Abstinence and Delayed Sexual Debut
Putting It Into Practice
The section below highlights some key programs that serve as representative samples and do not capture all programs being implemented at the field level. This section will be updated as information becomes available.
Promoting abstinence: lessons from four countries over four years
AIDS- XVII International AIDS Conference (2008), Abstract number: CDC0686
Purcell, P., et al.
Mobilizing Youth for Life (MYFL) is an abstinence and behavior change program from World Relief targeting youth in four countries over five years. Funded by USAID and the President´s Emergency Plan for AIDS Relief (PEPFAR), and started in 2004, this project has reached 1.8 million youth and those who influence them, in Haiti, Kenya, Mozambique, and Rwanda. The program engages youth through interactive training and encourages abstinence before marriage and mutual faithfulness within it as a means to protect against HIV. To understand components of impact and to propose recommendations for improvement, World Relief conducted a mid-term evaluation in all four countries between May and September, 2007. Emergent themes reported by youth beneficiaries and youth influencers included a commitment to abstinence, partner reduction, improved school performance, and identification and reporting of sexual abuse. Youth report that the lessons on self-esteem and making good choices were pivotal to the programs’ impact in their lives; particularly effective was the use of peer role models that moved abstinent couples to marriage.
An Outcome Assessment of an ABC-Based HIV Peer Education Intervention Among Kenyan University Students
Journal of Health Communication (2008), Vol. 13 No. 4, pp. 345-356
Miller, A. N., et al.
This study reports on an outcome assessment of a HIV peer education program initiated in 2004 on the main campus of Kenyatta University in Nairobi, Kenya. The program is being implemented by I Choose Life - Africa (ICL), a local nongovernmental organization. ICL’s early programs focused primarily, though not exclusively, on abstinence messages and other activities such as purity pledges. More recently, abstinence plus activities have been adopted including advocating for general sexual responsibility, faithfulness and condom use. After two years of on-campus ABC-based HIV peer education programming, no changes in behavior were evident with respect to either abstinence or number of sexual partners. Small but statistically significant changes were found in condom attitudes and behavior, and a large increase in HIV testing was evident. The authors contend that the effectiveness of peer education is likely to vary depending on contextual and cultural factors related to a given activity. However, the lack of a shift of abstinence and faithfulness indicators in this study raises questions about the ability of peer education to promote behavior change through a comprehensive ABC message. The authors advocate that future studies should compare abstinence-only approaches with full ABC programming.
Reducing the risk of HIV transmission among adolescents in Zambia: psychosocial and behavioral correlates of viewing a risk-reduction media campaign
Journal of Adolescent Health (2006), Vol. 38 No. 1, pp. 55
Underwood, C., et al.
AIDSTAR-One Summary: This study assessed Helping Each other Act Responsibly Together (HEART), a media campaign designed for and by urban youth in Zambia. The campaign targeted youth ages thirteen to nineteen with messages about STIs and HIV, and focused on abstinence promotion and consistent condom use. The campaign used multiple forms of media with an emphasis on televised public service announcements. Results showed that twelve months following the campaign, youth exposed to the messages were more likely to report primary or secondary abstinence and more likely to have used a condom the last time they had sex. Although it is challenging to isolate the effects of a single mass media program in the context of multiple campaigns, HEART provides a model for youth-created campaigns designed to influence adolescents.
Impact evaluation of the African youth alliance in Ghana, Tanzania and Uganda: implications for future youth programming
AIDS- XVII International AIDS Conference (2008), Abstract number: WEPE0320
Posner, et al.
AIDSTAR-One Summary: In 2005, the JSI Research and Training Institute, Inc. evaluated the impact of The African Youth Alliance (AYA) program, established in 2000 by the Bill & Melinda Gates Foundation and implemented by the United Nations Population Fund, Pathfinder International, and the Program for Appropriate Technology in Health. The evaluation measured whether exposure to AYA’s comprehensive, integrated HIV prevention program resulted in improved adolescent and sexual reproductive health (ASRH), knowledge, attitudes, and sexual behaviors among male and female youth ages seventeen to twenty-two in Ghana, Tanzania, and Uganda. Results demonstrated a significant positive impact on knowledge generation, condom use, contraceptive use, partner reduction, and several self-efficacy and knowledge antecedents. The program had less of an affect on male responsibility, sexual debut and/or abstinence and partner reduction. Results suggest that a comprehensive, scaled-up, multi-component HIV prevention approach can be effective in improving some key ASRH outcomes.
