Abstinence-only programs for HIV infection prevention in high-income countries

Evidence Summaries

Level of Evidence = C
Abstinence-only programs may be ineffective for reducing HIV risk in high-income countries.

A Cochrane review 1 included 13 studies with a total of 15,940 subjects. Six trials were cluster randomised. All included studies enrolled ethnically diverse youth in the US. Seven programs were school-based, two were community-based, and one was delivered in family homes. The trials compared abstinence-only programs to various control groups (e.g., "usual care," no intervention). Median final follow-up occurred 17 months after baseline. Results showed no indications that abstinence-only programs can reduce HIV risk as indicated by self-reported biological and behavioral outcomes. Compared to various controls, the evaluated programs consistently did not affect incidence of unprotected vaginal sex, frequency of vaginal sex, number of partners, sexual initiation, or condom use.

Comment: The quality of evidence is downgraded by indirectness (the homogeneity of the trial populations) and the probable self-reporting bias.


1. Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane Database Syst Rev 2007 Oct 17;(4):CD005421.  [PMID:17943855]

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