The American Foundation for AIDS Research has published a new issue briefing, which fully deserves to be widely circulated, which assesses the effectiveness of abstinence-only sex education programmes for HIV prevention amongst young people. The briefing pulls together the evidence from a wide range of published studies covering the outcomes of abstinence-only programmes in both the US and internationally and arrives at a wholly unsurprising set of conclusions:
A rigorous published review of 28 sexuality education programs in the United States and Canada aimed at reducing teen pregnancy and STIs (including HIV) found that none of the three abstinence-only programs that met the inclusion criteria for review demonstrated efficacy for delaying sexual debut. Furthermore, these three programs did not reduce the frequency of sex or the number of partners among those students who had ever had sex…
A systematic review of 13 published trials of abstinence-only programs conducted among 15,940 American youth found that abstinence-only programs did not affect the risk of HIV transmission or the incidence of unprotected vaginal sex, number of partners, condom use, or age of sexual debut.
Perhaps the starkest message comes from an evaluation review to 10 federally-funded abstinence-only programmes which was conducted with the full support of the US Federal Government:
A federally-supported, 10-year evaluation of abstinence-only-until-marriage programs found that these programs had no impact on youth remaining abstinent, age at first intercourse, number of sexual partners, or condom use. In fact, these programs appeared to have negative effects on knowledge: abstinence-only program participants were less likely to know that condoms can lower the risk of STIs, and more likely to report that condoms never protect against HIV.
So, abstience-only education not only fails to successfully promote abstinence but, when its run by religiously motivated organisations, as has often been the case in the United States, it frequently fosters dangerous levels of ignorance in relation to very basic practices which are proven to reduce the risk of STI transmission, i.e. condom use. Given that the Roman Catholic church and Catholic organisations have both been extremely active in promoting abstinence-only programmes, it comes as no great surprise to find that the myth that condoms never protect against HIV, which has been extensively promoted by the church hierarchy right up to, and including, the Pope, is prevalent amongst young people who’ve been subjected to this type of sex ‘education’.
Abstinence-only sex education is a proven failure by any reasonable measure, but the briefing also provides some useful insights into the evidence for what actually does work:
A systematic review of the efficacy of AIDS risk reduction interventions for adolescents in the U.S. found that two out of six studies meeting inclusion criteria showed efficacy in postponing sexual debut among virgins and an increase in “secondary” abstinence (return to abstinence) among those who had been sexually active.
A systematic review of 83 studies that measured the impact of curriculum based sex and HIV education among youth around the world found that two-thirds of the programs had a significant positive impact on sexual behavior, such as delaying or reducing sexual activity or increasing condom or contraceptive use, or both. Most programs also increased psychosocial mediating factors that are known to be related to sexual behaviors, such as relevant knowledge, awareness of risk, values and attitudes, self-efficacy and intentions.
A review of sex education and HIV education interventions in developing countries found that, of the 22 interventions that met the inclusion criteria, 16 significantly delayed sexual activity, reduced the frequency of sex, decreased the number of sexual partners, increased the use of condoms and contraceptives, or reduced the incidence of unprotected sex.
A systematic review of the efficacy of adolescent reproductive health interventions in developing countries found that, of the 15 abstinence-plus programs that measured sexual debut, five showed efficacy in delaying sexual debut.
“Abstinence-plus”, as the name suggests, promotes abstinence alongside accurate information on contraception, STI risks and risk reduction, etc. Many of these programmes still fall some way short of being fully comprehensive sex and relationships education because they omit information on variation in human sexuality and provide a rather narrow view of human sexual behavior but on the whole they are reasonably effective and a considerable improvement on the failed abstinence-only programmes.
Evidence in the social sciences is rarely, if ever, as clear cut as it is the core natural sciences (physics, chemistry, biology) but even allowing for that limitation, the evidence for what is and isn’t effective when it comes to sex and relationship education is about as clear as its possible to get.
If you’re at all serious about reducing the prevalence of unwanted pregnancy in young people and lowering the risk of STI transmission then comprehensive sex and relationship education, the kind that treats young people as independent, autonomous moral agents who are capable of making their own choices, is the only way to go.
That this is still a matter for debate in the UK is down to the failure of successive governments to promote the best interests of both the country and of young people in the face of parental and, particularly, religious objections to teaching young people the truth. That comprehensive sex and relationships education is not part of the national curriculum and not mandatory in all schools is matter something that we, as a nation, should be thoroughly ashamed of.