The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa
Journal of Adolescent Health (2005), Vol. 36 No. 4, pp. 289–304
Magnani, R., et al.
AIDSTAR-One Summary: A middle and high school-based Life Skills Program for ages fourteen to twenty-four was conducted in South Africa’s KwaZulu-Natal Province. The curriculum addressed eleven sexual and reproductive health-related life skill topics, ranging from drugs and alcohol to negotiation and assertiveness in relationships. Baseline and two-year follow-up data from 2,222 youth assessed the program’s impact on HIV-related knowledge, attitudes, and behaviors. Knowledge gains were generally minimal and uneven across the topics. The largest changes observed in sexual behaviors were for condom use at first and last sex. Minimal gains were observed for sexual health knowledge and reported self-efficacy to get and use a condom. The proportion of youth who had initiated sexual activity increased by nearly half, though it is important to note that the youth were two years older than at baseline; no change in age at sexual initiation was noted. There were no major effects on age at sexual initiation, secondary abstinence, or number of partners. While school-based life skills programs have the potential of helping youth reduce HIV risk, the long-term benefits of a national education program are unknown.
Program Guidelines and Standards
AIDSTAR-One Summary: This site offers six links to PEPFAR’s ABC approach including an introduction, defining the ABC approach, and implementing the ABC approach. There are also two appendices: one is on how to determine the appropriate mix of ABC activities and the other is a list of references. The last link is to the original ABC Guidance Number One which is in PDF format. These documents are designed to provide guidance to the field and missions to implement ABC programs.
Program Reports and Case Studies
Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing Countries
UNAIDS Inter-agency Task Team on Young People, WHO Technical Report Series (2006), No. 938
Ross, D. A., Dick, B. & Ferguson, J.
AIDSTAR-One Summary: This report documents the findings from key studies on youth-based HIV prevention programs organized into categories, depending on whether the evidence is strong enough to recommend the program. The report includes recommendations for policy-makers, program development and delivery staff, and researchers. Both chapters five and seven examine the effect of these activities on abstinence as one of the outcomes. These results, by study, are concisely summarized in tables. (Chapter Five: “The effectiveness of sex education and HIV education interventions in schools in developing countries,” and chapter seven: “The effectiveness of mass media in changing HIV/AIDS-related behavior among young people in developing countries”).
The less they know, the better: abstinence-only HIV/AIDS programs in Uganda
Human Rights Watch (2005), Vol. 17 No. 4A, pp. 1-79
Cohen, J. & Tate, T.
AIDSTAR-One Summary: This article assesses the “ABC” approach that has been heralded as a success in Uganda. Specifically, it cautions that abstinence-until-marriage messages fail to educate young people about accurate HIV and STI risks and prevention options, and thus violates human rights principles. The authors present a series of recommendations for the Government of Uganda, the United States government, and all other donors to Uganda AIDS programs. The recommendations focus on supporting effective HIV prevention programming; including encouraging youth to delay sex as part of a comprehensive approach to HIV prevention. The authors discourage use of ideology-based messages, e.g., abstinence-until-marriage, that do not incorporate scientifically-effective HIV prevention methods, including condoms, and accurate information about HIV risks.
Abstinence, Fewer Partners, and Condom Use are Complementary Messages
Family Health International (2003).
AIDSTAR-One Summary: The first phase of a major six-country study suggests that promotion of sexual abstinence to prevent HIV infection contributed to an approximately one-year delay of sexual initiation among youth in two countries, Uganda and Zambia, where HIV prevalence declined throughout the 1990s.
Preventing HIV with young people: a case study from Zambia
Reproductive Health Matters (2006), Vol. 14 No. 28, pp. 68-79
Gordon, G. & Mwale, V.
AIDSTAR-One Summary: This case study examines how Abstinence and Being Faithful programs for youth are being implemented in Zambia. They found that the majority of implementing agencies are supporting abstinence-only activities and have not challenged the overall prevention strategy. Many programs are providing erroneous information about condoms and refuse to distribute them. The authors caution against stigmatizing condoms and those who use them, and encourage all HIV/AIDS programmers to provide a wide range of prevention options to the target population based on their needs.
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