Abstinence and Delayed Sexual Debut
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HIV programs generally define abstinence as not engaging in sexual intercourse, delay of sexual debut, and/or abstaining from sex if one has already been sexually active (i.e. secondary abstinence). Abstinence-only programs promote complete abstinence as the only effective method for preventing unintended pregnancy and sexually transmitted infections (STIs), including HIV. The goal of abstinence-only programs is to delay the onset of sexual activity to protect more youth from HIV infection. However, complete abstinence over time is rarely practiced, thus limiting its effectiveness. Many researchers and programmers advocate for abstinence-plus programs that include sex education and information on abstinence, delay of sexual debut, condom use and contraception.
Abstinence activities are designed to address the heightened vulnerability of youth. Several national demographic surveys found a correlation between early onset of sexual activity and higher HIV prevalence among young people. Conversely, older age at first sex, appears to be one contributing factor in declines in HIV prevalence among youth in sub-Saharan countries with generalized epidemics. Abstinence programs can and should be incorporated into comprehensive sexual education and/or STI/HIV education programs. Abstinence programs are typically targeted towards youth and are predominately school-based; though abstinence messages can also apply to adults and be implemented in other settings.
Research also suggests that messages that encourage youth to remain abstinent, but also promote safer sex for those young people who are already sexually active are most effective. Health and sex education programs for youth are also more effective when they reinforce positive individual and group norms and provide opportunities to practice skills in negotiating or refusing sex. Effective programs have also included age-appropriate messaging that is integrated with media campaigns. While efforts to delay the onset of sexual activity can be an effective component of youth HIV prevention efforts, studies demonstrate that comprehensive safer sex education and access to condoms are most effective at sustaining long-term behavior change, and do not tend to increase participants’ sexual activity.
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