Is there a role for abstinence only programmes for HIV prevention in high income countries?

doi:10.1136/bmj.39287.463889.80

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Stephen E Hawes, assistant professor1,
Papa Salif Sow, professor2,
Nancy B Kiviat, professor3

¹Department of Epidemiology, University of Washington School of Public Health, Box 359933 Seattle, WA, 98195-7230, USA
²Department of Infectious Diseases, University of Dakar, BP 5005, Senegal
³Department of Pathology, University of Washington, Box 359791, Seattle, WA 98104

nbk@u.washington.edu

A robust systematic review finds no evidence that such programmes reduce risky sexual behaviours, incidence of sexually transmitted infections, or pregnancy

The systematic review in this week's BMJ by Underhill and colleagues brings valuable insights to a highly contentious issue: whether abstinence only (as opposed to abstinence plus) programmes can stop, delay, or decrease sexual activity and prevent HIV infection.1 This question is important because 38 million people are currently infected with HIV but, despite 25 years of research, we still have no vaccines to prevent HIV infection. Furthermore, HIV prevention has become a politically charged issue because funds from the US President's Emergency Plan for AIDS Relief (PEPFAR) can be used for abstinence only programmes, but cannot be used for other safer sex strategies, needle exchange, or instructions for using condoms. Is this an effective use of public funds?2

A previous review of abstinence only programmes in the developing world, presented at …