-Until-Marriage Education
Clinical Pharmacology and Therapeutics (2008), Vol. 84 No. 6, pp. 746-748
Duffy, K., Lynch, D. A. & Santinelli, J.
This article discusses the effectiveness of the United States federal government support of abstinence-only-until-marriage (AOUM) programs. AOUM programs are defined as promoting abstinence from sexual activity and limiting discussion of condoms and contraception, except in regard to failure rates. According to the authors, although monetary support for these programs has increased substantially in the past decade, no research has shown that they are effective at preventing teen pregnancies and STDs. Furthermore, recent analyses reveal that many of these programs contain misleading and medically inaccurate information. Federal support for AOUM programming began in 1982 under the auspices of the Adolescent Family Life Act, greatly expanding after 1996 with the enactment of welfare reform that provided $50 million per year to fund AOUM programs. Although the funding has continued to grow, because of the lack of evidence supporting the protective effects of AOUM programs, health experts, including the Society for Adolescent Medicine, have begun to question the utility of continued funding. Furthermore, the Society for Adolescent Medicine, recommends that current funding for abstinence-only programs should be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.
The impact of Uganda’s HIV/AIDS "A,B,C" prevention policy on married women: identification of a need to "reinvent" a successful approach
AIDS- XVII International AIDS Conference (2008), Abstract number: WEPE0813
Al-Bahish.
Uganda is often described as a beacon of hope in HIV/AIDS prevention. Its "ABC" prevention strategy, emphasizing abstinence, being faithful, and condom use, has garnered international attention and acclaim. This policy analysis examines the impact of the "ABC" strategy on married women by analyzing both quantitative and qualitative data, including governmental statistics, anthropological sources and human rights literature. The authors explore the interplay between the prevention strategy, gender relations within marriage, and HIV/AIDS risk for married women. They conclude that despite its decreasing prevalence, generally HIV/AIDS is a significant problem for married women in Uganda. Importantly, the disparity in prevalence between married women and other sectors of the population is growing. Aspects of the current prevention strategy, particularly the emphasis on abstinence, provide little to no protection to married women and may simply reinforce the gender inequities that increase their risk.
Moving beyond the alphabet soup of HIV prevention
AIDS (2008), Vol. 22 Suppl. 2, pp. S5-S8
Collins, C., Coates, T. J. & Curran, J.
The ‘ABCs’ of prevention (abstinence, being faithful, using a condom) continue to be one of the main focal points of HIV and AIDS prevention policy. ‘A’ (abstinence) can be an important or preferred choice for many individuals, particularly for many young people. Delaying sexual debut is an effective strategy in reducing infection rates among the youngest age group. However, abstinence or being faithful may not be realistic options for many people at different times in their lives. Women in particular may be ignorant of risk they incur as a result of their partner’s behaviors, and they may not be able to insist upon protection. The authors argue that the ABC terminology infantilizes the prevention discussion by placing too much focus on a few activities, instead of promoting comprehensive national prevention programs that have a measurable impact on HIV incidence. Governments, donors and global agencies should implement prevention programs that are tailored to the specific characteristics of national epidemics; bring quality programs to scale; address environmental factors in vulnerability, and link prevention and treatment services.
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