Many may think that sexual abstinence and fidelity may be two of the ABCs of HIV prevention and safe sexual behaviours. However, a new Stanford University School of Medicine study found no evidence of these strategies’ effectiveness.

The study, published in Health Affairs on May 2, involved assessing almost 500,000 patient records from 22 countries including 14 PEPFAR-targeted countries and eight non-PEPFAR nations in the region. PEPFAR or the President’s Emergency Fund for AIDS Relief was launched in 2004 by former US President George W. Bush to prevent and treat HIV by promoting abstinence and fidelity.

While a 2012 report conducted by this new study’s senior author Eran Bendavid showed that the PEPFAR decreased global HIV mortality rates and saved 740,000 lives in nine of the PEPFAR-targeted countries, its aim of sexual abstinence and partner fidelity is not only ineffective in limiting the number of sexual partners or reducing the age of sexual intercourse. It also does not work in preventing teen pregnancy, all of which have been known to increase the risk of HIV.

sexual abstinence

HIV test. Credit: Dr. Lal PathLabs

It turns out that women in PEPFAR countries start having sex only at a slightly later age than women in non-PEPFAR countries, about four months later. However, no difference was observed among the men in these countries.

Moreover, teenage pregnancy rates are the same in PEPFAR and non-PEPFAR countries. The researchers believe that PEPFAR deprives people of information about other risk-reduction efforts such as male circumcision, condom use and methods to prevent mother-to-child transmission of the virus.

Instead of emphasising and spending too much money on promoting abstinence and fidelity, the researchers suggest the PEPFAR funds be allocated to other strategies instead. The funding should be given to programmes that have actually been proven effective.

Moreover, PEPFAR programmes should encourage education among women, which is an important factor in preventing HIV. Even those who attended only primary school education have lower chances of practising risky sexual behaviours. The higher the education, the more they know about the behaviours that can put them at risk of contracting HIV.

The researchers hope that their findings will pave the way in developing more HIV prevention programmes that do not place too much importance on abstinence then overlook other behaviours that reduce the risk of getting HIV. Nevertheless, PEPFAR representatives have been noted of these findings and may soon make decisions that will improve their programmes.