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Study shows that promoting abstinence, fidelity for HIV prevention is ineffective

HIV testPEPFAR, the U.S. government’s signature program for HIV treatment and prevention, has long supported projects in the developing world that encourage sexual abstinence and fidelity. But a new Stanford study shows these projects are ineffective in changing sexual behavior and reducing risk for HIV.

In a study of 500,000 people in 22 countries, the researchers found PEPFAR had no impact in persuading men and women to limit their sexual partners or to delay their first sexual experience – among the primary prevention goals. Nor did it lead to any change in the number of teen pregnancies.

“Overall we were not able to detect any population-level benefit from this program,” said Nathan Lo, the study’s first author. “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.

“We believe funding should be considered for programs that have a stronger evidence basis,” he added.

Senior author Eran Bendavid, MD, told me that spending money on ineffective programs has a human cost, as it takes support away from proven prevention programs, such as male circumcision or methods of preventing transmission from mothers to their babies.

“Spending money and having no effect is a pretty costly thing because the money could be used elsewhere to save lives,” Bendavid told me.

PEPFAR was started by President George W. Bush with a $15 billion investment in treatment and prevention in 15 countries. It has had some success; a previous study by Bendavid found it saved 740,000 lives between 2004 and 2008, largely by providing antiretroviral drugs to infected individuals.

But the program’s initial requirement that one-third of prevention funds be dedicated to abstinence and “be faithful” initiatives remained highly controversial. The Obama administration eliminated the requirement in 2008, though some funds are still being used for this purpose.

The Stanford researchers studied people living in 14 countries supported by PEPFAR grants and 8 countries where these grants were not available. They looked at trends before and after PEPFAR was begun to see if there had been any changes in the number of sexual partners among men and women, whether the age of sexual intercourse had been delayed and whether there had been any change in the number of teen pregnancies as a result of PEPFAR-related prevention programs. They found no difference in any of these factors among individuals living in countries with U.S. support and those who were not.

“We hope our work will emphasize the difficulty in changing sexual behavior and the need to measure the impact of these programs if they are going to continue to be funded,” Lo said.

Previously: PEPFAR has saved lives – and not just from HIV/AIDS, Stanford study finds
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