Abstinence and faithfulness programmes for prevention of HIV/AIDS among young people: What are the current debates?

Abstract

Questions have been raised on whether abstinence and faithfulness programs work, particularly for young people. Research is needed for evidence-based documentation of the effectiveness or otherwise of abstinence and faithfulness programmes in young people. This review was conducted in three stages: identification of relevant studies, classification of these studies, review of data and analysis of findings. Different sources of published and unpublished research literature were searched to locate studies relevant to abstinence and faithfulness (AB) interventions. A few researchers supported the view that AB work and indicated that Uganda provided the clearest example that HIV is preventable if populations are mobilized to avoid risk. This is confirmed by a 70% decline in HIV prevalence, linked to a 60% reduction in casual sex, in Uganda since the early 1990s. However, most of the literature claiming effectiveness of abstinence and faithfulness interventions is based on personal opinions and qualitative assessment of small projects. The question on whether abstinence and fidelity work as HIV/AIDS prevention strategies among young people was never answered with convincing evidence. Several research studies found that abstinence and faithfulness interventions were not effective in the prevention of HIV/AIDS. They cited several interventions as reasons for the decline in HIV prevalence, such as increased condom use, use of cleaner needles and a combination of abstinence, be faithful and condomise (ABC). They also cite the death of AIDS patients as reasons for the decline in HIV prevalence. It can be concluded from the research provided in this review that not only are there question marks over exactly what defines abstinence and what makes it sustainable; there is no clear evidence that it works. A systematic review of U.S. programmes to reduce teenage pregnancy identified three studies evaluating the impact of abstinence-only programmes and found that none of these studies had any effect on sexual behaviour. There is no conclusive proof that abstinence-only programmes have been successful in reducing HIV transmission. Evidence is also growing that abstinence-only programmes have failed to prevent the spread of sexually transmitted infections and teenage pregnancy. A rigorous, five-year evaluation of 11 abstinence-only programmes, conducted in the U.S in 2006 concluded that abstinence-only interventions have failed to change youth behaviour in the USA. South African Family Practice Vol. 49 (8) 2007: pp. 5-10