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The Biggest Failure in America’s Abstinence Programs Is in Sub-Saharan Africa

American taxpayers have funded abstinence and faithfulness programs, intended to combat sub-Saharan Africa’s AIDS epidemic, for more than a decade. A new study finds that funding made no difference to how people behaved.

By Francie Diep


Laura Bush with an AIDS orphan in Zambia. (Photo: Wikimedia Commons)

The American government began funding abstinence-only sex education programs in the 1980s. By the mid-2000s, there was enough evidence to suggest such programs didn’t work. American teenagers who had taken abstinence-only classes continued to have sex with as many partners, and as much of it unprotected, as their peers, according to a systematic review.

Despite those results, taxpayer money continued to pay for such programs, both at home and abroad. The George W. Bush administration poured money into abstinence and faithfulness campaigns in sub-Saharan Africa, in an effort to stem the AIDS epidemic. But a new study finds abstinence education hasn’t worked there either.

Whether countries in sub-Saharan Africa received American aid for abstinence and stay-faithful programs made no difference to how long their citizens waited to have sex or how many partners they had, the study finds—behaviors that impact people’s risk of contracting HIV/AIDS. By 2013, the United States had invested more than $1.4 billion in such programs.

“The money could have been used on treatment or many of these other prevention programs that have a stronger evidence base.”

There are other HIV-fighting projects that are better supported by science, such as giving out antiretroviral treatment to HIV-positive folks, like pregnant women who would otherwise pass the virus onto their babies; giving the HIV-prophylaxis pill to people who are at high risk of contracting the virus; and offering adult men circumcisions. And indeed, the American government does fund efforts like these. But for years, the President’s Emergency Plan for AIDS Relief spent large portions of its budget on abstinence and faithfulness programs, especially billboards and other advertisements. During the Bush administration, which created PEPFAR, one-third of PEPFAR’s money was allocated to trying to convince people to delay sex until marriage and to stay monogamous. After Barack Obama became president, that requirement was dropped. Nevertheless, in 2013, PEPFAR spent $45 million on abstinence and faithfulness campaigns.

“We were not able to detect any unique changes in these behaviors associated with the funding,” says study author Nathan Lo, a graduate student at Stanford University’s School of Medicine. In addition, until his team tackled the question, Lo says no one had investigated the effectiveness of the controversial public service announcements, which the U.S. has been funding since 2004.

To study the effectiveness of abstinence and faithfulness programs, Lo and his colleagues analyzed U.S.-funded, nationally representative surveys from 22 sub-Saharan African nations. Some of the countries had received PEPFAR abstinence funding and some hadn’t. In each country, the scientists looked at how many sexual partners survey-takers reported in the past 12 months, the age at which survey-takers said they had lost their virginity, and whether survey-takers had become pregnant as teens — a proxy measure for condom use (or non-use, as it were). The Stanford team found no association between these measures of risky sexual behavior and how much abstinence funding a country received from PEPFAR.

Lo and his colleagues initially presented their data at a major AIDS conference last year to much applause, the New York Timesreported. Advocates had long argued that abstinence ads weren’t helping with sub-Saharan Africa’s AIDS epidemic. Now they had a study to support their stance.

After the presentation, PEPFAR officials requested that the team submit their research to a scientific journal, Lo says, to undergo peer review. More than a year later, that process is finished, as the journal Health Affairs published Lo and his team’s work this week. (Officials from PEPFAR declined to answer Pacific Standard’s request to confirm the 2015 conversation with Lo, or questions about whether the agency plans to fund abstinence ads in the future.)

“We spent a substantial amount of money in this program,” Lo says. “The money could have been used on treatment or many of these other prevention programs that have a stronger evidence base.”