Abstinence or Abstinence-Only?

Naina Dhingra is the Director of International Policy at Advocates for Youth and serves on the Developed Country NGO Board Delegation of the Global Fund.

At Wednesday's government reform hearing convened by Congressman Chris Shays on the abstinence-until-marriage earmark, Ambassador Mark Dybul, U.S. Global AIDS Coordinator, testified that the U.S. government does not fund "abstinence-only" programs. Repeatedly, U.S. government officials have stated that PEPFAR prevention programs are not abstinence-only and follow an evidence-based ABC approach.

Sorry, Ambassador Dybul, but we're not buying it.

After reviewing the policy directive designed to clarify the ABC approach within PEPFAR, "ABC Guidance #1: For United States Government In-Country Staff and Implementing Partners Applying the ABC Approach to Preventing Sexually-Transmitted HIV Infections Within The President's Emergency Plan for AIDS Relief," we found that the U.S. government is definitely not following an evidence-based approach.

Advocates for Youth has published a policy brief titled, "Improving U.S. Global HIV Prevention for Youth," critiquing this guidance. The OGAC (Office of the U.S. Global AIDS Coordinator) Guidance states that the ABC approach to HIV prevention need only be comprehensive at the country level and that sub-populations within a country should be targeted with specific components of the approach (A, B, or C) based upon OGAC's perception of their needs. Young people are identified as a sub-population that need not be provided with all three components of the ABC approach. Segmenting the ABC approach by population is fundamentally flawed and defeats its effectiveness. A sole "AB" strategy for preventing HIV infection for young people is effectively an abstinence-only approach.

Underlying the OGAC guidance regarding programs for youth are the following scientific inaccuracies:

  • Youth easily fall into two categories-those that have had sex and those who have not and neither needs information about condoms.
  • Promoting abstinence-until-marriage will increase abstinence and secondary abstinence for those who already have had sex.
  • Marriage is an effective HIV prevention tool because young people in PEPFAR countries have the power to choose when to have sex
  • Providing young people with information about condoms will confuse youth and encourage them to have sex.

While abstinence is the best option for protection for youth not yet sexually active and should be included in all comprehensive youth HIV prevention programs, these programs must also take into account the fact that a large share of unmarried adolescents in PEPFAR countries are already sexually active and require information that will enable them to make informed choices and to protect themselves if they choose to remain sexually active.

Research clearly indicates that all young adults-abstinent or not-benefit from full disclosure of medically accurate, age appropriate information about both abstinence and condoms. Providing comprehensive information about HIV that is linked with sexual and reproductive health that includes honest, accurate information about condoms is a proven strategy for reducing HIV infection in young people.

Advocates for Youth is urging OGAC to revise the ABC guidance to more accurately reflect evidence-based best practices. Revising the guidance will enhance PEPFAR's efficacy and will encourage PEPFAR implementing partners to replicate effective strategies for HIV prevention among youth.

Editor's note: Read the report to see AFY's suggested changes to OGAC's ABC Guidance.

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